Magnesium Sulfate Treatment Improves Outcome in Patients with Subarachnoid Hemorrhage: A Meta-analysis Study
Tóm tắt
The objective of this study was to elucidate the role of magnesium sulfate in patients with subarachnoid hemorrhagic (SAH) brain injury. Studies for the meta-analysis were identified from PubMed (1966–2009), Embase (1980–2009), and two Chinese journals (1989–2009). Paper selection was based on randomized controlled trials comparing magnesium sulfate to placebo treatment in patients with SAH. Two independent review authors extracted the data and assessed trial quality. Meta-analysis was performed using the Cochrane Review Manager software. Five trials involving 482 patients were included in the review. Magnesium sulfate reduced the risk of poor outcome and reduced the occurrence of delayed cerebral ischemia. In the treatment groups, relative risk for poor outcome was 0.73 (CI 0.57–0.93) and 0.66 (CI 0.47–0.92) for delayed cerebral ischemia. Case fatality assessment at 3 to 6 months did not show statistically significant data (relative risk 0.88, CI 0.61–1.29). Magnesium sulfate appears to be an effective treatment option in the management of SAH. Further clinical trials are needed before magnesium sulfate can become a routine treatment for SAH.
Tài liệu tham khảo
de Rooij NK, Linn FH, van der Plas JA, et al. Incidence of subarachnoid hemorrhage: a systematic review with emphasis on region, age, gender and time trends. Neurol Neurosurg Psychiatry. 2007;78(12):1365–72.
Hop JW, Rinkel GJE, Algra A, et al. Case fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997;28:660–4.
Schievink WI et al. Sudden death from aneurysmal subarachnoid hemorrhage. Neurology. 1995;45(5):871–4.
Zubkov AY et al. Medical management of cerebral vasospasm: present and future. Neurol Res. 2009;31(6):626–31 (Epub 3 Dec 2008).
Muir KW et al. Dose optimization of intravenous magnesium sulfate after acute stroke. Stroke. 1998;29(5):918–23.
van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;27:306–18.
Brilstra EH, Rinkel GJ, Algra A, et al. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology. 2000;55:1656–60.
Roos YB, de Haan RJ, Beenen LF, et al. Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands. J Neurol Neurosurg Psychiatry. 2000;68:337–41.
Naidu S, Payne AJ, Moodley J, et al. Randomised study assessing the effect of phenytoin and magnesium sulphate on maternal cerebral circulation in eclampsia using transcranial Doppler ultrasound. Br J Obstet Gynaecol. 1996;103:111–6.
Sadeh MS. Action of magnesium sulfate in the treatment of preeclampsia–eclampsia. Stroke. 1989;20:1273–5.
Boet R, Chan MT, Poon WS, et al. Intravenous magnesium sulfate to improve outcome after aneurysmal subarachnoid hemorrhage: interim report from a pilot study. Acta Neurochir Suppl. 2005;95:263–4.
Muroi C, Terzic A, Fortunati M, et al. Magnesium sulfate in the management of patients with aneurysmal subarachnoid hemorrhage: a randomized, placebo-controlled, dose-adapted trial. Surg Neurol. 2008;69(1):33–9.
van den Bergh WM, Algra A, van Kooten F, et al. Magnesium sulfate in aneurysmal subarachnoid hemorrhage: a randomized controlled trial. Stroke. 2005;36:1011–5.
Veyna RS, Seyfried D, Burke DG, et al. Magnesium sulfate therapy after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2002;96:510–4.
Wong GKC, Chan MTV, et al. Intravenous magnesium sulfate after aneurysmal subarachnoid hemorrhage: a prospective randomized pilot study. Journal of Neurosurgery and Anesthesiology. 2006;18(2):142–8.
Johnson JW, Ascher P. Voltage-dependent block by intracellular Mg2+ of N-methyl-d-aspartate-activated channels. Biophys J. 1990;57:1085–90.
Rothman S. Synaptic release of excitatory amino acid neurotransmitter mediates anoxic neuronal death. J Neurosci. 1984;4:1884–91.
Zhang L, Rzigalinski BA, Ellis EF, et al. Reduction of voltage dependent Mg2+ blockade of NMDA current in mechanically injured neurons. Science. 1996;274:1921–3.
Muir KW. New experimental and clinical data on the efficacy of pharmacological magnesium sulfate infusions in cerebral infarct. Magnes Res. 1998;11:43–56.
Perales AJ, Torregrosa G, Salom JB. In vivo and in vitro effects of magnesium sulfate in the cerebrovascular bed of the goat. Am J Obstet Gynecol. 1991;165:1534–8.
Alborch E, Salom HB, Perales AJ. Comparison of the anticonstrictor action of dihydropyridines (nimodipine and nicardipine) and Mg2+ in isolated human cerebral arteries. Eur J Pharmacol. 1992;229:83–9.
Ram Z, Sadeh M, Shacked I. Magnesium sulfate reverses experimental delayed vasospasm after subarachnoid hemorrhage in rats. Stroke. 1991;22:922–7.
Higgins JPT, Green S (editors) (2009) Cochrane handbook for systematic reviews of interventions version 5.0.1. The Cochrane Collaboration
Dorhout Mees S, Rinkel GJE, Feigin VL, et al. Calcium antagonists for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev. 2007;3:CD000277.
Jadad AR, Cook DJ, Jones A, et al. Methodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals. JAMA. 1998;280:278–80.
Schmid-Elsaesser R, Kunz M, Zausinger S, et al. Intravenous magnesium versus nimodipine in the treatment of patients with aneurysmal subarachnoid hemorrhage: a randomized study. Neurosurgery. 2006;58(6):1054–65.