Speziale G, Ruvolo G, Fattouch K, Macrina F, Tonelli E, Donnetti M, Marino B
Institute of Cardiac Surgery, La Sapienza University, Rome, Italy.
Thorac Cardiovasc Surg. 2000 Feb;48(1):22-6. doi: 10.1055/s-2000-12141.
Arrhythmias are common after open heart surgery and may be related to hypomagnesaemia due to cardiopulmonary bypass. Although perioperative prophylactic Mg2+ administration may prevent arrhythmias after coronary artery bypass grafting (CABG), clear indications as well as the timing of Mg2+ substitution and dose regimen need to be clarified. Aim of this study was to evaluate the antiarrhythmic effects of Mg2+ infusion in patients who underwent elective CABG.
Ninety-seven patients who underwent elective CABG were divided in four Groups. In Group A 1 g of magnesium sulfate was added to the pump prime, Group B received 1 g in the pump prime plus 5 mmol/L in the cardioplegic solution, Group C received 5 mmol/L in the cardioplegic solution, and Group D was a placebo control Group. Groups A, B, and C also received 24 h continuous infusion of magnesium sulfate at 10 mmol/L. Three-channel electrocardiogram (II-V5-V6) continuous monitoring was performed 12 hours preoperatively and 48 hours postoperatively. Blood samples were taken for subsequent Serum magnesium measurements, at five different time points before, during and after CBP.
In all Groups serum Mg2+ levels were reduced during CPB (Time 2) and statistically significant differences from pre-anaesthesia levels (Time 1) were noted (p <0.05). In Groups A, B, and C Serum Mg2+ levels increased progressively from Time 3 to Time 5; in Group D serum Mg2+ levels were still much lower at Time 5. Significant differences (p<0.05) were noted for Groups B and C vs Groups A and D in atrial ectopics, atrial fibrillation, and ventricular arrhythmic events.
Our results demonstrate that Mg2+ sulfate administration regimens used in Group B and C reduce postoperative arrhythmic events in patients undergoing CABG.
心脏直视手术后心律失常很常见，可能与体外循环导致的低镁血症有关。尽管围手术期预防性给予镁离子可能预防冠状动脉旁路移植术（CABG）后的心律失常，但镁离子替代的明确指征以及时机和剂量方案仍需明确。本研究的目的是评估镁离子输注对接受择期CABG患者的抗心律失常作用。
97例接受择期CABG的患者分为四组。A组在预充液中加入1g硫酸镁，B组在预充液中加入1g并在心脏停搏液中加入5mmol/L，C组在心脏停搏液中加入5mmol/L，D组为安慰剂对照组。A、B、C组还接受10mmol/L硫酸镁持续24小时输注。术前12小时和术后48小时进行三通道心电图（II-V5-V6）连续监测。在体外循环前、中、后五个不同时间点采集血样用于后续血清镁测量。
在所有组中，体外循环期间（时间2）血清镁离子水平降低，与麻醉前水平（时间1）相比有统计学显著差异（p<0.05）。在A、B、C组中，血清镁离子水平从时间3到时间5逐渐升高；在D组中，时间5时血清镁离子水平仍低得多。B组和C组与A组和D组在房性早搏、房颤和室性心律失常事件方面存在显著差异（p<0.05）。
我们的结果表明，B组和C组使用的硫酸镁给药方案可减少接受CABG患者的术后心律失常事件。
