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.	?朱國勇, 陳勝喜, 羅萬俊, 等.體外循環心臟直視手術后死亡原因探討.實用醫學雜志, 2006, 22(22): 2616-2618.
2.	張遵嚴, 劉先桃, 陳雪芬, 等.體外循環術中監測血鉀濃度的臨床意義.微循環學雜志, 2007, 17(3): 701-701.
3.	向定成, 黎檀實.心血管急危重癥快速診治指南.清華大學出版社有限公司. 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.	鄭慧, 林有光.門冬氨酸鉀鎂在心臟手術中的應用.中華心血管病雜志, 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, 駱璇, 王東進, 等.門冬氨酸鉀鎂在心臟瓣膜置換體外循環術中的心肌保護作用.現代醫學, 2008, 36(6): 437-439.
12.	劉明政, 吉冰洋, 王古巖, 等.門冬氨酸鉀鎂在冠狀動脈旁路移植術中對心肌的保護作用.中國體外循環雜志, 2008, 6(1): 12-14.
13.	張亮, 卿恩明, 蔡垣星, 等.門冬氨酸鉀鎂與氯化鉀對非停跳冠狀動脈旁路移植術圍術期心律失常作用的比較.心肺血管病雜志, 2009 (3): 159-161.
14.	趙東, 王振國, 李培軍, 等.門冬氨酸鉀鎂對心臟手術患者術后心律失常的預防和治療作用.中國全科醫學, 2010, 13(008): 843-845.
15.	劉醒帥, 趙麗云, 盧家凱, 等.門冬氨酸鉀鎂在不停跳冠狀動脈旁路移植術中對心肌的保護作用.心肺血管病雜志, 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.	甄永蘇.治療腫瘤的抗體靶向藥物.中華腫瘤防治雜志, 2006, 13(22): 1681-1682.
19.	岳峰, 柯永勝, 俞國華, 等.大鼠心肌缺血再灌注損傷對心肌細胞膜Na+-K+-ATP酶亞基基因表達的影響與意義.中國動脈硬化雜志, 2008 (3): 173-177.
20.	朱亞.微創心臟直視手術的術后護理.東南國防醫藥, 2004, (06): 452-453.
21.	黃仕澤, 黃世坤, 趙月波.大劑量門冬氨酸鉀鎂治療心律失常的臨床觀察.瀘州醫學院學報, 1999, 5: 045.
22.	叢悅璽, 駱東峰, 陳坤明, 等.生物鎂離子轉運體研究進展.農業生物技術學報, 2012, 20(7): 837-848.
23.	馮庚.危重癥社區現場急救系列講座——急性心肌梗死合并心律失常的機制和院前急救要點.中國全科醫學, 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.	劉洋, 王利亞, 鄭相慧.門冬氨酸鉀鎂聯合胺碘酮治療冠心病室性心律失常的療效以及對心電圖PR間期和QRS時限的影響.中國老年學雜志, 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.	王麗萍.門冬氨酸鉀鎂對充血性心力衰竭患者室性心律失常的影響.山東醫藥, 2008, 48(7): 63-64.

1. ?朱國勇, 陳勝喜, 羅萬俊, 等.體外循環心臟直視手術后死亡原因探討.實用醫學雜志, 2006, 22(22): 2616-2618.
2. 張遵嚴, 劉先桃, 陳雪芬, 等.體外循環術中監測血鉀濃度的臨床意義.微循環學雜志, 2007, 17(3): 701-701.
3. 向定成, 黎檀實.心血管急危重癥快速診治指南.清華大學出版社有限公司. 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. 鄭慧, 林有光.門冬氨酸鉀鎂在心臟手術中的應用.中華心血管病雜志, 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, 駱璇, 王東進, 等.門冬氨酸鉀鎂在心臟瓣膜置換體外循環術中的心肌保護作用.現代醫學, 2008, 36(6): 437-439.
12. 劉明政, 吉冰洋, 王古巖, 等.門冬氨酸鉀鎂在冠狀動脈旁路移植術中對心肌的保護作用.中國體外循環雜志, 2008, 6(1): 12-14.
13. 張亮, 卿恩明, 蔡垣星, 等.門冬氨酸鉀鎂與氯化鉀對非停跳冠狀動脈旁路移植術圍術期心律失常作用的比較.心肺血管病雜志, 2009 (3): 159-161.
14. 趙東, 王振國, 李培軍, 等.門冬氨酸鉀鎂對心臟手術患者術后心律失常的預防和治療作用.中國全科醫學, 2010, 13(008): 843-845.
15. 劉醒帥, 趙麗云, 盧家凱, 等.門冬氨酸鉀鎂在不停跳冠狀動脈旁路移植術中對心肌的保護作用.心肺血管病雜志, 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. 甄永蘇.治療腫瘤的抗體靶向藥物.中華腫瘤防治雜志, 2006, 13(22): 1681-1682.
19. 岳峰, 柯永勝, 俞國華, 等.大鼠心肌缺血再灌注損傷對心肌細胞膜Na+-K+-ATP酶亞基基因表達的影響與意義.中國動脈硬化雜志, 2008 (3): 173-177.
20. 朱亞.微創心臟直視手術的術后護理.東南國防醫藥, 2004, (06): 452-453.
21. 黃仕澤, 黃世坤, 趙月波.大劑量門冬氨酸鉀鎂治療心律失常的臨床觀察.瀘州醫學院學報, 1999, 5: 045.
22. 叢悅璽, 駱東峰, 陳坤明, 等.生物鎂離子轉運體研究進展.農業生物技術學報, 2012, 20(7): 837-848.
23. 馮庚.危重癥社區現場急救系列講座——急性心肌梗死合并心律失常的機制和院前急救要點.中國全科醫學, 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. 劉洋, 王利亞, 鄭相慧.門冬氨酸鉀鎂聯合胺碘酮治療冠心病室性心律失常的療效以及對心電圖PR間期和QRS時限的影響.中國老年學雜志, 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. 王麗萍.門冬氨酸鉀鎂對充血性心力衰竭患者室性心律失常的影響.山東醫藥, 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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