Teo Koon K, Yusuf Salim
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
Drugs. 1993 Sep;46(3):347-359. doi: 10.2165/00003495-199346030-00002.
A number of small, randomised clinical trials and one large trial of intravenous magnesium have been conducted on patients with acute myocardial infarction (AMI). Most of these trials indicate that treatment with magnesium has a beneficial effect on short term mortality, although in most of the small trials the results are inconclusive. A systematic overview of mortality and serious morbidity data from all the available randomised controlled trials of magnesium conducted in a total of nearly 4000 patients with AMI indicates that there were 123 deaths in 1974 patients allocated magnesium, and 193 deaths in 1949 controls (odds ratio 0.61, 95% confidence interval 0.48 to 0.76, p < 0.0001). Data on the effects of magnesium on serious ventricular arrhythmias and heart failure are incomplete, and definitions for these serious complications of AMI vary greatly among the trials. Nevertheless, the available data suggest that magnesium also significantly reduces these 2 serious forms of morbidity. These data suggest that magnesium given to patients during AMI can produce significant reductions in mortality and serious morbidity. Although the mechanism of action of magnesium is likely to be independent of other currently used agents, its value when added to thrombolytic therapy, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and nitrates is not clear, and is presently being studied in the very large Fourth International Studies of Infarct Survival (ISIS-4) trial.
已经针对急性心肌梗死（AMI）患者开展了多项小型随机临床试验以及一项关于静脉注射镁的大型试验。这些试验中的大多数表明，镁治疗对短期死亡率有有益影响，尽管在大多数小型试验中结果尚无定论。对总共近4000例AMI患者进行的所有可用镁随机对照试验的死亡率和严重发病率数据进行的系统综述表明，1974例分配接受镁治疗的患者中有123例死亡，1949例对照组中有193例死亡（比值比0.61，95%置信区间0.48至0.76，p<0.0001）。关于镁对严重室性心律失常和心力衰竭影响的数据不完整，并且在这些试验中，AMI这些严重并发症的定义差异很大。尽管如此，现有数据表明镁也能显著降低这两种严重的发病形式。这些数据表明，在AMI期间给予患者镁可显著降低死亡率和严重发病率。尽管镁的作用机制可能独立于目前使用的其他药物，但其与溶栓治疗、β受体阻滞剂、血管紧张素转换酶（ACE）抑制剂和硝酸盐联合使用时的价值尚不清楚，目前正在非常大型的第四次国际心肌梗死存活研究（ISIS-4）试验中进行研究。
