Taksaudom Noppon, Cheewinmethasiri Jaroen, Chittawatanarat Kaweesak, Nawarawong Weerachai, Ko-iam Wasana, Sudthiviseschai Petchara
J Med Assoc Thai. 2016 Jul;99(7):794-801.
Atrial fibrillation (AF) is a common complication after cardiac surgery and impacts length of hospital stay, greater utilization of health care resources, and increases morbidity and mortality. Magnesium sulfate (MgSO4 ) has been well documented in its effect of AF reduction after cardiac surgery especially in coronary artery bypass grafting (CABG) but the dosages are still not settled.
Eighty-eight elective CABG cases were randomized to receive a high dose (10 gm) or low dose (5 gm) MgSO4 and were blinded into bottle 1 (n = 46) and bottle 2 (n = 42). Patients were closely observed with continuous ECG monitoring in the first 24 hours then observed for clinical symptoms until discharge.
The demographic data were comparable except for a higher body weight in the high dose group (60.21±11.32 kg vs. 65.85±12.2 kg, p = 0.03) and higher incidence of diabetes in high dose group (52.4% vs. 28.3%, p = 0.02). Intraoperative data were similar. No complications were related to MgSO4 except one patient in the high dose group that experienced flushing and abdominal discomfort during administration. Immediate postoperative serum magnesium was higher in the high dose group but rapidly returned to similar level one day postoperatively. AF occurred in nine patients (10.23%), four in the low dose and five in the high dose group and there was no statistical significance (p = 0.62).
Current data suggested the safety and effectiveness of MgSO4 for the reduction of the incidence of AF during postoperative CABG surgery. However, there was no statistical difference between the dosages of MgSO4 supplement. The 5-gm-MgSO4 supplement was effective in AF prevention and could avoid the adverse effect from high dose MgSO4 infusion.
心房颤动（AF）是心脏手术后常见的并发症，会影响住院时间、增加医疗资源的使用，并提高发病率和死亡率。硫酸镁（MgSO4）在心脏手术后降低AF发生率方面的作用已有充分记录，尤其是在冠状动脉旁路移植术（CABG）中，但剂量仍未确定。
88例择期CABG患者被随机分为高剂量组（10克）或低剂量组（5克）MgSO4，并被随机分配到1号瓶组（n = 46）和2号瓶组（n = 42）。患者在术后前24小时进行连续心电图监测，密切观察，然后观察临床症状直至出院。
除高剂量组体重较高（60.21±11.32千克对65.85±12.2千克，p = 0.03）和高剂量组糖尿病发病率较高（52.4%对28.3%，p = 0.02）外，两组人口统计学数据具有可比性。术中数据相似。除1例高剂量组患者在给药期间出现潮红和腹部不适外，无与MgSO4相关的并发症。术后即刻高剂量组血清镁较高，但术后1天迅速恢复到相似水平。9例患者（10.23%）发生AF，低剂量组4例，高剂量组5例，无统计学意义（p = 0.62）。
目前数据表明MgSO4在降低CABG术后AF发生率方面具有安全性和有效性。然而，补充MgSO4的剂量之间无统计学差异。补充5克MgSO4对预防AF有效，且可避免高剂量MgSO4输注的不良反应。
