Hampton E M, Whang D D, Whang R
Pharmacokinetic Dosing and Research Unit, Department of Veterans Affairs Medical Center, Oklahoma City, OK 73104.
Ann Pharmacother. 1994 Feb;28(2):212-9. doi: 10.1177/106002809402800212.
To review the methods and summarize the findings of clinical trials evaluating the use of intravenous magnesium (Mg2+) in acute myocardial infarction (AMI); to discuss serum Mg2+ in AMI and the potential mechanisms by which intravenous Mg2+ may be effective. Tables are used extensively to provide detailed information about the various trials.
A MEDLINE search was used to identify pertinent literature. Additional references were obtained from the articles retrieved from that search.
Studies randomized and/or placebo-controlled were selected for review. Additional relevant citations were used in the introductory material and discussion.
There were surprisingly few large, placebo-controlled trials. All clinical trials available at the time of publication were reviewed. Only eight trials enrolled sufficient numbers of patients and/or were of adequate design to make meaningful interpretations. The description of the methods and results of these articles are the basis of this review. Although additional controlled studies with more subjects are needed, the results to date form a foundation from which to make inferences regarding the utility of this therapeutic modality.
Intravenous Mg2+ has been demonstrated, albeit inconclusively, to reduce immediate and long-term morbidity and mortality when given in the immediate postinfarction period. Six of the eight controlled trials discussed report a decrease in the overall incidence of arrhythmia or in the frequency of arrhythmia requiring treatment. Four of the eight reported statistical significance. Five of the six trials evaluating mortality reported a decrease in the mortality rate from intravenous Mg2+ administered post-MI. Four of the five reported statistical significance. The favorable effect of intravenous Mg2+ on the mortality rate appears to occur in the first 30 days post-MI and is maintained through at least one year. The effects appear to be independent of concurrent therapy and do not appear to relate to baseline serum Mg2+ concentrations. Intravenous Mg2+ appears to be safe and well tolerated. Flushing, hypotension, and atrioventricular (AV) node conduction abnormalities occur on occasion and seem related to the rate of administration. The exact dosage in this setting remains to be determined.
Additional, well-designed, multicenter, controlled trials evaluating intravenous Mg2+ in AMI are needed. The pending Fourth International Study of Infarct Survival, with an anticipated 400,000 subjects, should clarify a number of unresolved issues regarding this therapy. Based on the information available to date, however, intravenous Mg2+ as a significant therapeutic modality for AMI shows promise. Pending further investigation, however, it should be avoided in patients with significant sinoatrial or AV conduction disturbances.
回顾评估急性心肌梗死（AMI）中静脉使用镁离子（Mg2+）的临床试验方法并总结其结果；讨论 AMI 中的血清镁离子以及静脉使用 Mg2+可能有效的潜在机制。广泛使用表格来提供有关各种试验的详细信息。
使用 MEDLINE 检索来识别相关文献。从该检索中检索到的文章中获取了其他参考文献。
选择随机和/或安慰剂对照的研究进行综述。在引言材料和讨论中使用了其他相关引用。
令人惊讶的是，大型安慰剂对照试验很少。对发表时所有可用的临床试验进行了综述。只有八项试验纳入了足够数量的患者和/或设计合理，能够做出有意义的解释。这些文章的方法和结果描述是本综述的基础。尽管需要更多受试者的额外对照研究，但迄今为止的结果形成了一个基础，可以据此推断这种治疗方式的效用。
静脉注射 Mg2+在心肌梗死后立即给药时，虽未得出定论，但已证明可降低近期和长期的发病率及死亡率。所讨论的八项对照试验中有六项报告心律失常的总体发生率或需要治疗的心律失常频率有所降低。八项中有四项报告具有统计学意义。评估死亡率的六项试验中有五项报告静脉注射 Mg2+后心肌梗死死亡率降低。五项中有四项报告具有统计学意义。静脉注射 Mg2+对死亡率的有利影响似乎发生在心肌梗死后的前 30 天，并至少维持一年。这些影响似乎与同时进行的治疗无关，也似乎与基线血清镁离子浓度无关。静脉注射 Mg2+似乎是安全的且耐受性良好。偶尔会出现潮红、低血压和房室（AV）结传导异常，这似乎与给药速度有关。在这种情况下的确切剂量仍有待确定。
需要进行更多设计良好的多中心对照试验来评估 AMI 中静脉注射 Mg2+的情况。即将开展的第四次国际心肌梗死生存研究预计有 40 万名受试者，应能阐明有关这种治疗的一些未解决问题。然而，根据目前可得的信息，静脉注射 Mg2+作为 AMI 的一种重要治疗方式显示出前景。不过，在进一步研究之前，对于有严重窦房结或房室传导障碍的患者应避免使用。
