门冬氨酸钾镁预防心脏手术后心律失常疗效的Meta分析

Efficacy of Potassium Magnesium Aspartate in Prevention of Arrhythmia after Cardiac Heart Surgery

目的系统评价门冬氨酸钾镁预防心脏手术后心律失常的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library(2014年第5期)、CNKI、VIP和WanFang Data,查找门冬氨酸钾镁预防心脏手术后心律失常的随机对照试验(RCT),检索时限均为从建库至2014年5月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入9个RCT,共825例患者。Meta分析结果显示:1与对照组相比,手术前后及时给予门冬氨酸钾镁补充钾、镁离子能明显减少心律失常的发生[OR=0.25,95%CI(0.09,0.69),P=0.008],两组差异有统计学意义。2与对照组相比,手术前后及时给予门冬氨酸钾镁补充钾、镁离子能减少早搏[OR=0.08,95%CI(0.03,0.23),P<0.000 01]和心动过速的发生率[OR=0.29,95%CI(0.17,0.49),P<0.000 01],降低24小时低心排发生率[OR=0.27,95%CI(0.10,0.72),P=0.009],提高自动复跳率[OR=12.16,95%CI(4.82,30.68),P<0.000 01],两组差异均有统计学意义。4两者在改善房颤[OR=0.05,95%CI(–0.16,0.05),P=0.34]和室颤[OR=1.24,95%CI(0.73,2.13),P=0.43]方面无明显差异。结论门冬氨酸钾镁能有效预防心脏手术后心律失常发生,同时对心肌具有一定保护作用,但在改善患者术后房颤、室颤发生率方面与常规治疗无明显差异。受纳入研究数量和质量所限,上述结论尚待进一步开展更多大样本、多中心、高质量的RCT加以验证。

Objective To systematically review the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery. Methods Searching PubMed, MEDLINE, EMbase, The Cochrane Library （Issue 5, 2014）, CNKI, VIP and WanFang Data to collect randomized controlled trials （RCTs） about the clinical efficacy of potassium magnesium aspartate in prevention of arrhythmia after cardiac heart surgery from the date of establishment of the databases to May 2014. Literature screening according to the inclusion and exclusion criteria, data extraction and methodological quality assessment of the included studies were completed by two reviewers independently. Meta-analysis was then conducted by RevMan 5.2 software. Results A total of nine RCTs involving 825 patients were enrolled. The results of meta-analysis indicated that： compared with the control group, timely giving supplement of potassium magnesium aspartate before and after surgery significantly reduced the incidences of arrhythmia （OR= 0.25, 95%CI 0.09 to 0.69, P=0.008）, premature beats （OR=0.08, 95%CI 0.03 to 0.23, P〈0.000 01）, tachycardia （OR=0.29, 95%CI 0.17 to 0.49, P〈0.000 01） and 24 h low cardiac output （OR=0.27, 95%CI 0.10 to 0.72, P=0.009）; and increased auto-resuscitation rates （OR=12.16, 95%CI 4.82 to 30.68, P〈0.000 01）, with significant differences. However, the two groups were alike in the incidences of atrial fibrillation （OR=0.05, 95%CI -0.16 to 0.05, P=0.34） and ventricular fibrillation （OR=1.24, 95%CI 0.73 to 2.13, P=0.43）. Conclusion Potassium magnesium aspartate is effective in prevention of arrhythmias after cardiac surgery, and protective to the myocardium. However, compared with conventional treatment it cannot significantly decrease the incidences of atrial fibrillation and ventricular fibrillation. Due to the limited quantity and quality of the included studies, more multi-centre high quality RCTs with large sample size are needed to verify the above conclusion.