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Stroke:早期镁治疗对于动脉瘤性蛛网膜下腔出血没有明显效果(荟萃分析)

2015-11-08 崔倩 译 MedSci原创

迟发性脑缺血(DCI)是动脉瘤性蛛网膜下腔出血(SAH)后预后不良的一个重要原因。症状发作后<4天开始镁治疗的试验发现对于SAH预后不良或DCI没有影响。更早期的治疗可能会更有效,但个别试验没有足够的力量进行这样的亚组分析。研究人员进行了一项个别患者数据的荟萃分析,以研究是否SAH后24小时内不同的时间内给予镁治疗是有效的。患者根据症状发作和研究药物的开始之间进行分类:<6,6至12,

迟发性脑缺血(DCI)是动脉瘤性蛛网膜下腔出血(SAH)后预后不良的一个重要原因。症状发作后<4天开始镁治疗的试验发现,对于SAH预后不良或DCI没有影响。更早期的治疗可能会更有效,但个别试验没有足够的力量进行这样的亚组分析。研究人员进行了一项个别患者数据的荟萃分析,以研究是否SAH后24小时内不同的时间内给予镁治疗是否有效。

患者根据症状发作和研究药物的开始之间进行分类:<6,6至12,12至24,和>24小时。研究人员计算出镁与安慰剂治疗效果对于较差预后和DCI相对应的95%置信区间的调整的风险比。

该研究包括5项试验共1981年患者;83例患者<6小时开始治疗。对于较差的预后,镁治疗<6小时调整的风险比率为1.44(95%置信区间,0.83-2.51);6〜12小时为1.03(0.65-1.63),12〜24小时为0.84(0.65-1.09),>24个小时为1.06(0.87-1.31);对于DCI,<6个小时为1.76(0.68-4.58),6〜12小时为2.09(0.99-4.39),12〜24小时为0.80(0.56-1.16),> 24个小时为1.08(0.88-1.32)。

此荟萃分析表明,当SAH发病后早期镁治疗对预后不良或DCI没有益处。虽然患者的数量很小,产生有益的影响不能被明确排除在外,但研究人员没有发现SAH后早期镁治疗的优势的证据。

原始出处:

Dorhout Mees,Algra,Wong,et al.Early Magnesium Treatment After Aneurysmal Subarachnoid Hemorrhage,Stroke,2015.11.5

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