Division of Cardiovascular Surgery, Children's National Health System, Washington, DC.
Division of Cardiology, Children's National Health System, Washington, DC.
J Thorac Cardiovasc Surg. 2018 Aug;156(2):763-770.e1. doi: 10.1016/j.jtcvs.2018.04.044. Epub 2018 Apr 18.
Postoperative arrhythmias are common in children undergoing congenital heart surgery. We evaluated whether intraoperative administration of magnesium was associated with a reduced occurrence of specific postoperative arrhythmias, as has been described previously, or had a broader effect on multiple arrhythmia types, and whether there existed a dose-effect of intraoperative magnesium.
We used a historical prospective observational cohort study. Propensity score matching using logistic regression was applied to establish similar populations of treatment groups balanced on 5 important covariates.
Based on propensity score-matched groups, magnesium 50 mg/kg administration was associated with a reduced odds of occurrence of postoperative arrhythmias: any arrhythmia (odds ratio [OR] = 0.50, P < .001), junctional ectopic tachycardia (OR = 0.56, P = .004), accelerated junctional rhythm (OR = 0.56, P = .089), atrial tachycardia (OR = 0.48, P = .005), ventricular tachycardia (OR = 0.52, P = .04), and atrioventricular block (OR = 0.47, P = .03). The effect of magnesium on reducing the odds of occurrence of postoperative arrhythmias did not differ between 25 mg/kg versus 50 mg/kg.
As many as one third of our patients undergoing congenital heart surgery had postoperative arrhythmias. Use of intraoperative magnesium was associated with a reduction in the odds of occurrence of all postoperative arrhythmias. Our results do not provide evidence that a greater dose of magnesium is associated with greater arrhythmia risk reduction. Despite the intraoperative use of magnesium, there continued to be a high residual incidence of postoperative arrhythmias, raising the question for studying new or additional agents.
儿童先天性心脏手术后常发生术后心律失常。我们评估了术中给予镁是否与以前描述的特定术后心律失常的发生率降低相关，或者对多种心律失常类型有更广泛的影响，以及术中镁是否存在剂量效应。
我们使用了一项历史前瞻性观察队列研究。使用逻辑回归进行倾向评分匹配，以建立治疗组的相似人群，这些人群在 5 个重要协变量上平衡。
基于倾向评分匹配的组，镁 50mg/kg 给药与术后心律失常的发生几率降低相关：任何心律失常（比值比 [OR] = 0.50，P <.001）、交界性异位心动过速（OR = 0.56，P =.004）、加速交界性节律（OR = 0.56，P =.089）、房性心动过速（OR = 0.48，P =.005）、室性心动过速（OR = 0.52，P =.04）和房室传导阻滞（OR = 0.47，P =.03）。镁对降低术后心律失常发生几率的影响在 25mg/kg 与 50mg/kg 之间没有差异。
多达三分之一的接受先天性心脏手术的患者发生术后心律失常。术中使用镁与降低所有术后心律失常的几率相关。我们的结果没有提供证据表明更大剂量的镁与更大的心律失常风险降低相关。尽管术中使用了镁，但术后心律失常的残留发生率仍然很高，这引发了对研究新的或额外药物的疑问。
