Solomon A J, Berger A K, Trivedi K K, Hannan R L, Katz N M
Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.
Ann Thorac Surg. 2000 Jan;69(1):126-9. doi: 10.1016/s0003-4975(99)01187-x.
Atrial fibrillation is a common complication of cardiovascular surgery. Beta-blockers have been shown to decrease the incidence of postoperative atrial fibrillation. However, the use of magnesium is more controversial. It was our hypothesis that adjunctive magnesium sulfate would improve the efficacy of beta-blockers alone in the prevention of postoperative atrial fibrillation.
We prospectively randomized 167 coronary artery bypass patients (mean age 61+/-10 years, 115 men) to receive propranolol alone (20 mg four times daily) or propranolol and magnesium (18 g over 24 hours). Magnesium was begun intraoperatively, and propranolol was started on admission to the intensive care unit.
Using an intention-to-treat analysis, the incidence of postoperative atrial fibrillation was 19.5% in the propranolol-treated patients and 22.4% in propranolol + magnesium-treated patients (p = 0.65). Because combination therapy resulted in an excess of postoperative hypotension, which required withholding doses of propranolol, an on-treatment analysis was also performed. In this analysis, the incidence of atrial fibrillation was still not significantly different (18.5% in propranolol-treated patients and 10.0% in propranolol + magnesium-treated patients, p = 0.20).
Adjunctive magnesium sulfate, in combination with propranolol, does not decrease the incidence of postoperative atrial fibrillation.
心房颤动是心血管手术常见的并发症。β受体阻滞剂已被证明可降低术后心房颤动的发生率。然而，镁的使用存在更多争议。我们的假设是，辅助使用硫酸镁可提高单独使用β受体阻滞剂预防术后心房颤动的疗效。
我们将167例冠状动脉搭桥患者（平均年龄61±10岁，115例男性）前瞻性随机分为单独接受普萘洛尔治疗（每日4次，每次20 mg）或普萘洛尔与镁联合治疗（24小时内18 g）。镁在术中开始使用，普萘洛尔在进入重症监护病房时开始使用。
采用意向性分析，普萘洛尔治疗组术后心房颤动的发生率为19.5%，普萘洛尔+镁治疗组为22.4%（p = 0.65）。由于联合治疗导致术后低血压过多，需要停用普萘洛尔，因此也进行了实际治疗分析。在该分析中，心房颤动的发生率仍无显著差异（普萘洛尔治疗组为18.5%，普萘洛尔+镁治疗组为10.0%，p = 0.20）。
硫酸镁与普萘洛尔联合使用并不能降低术后心房颤动的发生率。
