Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.
Eur J Cardiothorac Surg. 2011 Sep;40(3):722-9. doi: 10.1016/j.ejcts.2010.09.049. Epub 2011 Feb 24.
OBJECTIVE: Magnesium (Mg²⁺) is cardioprotective and has been routinely used to supplement cardioplegic solutions during coronary artery bypass graft (CABG) surgery. However, there is no consensus about the Mg²⁺ concentration that should be used. The aim of this study was to compare the effects of intermittent antegrade warm-blood cardioplegia supplemented with either low- or high-concentration Mg²⁺. METHODS: This study was a randomised controlled trial carried out in two cardiac surgery centres, Bristol, UK and Cuneo, Italy. Patients undergoing isolated CABG with cardiopulmonary bypass were eligible. Patients were randomised to receive warm-blood cardioplegia supplemented with 5 or 16 mmol l⁻¹ Mg². The primary outcome was postoperative atrial fibrillation. Secondary outcomes were serum biochemical markers (troponin I, Mg²⁺, potassium, lactate and creatinine) and time-to-plegia arrest. Intra-operative and postoperative clinical outcomes were also recorded. RESULTS: Data from two centres for 691 patients (342 low and 349 high Mg²⁺) were analysed. Baseline characteristics were similar for both groups. There was no significant difference in the frequency of postoperative atrial fibrillation in the high (32.8%) and low (32.0%) groups (risk ratio 1.03, 95% confidence interval, CI, 0.82-1.28). However, compared with the low group, troponin I release was 28% less (95% CI 55-94%, p=0.02) in the high-Mg²⁺ group. The 30-day mortality was 0.72% (n = 5); all deaths occurred in the high-Mg²⁺ group but there was no significant difference between the groups (p=0.06). Frequencies of other major complications were similar in the two groups. CONCLUSIONS: Warm-blood cardioplegia supplemented with 16 mmol l⁻¹ Mg²⁺, compared with 5 mmol l⁻¹ Mg²⁺, does not reduce the frequency of postoperative atrial fibrillation in patients undergoing CABG but may reduce cardiac injury. (This trial was registered as ISRCTN95530505.).
目的：镁（Mg²⁺）具有心脏保护作用，在冠状动脉旁路移植术（CABG）期间，常被常规用于补充心脏停搏液。然而，对于应该使用的 Mg²⁺浓度尚无共识。本研究旨在比较补充低浓度或高浓度 Mg²⁺的间断顺行温血心脏停搏的效果。
方法：这是一项在英国布里斯托尔和意大利库尼奥的两个心脏手术中心进行的随机对照试验。符合条件的患者为接受体外循环下的单纯 CABG。患者被随机分配接受补充 5 或 16 mmol l⁻¹ Mg²⁺的温血心脏停搏液。主要结局是术后心房颤动。次要结局是血清生化标志物（肌钙蛋白 I、Mg²⁺、钾、乳酸和肌酐）和停搏时间。术中及术后临床结局也被记录。
结果：对来自两个中心的 691 例患者（低 Mg²⁺组 342 例，高 Mg²⁺组 349 例）的数据进行了分析。两组患者的基线特征相似。高 Mg²⁺组（32.8%）和低 Mg²⁺组（32.0%）术后心房颤动的发生率无显著差异（风险比 1.03，95%置信区间，CI，0.82-1.28）。然而，与低 Mg²⁺组相比，高 Mg²⁺组肌钙蛋白 I 释放减少了 28%（95%CI 55-94%，p=0.02）。30 天死亡率为 0.72%（n=5）；所有死亡均发生在高 Mg²⁺组，但两组之间无显著差异（p=0.06）。两组其他主要并发症的发生率相似。
结论：与补充 5 mmol l⁻¹ Mg²⁺相比，补充 16 mmol l⁻¹ Mg²⁺的温血心脏停搏液不会降低 CABG 患者术后心房颤动的发生率，但可能会减少心脏损伤。（本试验在 ISRCTN 注册，编号为 ISRCTN95530505。）
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