镁对心力衰竭患者室性心律失常的影响

Effect of magnesium on ventricular arrhythmias in patients with heart failure

目的探讨镁盐对心力衰竭患者室性心律失常的作用．方法对３１例血清镁≤１９ｍｇ·Ｌ－１、室性早搏＞１０次·ｈ－１的充血性心力衰竭患者给予硫酸镁（０．２ｍＥｑ·ｋ·ｇ－１）静脉滴注，比较滴注前后血清镁浓度变化与６ｈ动态心电图记录分析的室性早搏频率变化的关系。结果血清镁浓度与室性早搏频率呈负相关（ｒ＝－０．８２，Ｐ＜０．００１）。镁浓度增加≥７ｍｇ·Ｌ－１者，室性早搏频率下降３０９±２４１次·ｈ－１，增加≤６ｍｇ·Ｌ－１者，室性早搏频率是多变的；滴注前平均室性早搏频率为４０５±３６６次·ｈ－１，滴注后为２１４±１６５次·ｈ－１（Ｐ＜０．００１）。其中滴注前室性早搏频率＜２５０次·ｈ－１（偶发室早）的患者，滴注后室性早搏频率无明显改变（分别为１２６±４５次·ｈ－１及１２０±１１３次·ｈ－１，Ｐ＞０．０５）。结论静脉滴注硫酸镁对于心力衰竭伴频发室性早搏的患者有明显的抗心律失常作用，其机制跟血清镁浓度快速增加有关。

Objective To research the effect of magnesium on ventricular arrhythimias in patients with heart failure.Methods Thirty one patients conformed to the standerds set up by New York Heart Association(NYHA) class Ⅱ to Ⅳ heart failure and serum magnesium ≤1.9mg per dl was selected.Within 2 days,a baseline 6-hour dynamic electrocargraphic recording,an infusion of 0.2mEq·kg -1 of MgSO 4 was given over 1 hour and a repeat 6-hour recording was obtained.The change in the frequency of ventricular arrhythmias and the relationship between this change and the increase in serum magnesium concentration were evaluated.Results A negative correlation between the change in magnesium concentration and the change in frequency of ventricular premature(r=-0.82,P<0.001) was obtained.Ventricular premature beats declined by 309±241·h -1 in patients whom serum magnesium concentration increased ≥0.7mg·dl -1 ,but it was a variable response in patients with a change ≤mg per dl.For all patients,the frequency of premature ventricular depolarization was 405±366·h -1 pretreatment and 214±165·h -1 following magnesium infusion(P<0.001).However,for patients with <250·h -1 ventricular premature beats,it was not significant diffrence pretreatment and after treartment.Conclusion Intravenous magnesium administraton have significant antiarrhymic effect in patients with heart falure and frequent ventricular arrhythmias.This may be duo to the pharmacologic effect of acute elevation of serum magnesium concentration.