Fanning W J, Thomas C S, Roach A, Tomichek R, Alford W C, Stoney W S
Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Ann Thorac Surg. 1991 Sep;52(3):529-33. doi: 10.1016/0003-4975(91)90918-g.
Ninety-nine consecutive consenting patients were prospectively entered into a randomized, double-blind, placebo-controlled trial to determine the efficacy of postoperative magnesium therapy on the incidence of cardiac arrhythmias after elective coronary artery bypass grafting. No patient had documented or suspected arrhythmias preoperatively. Forty-nine patients received 178 mEq of magnesium given over the first 4 postoperative days, and 50 patients received only placebo. The clinical characteristics of both groups were similar. The preoperative mean serum magnesium concentration was similar in both study (1.90 mEq/L) and placebo (1.90 mEq/L) groups. The mean postoperative serum magnesium concentration in study patients was significantly elevated over postoperative days 1 through 4 when compared with preoperative levels (p less than 0.001). The postoperative mean serum magnesium concentration in control patients declined and remained significantly depressed through postoperative day 3 (p less than 0.001), but increased to preoperative levels by postoperative day 4. The mean serum magnesium concentration was significantly greater in the study patients as compared with the control patients over postoperative days 1 through 4 (p less than 0.001). Although there was no significant difference between groups with respect to episodes of ventricular arrhythmias, there was a significant decrease in the number of episodes of atrial fibrillation in the group receiving magnesium therapy (p less than 0.02). There were no recognized adverse effects of magnesium therapy. Prophylactic magnesium administration seems to lessen the incidence and severity of atrial fibrillation after coronary artery bypass grafting.
99例连续同意参与研究的患者被前瞻性纳入一项随机、双盲、安慰剂对照试验，以确定术后镁剂治疗对择期冠状动脉旁路移植术后心律失常发生率的疗效。术前无患者有记录或疑似心律失常。49例患者在术后头4天接受178 mEq镁剂，50例患者仅接受安慰剂。两组的临床特征相似。研究组（1.90 mEq/L）和安慰剂组（1.90 mEq/L）术前平均血清镁浓度相似。与术前水平相比，研究组患者术后第1至4天的平均血清镁浓度显著升高（p<0.001）。对照组患者术后平均血清镁浓度下降，至术后第3天仍显著低于术前水平（p<0.001），但至术后第4天升至术前水平。术后第1至4天，研究组患者的平均血清镁浓度显著高于对照组患者（p<0.001）。虽然两组在室性心律失常发作方面无显著差异，但接受镁剂治疗组的房颤发作次数显著减少（p<0.02）。镁剂治疗未发现公认的不良反应。预防性给予镁剂似乎可降低冠状动脉旁路移植术后房颤的发生率和严重程度。
