Bert A A, Reinert S E, Singh A K
Department of Anesthesiology, Rhode Island Hospital and Brown Medical School, Providence, RI 02903, USA.
J Cardiothorac Vasc Anesth. 2001 Apr;15(2):204-9. doi: 10.1053/jcan.2001.21959.
To evaluate magnesium as a sole or adjuvant agent with currently used prophylactic drugs in suppressing postoperative atrial tachyarrhythmias (POAT) after coronary artery bypass graft (CABG) surgery.
Single-center prospective, randomized clinical trial.
University hospital.
Patients (n = 400) undergoing CABG surgery.
Patients were randomized among 6 prophylaxis regimens: (1) control (no antiarrhythmics), (2) magnesium only, (3) digoxin only, (4) magnesium and digoxin, (5) propranolol only, and (6) magnesium and propranolol. Patients randomized to a regimen including magnesium received 12 g given during 96 hours postoperatively. Patients in a digoxin regimen received 1 mg after cardiopulmonary bypass and 0.25 mg daily. Patients in a propranolol regimen received 1 mg intravenously every 6 hours until able to take 10 mg orally 4 times a day. Prophylaxis regimens were discontinued after 4 days postoperatively.
The primary outcome was a sustained POAT or discharge from the hospital. Control patients had an incidence of POAT (38%) not significantly different from patients in magnesium-only (38%), digoxin-only (31%), and magnesium with digoxin (37%) regimens. Patients treated with propranolol had a significant reduction in POAT. Nearly identical POAT rates in the propranolol-only (18%) and propranolol with magnesium (19%) groups support the lack of efficacy of magnesium in this trial. Study design allowed analysis of and showed a beta-blocker withdrawal effect in addition to suppressive benefit of postoperative beta-blockers.
beta-Blocker prophylaxis is indicated to reduce the incidence of POAT in CABG surgery patients and to prevent a beta-blocker withdrawal effect in patients receiving these medications preoperatively. Digoxin and magnesium as sole or adjuvant agents do not offer suppressive or ventricular rate reduction benefits in POAT.
评估镁作为单一药物或与目前使用的预防性药物联合使用，在抑制冠状动脉旁路移植术（CABG）后术后房性快速心律失常（POAT）方面的效果。
单中心前瞻性随机临床试验。
大学医院。
接受CABG手术的患者（n = 400）。
患者被随机分为6种预防方案：（1）对照组（不使用抗心律失常药物），（2）仅使用镁，（3）仅使用地高辛，（4）镁和地高辛，（5）仅使用普萘洛尔，（6）镁和普萘洛尔。随机分配到含镁方案的患者在术后96小时内给予12 g镁。接受地高辛方案的患者在体外循环后给予1 mg，每日0.25 mg。接受普萘洛尔方案的患者每6小时静脉注射1 mg，直至能够每天口服4次，每次10 mg。预防方案在术后4天停止。
主要结局是持续性POAT或出院。对照组患者的POAT发生率（38%）与仅使用镁（38%）、仅使用地高辛（31%）和镁与地高辛联合使用（37%）方案的患者无显著差异。接受普萘洛尔治疗的患者POAT显著减少。仅使用普萘洛尔组（18%）和普萘洛尔与镁联合使用组（19%）的POAT发生率几乎相同，这支持了本试验中镁缺乏疗效的结论。研究设计允许分析并显示了除术后β受体阻滞剂的抑制作用外，还有β受体阻滞剂撤药效应。
β受体阻滞剂预防可降低CABG手术患者POAT的发生率，并预防术前接受这些药物治疗的患者出现β受体阻滞剂撤药效应。地高辛和镁作为单一药物或辅助药物在POAT中没有提供抑制作用或降低心室率的益处。
