The effects of magnesium sulfate therapy after severe diffuse axonal injury
Authors Zhao L, Wang W, Zhong J, Li YY, Cheng YZ, Su Z, Zheng W, Guan XD
Received 29 March 2016
Accepted for publication 18 July 2016
Published 27 September 2016 Volume 2016:12 Pages 1481—1486
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Hoa Le
Peer reviewer comments 4
Editor who approved publication: Professor Deyun Wang
Ling Zhao,1 Wei Wang,1 Jiwen Zhong,1 YaYun Li,1 YanZi Cheng,1 Zhenjiao Su,1 Wei Zheng,1 Xiang-Dong Guan2
1Department of Critical Care Medicine, Zhuhai People’s Hospital, Zhuhai, Guangdong, 2Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
Purpose: To evaluate the clinical effects of magnesium sulfate in the treatment of diffuse axonal injury (DAI).
Patients and methods: This study was a randomized, double-blind, placebo-controlled trial conducted in the First Affiliated Hospital of Sun Yat-sen University, Guangzhou and Zhuhai People’s Hospital, Zhuhai, two trauma center hospitals. A total of 128 patients suffered from DAI, with initial Glasgow coma scale (GCS) scores of 3–8. They were randomly divided into two groups: magnesium sulfate treatment (MST) group (n=64) and control group (n=64). The MST group received 250 µmol/kg magnesium sulfate intravenously 20 minutes after admission, followed by 750 µmol/kg magnesium sulfate intravenously daily for 5 days. The control group received standard management without MST. GCS scores and serum neuron-specific enolase values were measured and recorded at admission, and on days 3 and 7 after injury. Outcomes were determined by Glasgow outcome scale scores at discharge and at 3 months’ follow-up, respectively.
Results: After the 7-day treatment, patients in the MST group, compared with those in the control group, had a lower serum neuron-specific enolase level (25.40±6.66 vs 29.58±7.32, respectively, P=0.001) and higher GCS score (8.23±2.72 vs 7.05±2.64, respectively, P=0.016). Although the length of stay and mortality did not differ between the groups in the intensive care unit, Glasgow outcome scale score was significantly lower in the MST group at discharge (3.30±1.35 vs 3.90±1.10, P=0.004) and 3 months after discharge (2.95±1.48 vs 3.66±1.44, P=0.009).
Conclusion: Early treatment with magnesium sulfate resulted in a significant improvement in DAI outcome. Further studies are needed to confirm the clinical significance of treatment of DAI patients with magnesium sulfate.
Keywords: diffuse axonal injury, magnesium sulfate, outcome
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