体外循环预充液中补充镁剂对预防儿童先天性心脏病术后心律失常的作用  

Efficacy of Magnesium in Prevention of Arrhythmia in Pediatric Patients After the Surgery of Congenital Heart Disease

作　　者：宋振江[1] 陆进[1] 李晓峰[1] 高国庆[1] 赵宇东[1] 郑佳[1] 李仲智[1] 

机构地区：[1]首郁医科大学附属北京儿童医院心脏中心心脏外科,北京市100045

出　　处：《中国循环杂志》2010年第3期219-222,共4页Chinese Circulation Journal

摘　　要：目的:探讨体外循环(CPB)预充液中补充镁剂对儿童先天性心脏病(先心病)修补术后早期心律失常发生的预防性作用。方法:99例CPB下实施先心病心内直视修补手术的患儿被随机双盲地分成两组,实验组(即预充液补镁,n=49)和对照组(预充液补充生理盐水,n=50)。在7个检测点即术前1天、停CPB时、术后0h〔入重症监护室(ICU)即刻〕和ICU内术后6h、术后12h、术后24h、术后48h,测量血清镁浓度。术后48h内实施持续动态心电图监测。结果:在5个检测点(从停CPB时到术后24h)对照组血清镁浓度明显低于实验组。差异有统计学意义(P<0.01～0.05)。术后24h内对照组心律失常发生率明显高于实验组(P=0.003)。在ICU最初的24h内对照组有6例(12.0%)发生异位性交界区心动过速(JET),实验组没有观察到异位性交界区心动过速发生,差异有统计学意义(P=0.012)。结论:低镁血症与术后早期心律失常的发生有关,并提高异位性交界区心动过速的发生率。CPB预充液中补充镁剂可以预防儿童先心病CPB术后心律失常的发生。Objective ：To approach the efficacy of magnesium supplement in prevention of arrhythmia with pump prime of cardiopulmonary bypass（CPB） surgery of congenital heart disease in pediatric patients. Methods：A total of 99 pediatric patients with CPB surgery were randomly assigned in two double-blind groups. Trial group, n =49 ,the patients had magnesium supplement of 50 mg/kg, and Control group,n = 50, the patients received the normal saline in the pump prime of CPB. The serum magnesium concentrations were measured at 7 time points as 1 day before the surgery,finishing of CPB, ICU starting,6-hour, 12-hour,24-hour, and 48-hour after the surgery. Continuous electrocardiography was monitored within 48 hours after the surgery in each group respectively. Results ： The serum magnesium concentration in Control group was obviously lower than that in Trial group until 24-hour after CPB surgery. AT the same period of time, the arrhythmia occurrence in Control group was higher than that in Trial group （ P = 0. 003 ）. 6 patients（ 12.0% ）suffered from junctional ectopic tachycardia（JET） within 24 hours at ICU in Control group and no JET was observed in Trial group（P = 0. 012）. Conclusion：Hypomagnesaemia related to the occurrence of arrhythmia in the early stage at post-cardiac surgery and it increased the incidence of JET. Magnesium supplement in the pump prime of CPB could prevent those symptoms in pediatric patients after the surgery of congenital heart disease.

关 键 词：体外循环 先天性心脏病 儿章 心律失常 低镁血症 

分 类 号：R541[医药卫生—心血管疾病]