Efficacy of Potassium Magnesium Aspartate in Prevention of Arrhythmia after Cardiac Heart Surgery_Chinese Journal of Evidence-Based Medicine

Authors：

 CHUYang ^1,2 , HUGuo-zhen ^1,2 ,  JIANGMing-yan ¹

1. Department of Pharmacy, Frist Hospital of China Medical University, Shenyang 110001, China;
2. School of Pharmacy, China Medical University, Shenyang 110001, China;

Corresponding author：

JIANGMing-yan, Email: syjmy@126.com

Keywords：

Potassium magnesium aspartate; Potassium chloride; Cardiac surgery; Arrhythmia; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140160

Video：

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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.

Citation： CHUYang, HUGuo-zhen, JIANGMing-yan. Efficacy of Potassium Magnesium Aspartate in Prevention of Arrhythmia after Cardiac Heart Surgery. Chinese Journal of Evidence-Based Medicine, 2014, 14(8): 966-973. doi: 10.7507/1672-2531.20140160 Copy

1.	朱国勇, 陈胜喜, 罗万俊, 等.体外循环心脏直视手术后死亡原因探讨.实用医学杂志, 2006, 22(22): 2616-2618.
2.	张遵严, 刘先桃, 陈雪芬, 等.体外循环术中监测血钾浓度的临床意义.微循环学杂志, 2007, 17(3): 701-701.
3.	向定成, 黎檀实.心血管急危重症快速诊治指南.清华大学出版社有限公司. 2005: 143-149.
4.	Zhi YF, Huang YS, Xu BS, et al. Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism. Chinese Critical Care Medicine, 2007, 19(11): 662-666.
5.	Wulf H, Schulzeck S, Petry A, et al. Potassium substitution during coronary surgery: K⁺-Mg²⁺-aspartate-complex (Inzolen) versus potassium chloride. Anaesthesiol Reanim, 1993, 18(6): 158.
6.	Piper SN, Kiessling AH, Suttner SW, et al. Prevention of atrial fibrillation after coronary artery bypass graft surgery using a potassium-magnesium-aspartate solution (Inzolen^®). Thorac Cardiovasc Surg, 2007, 55(07): 418-423.
7.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviewsof Interventions Version 5.1.0. Avaliable at: www.cochranehandbook.org.
8.	Review Manager. The Cochrane Collaboration. Copenhagen: The Nordic Cochrane Centre, 2008.
9.	郑慧, 林有光.门冬氨酸钾镁在心脏手术中的应用.中华心血管病杂志, 1996, 24(1): 31-32.
10.	Ji B, Liu J, Liu M, et al. Effect of cold blood cardioplegia enriched with potassium-magnesium aspartate during coronary artery bypass grafting. J Cardiovasc Surg, 2006, 47(6): 671.
11.	王喆妍, 骆璇, 王东进, 等.门冬氨酸钾镁在心脏瓣膜置换体外循环术中的心肌保护作用.现代医学, 2008, 36(6): 437-439.
12.	刘明政, 吉冰洋, 王古岩, 等.门冬氨酸钾镁在冠状动脉旁路移植术中对心肌的保护作用.中国体外循环杂志, 2008, 6(1): 12-14.
13.	张亮, 卿恩明, 蔡垣星, 等.门冬氨酸钾镁与氯化钾对非停跳冠状动脉旁路移植术围术期心律失常作用的比较.心肺血管病杂志, 2009 (3): 159-161.
14.	赵东, 王振国, 李培军, 等.门冬氨酸钾镁对心脏手术患者术后心律失常的预防和治疗作用.中国全科医学, 2010, 13(008): 843-845.
15.	刘醒帅, 赵丽云, 卢家凯, 等.门冬氨酸钾镁在不停跳冠状动脉旁路移植术中对心肌的保护作用.心肺血管病杂志, 2013 (2): 197-199.
16.	Kotani Y, Tweddell J, Gruber P, et al. Current cardioplegia practice in pediatric cardiac surgery: a North American multiinstitutional survey. Ann Thorac Surg, 2013, 96(3): 923-929.
17.	Post TM, Freijer JI, Ploege BA, et al. Extensions to the visual predictive check to facilitate model performance evaluation. J Pharmacokinet Pharmacodyn, 2008, 35: 185-202.
18.	甄永苏.治疗肿瘤的抗体靶向药物.中华肿瘤防治杂志, 2006, 13(22): 1681-1682.
19.	岳峰, 柯永胜, 俞国华, 等.大鼠心肌缺血再灌注损伤对心肌细胞膜Na+-K+-ATP酶亚基基因表达的影响与意义.中国动脉硬化杂志, 2008 (3): 173-177.
20.	朱亚.微创心脏直视手术的术后护理.东南国防医药, 2004, (06): 452-453.
21.	黄仕泽, 黄世坤, 赵月波.大剂量门冬氨酸钾镁治疗心律失常的临床观察.泸州医学院学报, 1999, 5: 045.
22.	丛悦玺, 骆东峰, 陈坤明, 等.生物镁离子转运体研究进展.农业生物技术学报, 2012, 20(7): 837-848.
23.	冯庚.危重症社区现场急救系列讲座——急性心肌梗死合并心律失常的机制和院前急救要点.中国全科医学, 2007, 10(3): 255-256.
24.	Korantzopoulos P, Kolettis T, Siogas K, et al. A trial fib rillat ion and electrical rem od eling: the potent ial role of inf lamm at ion and ox idative astress. Med Sci, 2003, 9 (9): RA225-229.
25.	Matsusaka T, Hasebe N, Jin YT, et al. Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in rabbits. Cardiovasc Res, 2002, 54(3): 568-575.
26.	刘洋, 王利亚, 郑相慧.门冬氨酸钾镁联合胺碘酮治疗冠心病室性心律失常的疗效以及对心电图PR间期和QRS时限的影响.中国老年学杂志, 2012, 32(23): 5307-5308.
27.	Allingham AA, Al-Radi OO, Latter DA. Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis. J Cardiac Surg, 2005, 20(3): 293-299.
28.	王丽萍.门冬氨酸钾镁对充血性心力衰竭患者室性心律失常的影响.山东医药, 2008, 48(7): 63-64.

1. 朱国勇, 陈胜喜, 罗万俊, 等.体外循环心脏直视手术后死亡原因探讨.实用医学杂志, 2006, 22(22): 2616-2618.
2. 张遵严, 刘先桃, 陈雪芬, 等.体外循环术中监测血钾浓度的临床意义.微循环学杂志, 2007, 17(3): 701-701.
3. 向定成, 黎檀实.心血管急危重症快速诊治指南.清华大学出版社有限公司. 2005: 143-149.
4. Zhi YF, Huang YS, Xu BS, et al. Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism. Chinese Critical Care Medicine, 2007, 19(11): 662-666.
5. Wulf H, Schulzeck S, Petry A, et al. Potassium substitution during coronary surgery: K⁺-Mg²⁺-aspartate-complex (Inzolen) versus potassium chloride. Anaesthesiol Reanim, 1993, 18(6): 158.
6. Piper SN, Kiessling AH, Suttner SW, et al. Prevention of atrial fibrillation after coronary artery bypass graft surgery using a potassium-magnesium-aspartate solution (Inzolen^®). Thorac Cardiovasc Surg, 2007, 55(07): 418-423.
7. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviewsof Interventions Version 5.1.0. Avaliable at: www.cochranehandbook.org.
8. Review Manager. The Cochrane Collaboration. Copenhagen: The Nordic Cochrane Centre, 2008.
9. 郑慧, 林有光.门冬氨酸钾镁在心脏手术中的应用.中华心血管病杂志, 1996, 24(1): 31-32.
10. Ji B, Liu J, Liu M, et al. Effect of cold blood cardioplegia enriched with potassium-magnesium aspartate during coronary artery bypass grafting. J Cardiovasc Surg, 2006, 47(6): 671.
11. 王喆妍, 骆璇, 王东进, 等.门冬氨酸钾镁在心脏瓣膜置换体外循环术中的心肌保护作用.现代医学, 2008, 36(6): 437-439.
12. 刘明政, 吉冰洋, 王古岩, 等.门冬氨酸钾镁在冠状动脉旁路移植术中对心肌的保护作用.中国体外循环杂志, 2008, 6(1): 12-14.
13. 张亮, 卿恩明, 蔡垣星, 等.门冬氨酸钾镁与氯化钾对非停跳冠状动脉旁路移植术围术期心律失常作用的比较.心肺血管病杂志, 2009 (3): 159-161.
14. 赵东, 王振国, 李培军, 等.门冬氨酸钾镁对心脏手术患者术后心律失常的预防和治疗作用.中国全科医学, 2010, 13(008): 843-845.
15. 刘醒帅, 赵丽云, 卢家凯, 等.门冬氨酸钾镁在不停跳冠状动脉旁路移植术中对心肌的保护作用.心肺血管病杂志, 2013 (2): 197-199.
16. Kotani Y, Tweddell J, Gruber P, et al. Current cardioplegia practice in pediatric cardiac surgery: a North American multiinstitutional survey. Ann Thorac Surg, 2013, 96(3): 923-929.
17. Post TM, Freijer JI, Ploege BA, et al. Extensions to the visual predictive check to facilitate model performance evaluation. J Pharmacokinet Pharmacodyn, 2008, 35: 185-202.
18. 甄永苏.治疗肿瘤的抗体靶向药物.中华肿瘤防治杂志, 2006, 13(22): 1681-1682.
19. 岳峰, 柯永胜, 俞国华, 等.大鼠心肌缺血再灌注损伤对心肌细胞膜Na+-K+-ATP酶亚基基因表达的影响与意义.中国动脉硬化杂志, 2008 (3): 173-177.
20. 朱亚.微创心脏直视手术的术后护理.东南国防医药, 2004, (06): 452-453.
21. 黄仕泽, 黄世坤, 赵月波.大剂量门冬氨酸钾镁治疗心律失常的临床观察.泸州医学院学报, 1999, 5: 045.
22. 丛悦玺, 骆东峰, 陈坤明, 等.生物镁离子转运体研究进展.农业生物技术学报, 2012, 20(7): 837-848.
23. 冯庚.危重症社区现场急救系列讲座——急性心肌梗死合并心律失常的机制和院前急救要点.中国全科医学, 2007, 10(3): 255-256.
24. Korantzopoulos P, Kolettis T, Siogas K, et al. A trial fib rillat ion and electrical rem od eling: the potent ial role of inf lamm at ion and ox idative astress. Med Sci, 2003, 9 (9): RA225-229.
25. Matsusaka T, Hasebe N, Jin YT, et al. Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in rabbits. Cardiovasc Res, 2002, 54(3): 568-575.
26. 刘洋, 王利亚, 郑相慧.门冬氨酸钾镁联合胺碘酮治疗冠心病室性心律失常的疗效以及对心电图PR间期和QRS时限的影响.中国老年学杂志, 2012, 32(23): 5307-5308.
27. Allingham AA, Al-Radi OO, Latter DA. Intravenous magnesium for prevention of atrial fibrillation after coronary artery bypass surgery: a systematic review and meta-analysis. J Cardiac Surg, 2005, 20(3): 293-299.
28. 王丽萍.门冬氨酸钾镁对充血性心力衰竭患者室性心律失常的影响.山东医药, 2008, 48(7): 63-64.

Chinese Journal of Evidence-Based Medicine

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

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