Hoshino Kenji, Ogawa Kiyoshi, Hishitani Takashi, Isobe Takeshi, Etoh Yoshikatsu
Department of Pediatric Cardiology, Saitama Children's Medical Center, Iwatsuki City, Saitama, Japan.
Pediatr Int. 2006 Apr;48(2):112-7. doi: 10.1111/j.1442-200X.2006.02177.x.
Administration of magnesium sulfate (MgSO4) is an effective and safe treatment for torsades de pointes (TdP) associated with acquired long QT syndrome (LQTS) in adults. As for children, there are few reports focusing on it. The authors discuss the efficacy of MgSO4 for TdP in children with congenital and acquired LQTS. The authors also discuss the optimal administration dosage and serum magnesium (SMg) concentration during MgSO4 therapy.
The authors studied seven consecutive LQTS children undergoing MgSO4 therapy for TdP. Of the seven children, five were congenital LQTS and two were acquired LQTS. A bolus injection of MgSO4 was given intravenously over 1-2 min followed by continuous infusion for the next 2-7 days.
Of the seven patients, six responded completely to the initial bolus. The bolus dosage was 5.9 +/- 3.8 mg/kg (range, 2.3-12 mg/kg) in these six, and the other remaining one (neonate with congenital LQTS) required a total of 30 mg/kg until complete abolishment. The continuous infusion was given at rates of 0.3-1.0 mg/kg per h and patients did not show recurrence of TdP. The SMg concentration was 3.9 +/- 1.0 mg/dL (2.9-5.4 mg/dL) immediately after bolus injection. The mean corrected QT (QTc) interval before and after bolus injection did not show significant difference.
Intravenous infusion of MgSO4 was effective for TdP in children with LQTS, and MgSO4 abolished TdP without shortening the QTc interval. The optimal bolus dosage, infusion rates and SMg concentration were 3-12 mg/kg, 0.5-1.0 mg/kg per h and 3-5 mg/dL, respectively.
硫酸镁（MgSO4）给药是治疗成人获得性长QT综合征（LQTS）相关尖端扭转型室速（TdP）的一种有效且安全的方法。至于儿童，关注这方面的报道很少。作者讨论了MgSO4对先天性和获得性LQTS儿童TdP的疗效。作者还讨论了MgSO4治疗期间的最佳给药剂量和血清镁（SMg）浓度。
作者研究了连续7例接受MgSO4治疗TdP的LQTS儿童。这7名儿童中，5例为先天性LQTS，2例为获得性LQTS。静脉内1 - 2分钟内推注MgSO4，随后在接下来的2 - 7天持续输注。
7例患者中，6例对初始推注完全有反应。这6例患者的推注剂量为5.9±3.8mg/kg（范围2.3 - 12mg/kg），其余1例（先天性LQTS新生儿）直至完全消除共需要30mg/kg。持续输注速率为每小时0.3 - 1.0mg/kg，患者未出现TdP复发。推注后即刻SMg浓度为3.9±1.0mg/dL（2.9 - 5.4mg/dL）。推注前后平均校正QT（QTc）间期无显著差异。
静脉输注MgSO4对LQTS儿童的TdP有效，且MgSO4消除TdP时不缩短QTc间期。最佳推注剂量、输注速率和SMg浓度分别为3 - 12mg/kg、每小时0.5 - 1.0mg/kg和3 - 5mg/dL。
