Dabbagh Ousama C, Aldawood Abdulaziz S, Arabi Yaseen M, Lone Nazair A, Brits Riette, Pillay Monica
Department of Intensive Care Unit, King Fahad Hospital, King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2006 Jun;27(6):821-5.
Recent literature showed that development of hypomagnesemia is associated with higher mortality. The objective of this study is to evaluate the impact of magnesium supplementation on mortality rates of critically ill patients.
All patients admitted to the Intensive Care Unit (ICU) of King Abdul-Aziz Medical City, Riyadh, Saudi Arabia since September 2003 were included. We recorded the demographics data, APACHE score, daily magnesium levels and magnesium supplementation. We collected the data for 30 days or until discharge from ICU. Statistical analysis was performed using the student t-test for continuous data and the Fischers exact test for categorical data. Nothing was carried out to influence the behavior of intensivists in replacing magnesium.
During the study period, 71 patients (45 males and 26 females) were admitted to the ICU, the mean age was 54 +/- 18 years for males and 56 +/- 19.2 years for females. The mean magnesium level on admission was 0.78 +/- 0.2 mmol/L and the majority of the patients were medical admissions. Approximately 39.4% had hypomagnesemia on admission and the overall mortality rate was 31%. In able to standardize the supplementation of magnesium among groups, the daily magnesium supplementation index (DMSI = total magnesium supplement in grams/length of stay in days) was calculated. The mortality rates for DMSI with <1 grm/day (low groups) was statistically significant higher than that of DMSI with >or=1 grm/day (high group) (43.5% versus 17%, p=0.035). There was no statistically significant differences between magnesium levels of both groups of DMSI except at admission where DMSI group had higher magnesium levels (<1 grm/day).
Daily magnesium supplementation index higher than 1 grm/day is associated with lower mortality rates for critically ill patients. This effect was not found to be independent and may be related to severity of illness. Given that magnesium levels were similar between the 2 groups of DMSI at almost all points of the study, magnesium supplementation per se may be beneficial in lowering mortality rates. The exact cause of this effect is unknown. An aggressive magnesium supplementation protocol may be warranted. A larger scale randomized study is necessary to evaluate this effect.
近期文献表明，低镁血症的发生与较高的死亡率相关。本研究的目的是评估补充镁对危重症患者死亡率的影响。
纳入自2003年9月起入住沙特阿拉伯利雅得阿卜杜勒-阿齐兹国王医疗城重症监护病房（ICU）的所有患者。我们记录了人口统计学数据、急性生理与慢性健康状况评分系统（APACHE）评分、每日镁水平及镁补充情况。我们收集了30天的数据或直至患者从ICU出院。对连续数据采用学生t检验，对分类数据采用Fisher精确检验进行统计分析。未采取任何措施影响重症监护医生补充镁的行为。
在研究期间，71例患者（45例男性和26例女性）入住ICU，男性的平均年龄为54±18岁，女性为56±19.2岁。入院时的平均镁水平为0.78±0.2 mmol/L，大多数患者因内科疾病入院。入院时约39.4%的患者有低镁血症，总体死亡率为31%。为了使各组间的镁补充标准化，计算了每日镁补充指数（DMSI = 补充镁的总量（克）/住院天数）。DMSI＜1克/天（低剂量组）的死亡率显著高于DMSI≥1克/天（高剂量组）（43.5%对17%，p = 0.035）。除入院时DMSI组（＜1克/天）的镁水平较高外，两组DMSI的镁水平在其他时间点无统计学显著差异。
每日镁补充指数高于1克/天与危重症患者较低的死亡率相关。未发现这种效应具有独立性，可能与疾病严重程度有关。鉴于在研究的几乎所有时间点两组DMSI的镁水平相似，补充镁本身可能有助于降低死亡率。这种效应的确切原因尚不清楚。可能需要积极的镁补充方案。有必要进行更大规模的随机研究来评估这种效应。
