DOI QR코드

DOI QR Code

Antiinflammatory and Myocardial Protective Effects of Magnesium in Patents Undergoing Valvular Heart Surgery

심장판막 수술 시 마그네슘의 항염증 및 심근보호 효과

  • Moon, Seong-Min (Laboratory of Cardiopulmonary Bypass, Department of Thoracic and Caridovascular Surgery, Dong-A University) ;
  • Kang, Shin-Beum (Department of Ocean Physical Education College of Ocean Science & Technology) ;
  • Hyun, Kyung-Yae (Department of Biomedical Laboratory of Science, Inje University) ;
  • Choi, Seok-Cheol (Department of Clinical Laboratory Science, College of Health Science, Catholic University of Pusan)
  • 문성민 (동아대학교 의과대학 흉부외과 체외순환연구실) ;
  • 강신범 (한국해양대학교 해양과학기술대학 해양체육학과) ;
  • 현경예 (인제대학교 식의약대학 임상병리학과) ;
  • 최석철 (부산가톨릭대학교 보건과학대학 임상병리학과)
  • Published : 2007.11.30

Abstract

We have investigated whether the supplement of magnesium to cold blood cardioplegia improves myocardial protection. Sixty patients scheduled for elective valvular heart surgery were randomly assigned to a control group (n=30) which received conventional cold blood cardioplegia and an Mg group (n=30) which received cold blood cardioplegia supplemented with 2 g of magnesium sulfate. Electrolytes levels including $Mg^{++}$, hematological and biochemical variables, cytokines, myocardial marker levels, and postoperative outcomes were compared between two groups before, during or idler operation. $Mg^{++}\;and\;Ca^{++}$ levels in the Mg group were higher than those of the control group after surgery. The total WBC counts, CK-MB, troponin-I and Interleukin-6 levels in the Mg group were lower than those of the control group after surgery. Postoperative incidence of atrial fibrillation was lower in the Mg group compared with the control group. These results showed that $Mg^{++}$ attenuated inflammatory reaction, myocardial damage, and hypomagnesemia during valvular surgery and reduced postoperative arrhythmia incidence without side effects.

연구저자들은 심장판막 수술 환자를 대상으로 냉각 혈액 심정지액에 마그네슘 첨가(2 g)의 효과를 실험하였다. 수술동안 및 후의 $Mg^{++}$ 농도와 $Ca^{++}$ 농도는 마그네슘군이 대조군보다 유의하게 더 높았다. 수술 후 시기에 총 백혈구 수, CK-MB, troponin-I, interleukin-6의 농도는 마그네슘군이 대조군보다 유의하게 더 낮았다. 수술 후 심방세동 발생률 역시 마그네슘군이 대조군보다 유의하게 더 낮았다. 본 연구의 결과들은 심장수술 시 심정지액에 대한 일정량의 마그네슘 첨가가 특별한 부작용 없이 저마그네슘혈증, 전신염증반응, 심방세동의 발생률을 줄이고 심근보호 효과 역시 가져다줌을 시사하고 있다.

Keywords

References

  1. Aglio, L. S., G. G. Stanford and R. Maddi. 1991. Hypomagnesemia is common following cardiac surgery. J. Cardiothorac. Anesth. 5, 201-208. https://doi.org/10.1016/1053-0770(91)90274-W
  2. Altura, B. M. 1994. Importance of Mg in physiology and medcine and the need for ion-selective electrodes. Scand. J. Clin. Lab. Invest 217, 5-9.
  3. Ataka, K., D. Chen, J. McCully, S. Levistsky and H. Feinberg. 1993. Magnesium cardioplegia prevents accumulation of cytosolic calcium in the ischemic myocardium. J. Mol. cell Cariol. 25, 1387-1390. https://doi.org/10.1006/jmcc.1993.1155
  4. Caputo, M., A. J. Bryan, A. M. Calafiore, M. S. Suleiman and G. D. Angelini. 1998. Intermittent antegrade hyperlaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery. European Journal of Cardio-thoracic Surgery 14, 596-601. https://doi.org/10.1016/S1010-7940(98)00247-4
  5. Caspi, J., E. Rudis, I. Bar, T. Safadi and M. Saute. 1995. Effects of magnesium on myocardial function after coronary artery bypass grafting. Ann. Thorac. Surg. 59, 942-947 https://doi.org/10.1016/0003-4975(95)00050-U
  6. Dacey, M. J. 2001. Hypomagnesemic disorders. Crit. Care Clin. 17, 155-173. https://doi.org/10.1016/S0749-0704(05)70157-3
  7. Dichtl, A and W. Vierling. 1991. Inhibition by magnesium of calcium inward current in heart ventricular muscle. Eur. J. Pharmacol. 204, 243-248. https://doi.org/10.1016/0014-2999(91)90848-K
  8. England, M. R., G. Gordon and M. Salem. 1992. Magnesium administration and dysrhythmias after cardiac surgery: a placebo-controlled, double-blind, randomized trial. JAMA. 268, 2935-2940. https://doi.org/10.1001/jama.268.20.2935
  9. Fanning, W. J., C. S. Thomas, A. Roach, R. Tomicheck, W. C. Alford and W. S. Stoney. 1991. Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann. Thorac. Surg. 52, 529-533. https://doi.org/10.1016/0003-4975(91)90918-G
  10. Gries, A., C. Bode and S. Gross. 1999. The effect of intravenously administered magnesium on platelet function in patients after cardiac surgery. Anesth. Analg. 88, 1213-1219. https://doi.org/10.1097/00000539-199906000-00005
  11. Karmy-Jones, R., A. Hamilton, V. Dzavik, M. Allegreto, B. A. Finegan and A. Koshal. 1995. Magnesium sulfate prophylaxis after cardiac operations. Ann. Thorac. Surg. 55, 502-507.
  12. Kohno, H., T. Koyanagi, H. Kasegawa and M. Miyazaki. 2005. Three day magnesium administration prevents atrial fibrillation after coronary artery bypass grafting. Ann. Thorac. Surg. 79, 117-126. https://doi.org/10.1016/j.athoracsur.2004.06.062
  13. Repke, J. T., S. A. Friedman, and P. W. Kaplan. 1992. Prophylaxis of eclamptic seizures: Current controversies. Clin. Obstet. Gynecol. 35, 365-374. https://doi.org/10.1097/00003081-199206000-00017
  14. Seeling, M. S., R. J. Elin and E. M. Antman. 1998. Magnesium in acute myocardial infaction: Still an open question. Can. J. Cardiol. 14, 745-749.
  15. Toraman, F., H. Karabulut, C. Alhan, S. Dağdelen and S. Tarcan. 2001. Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting. Ann. Thorac. Surg. 72, 1256-1262. https://doi.org/10.1016/S0003-4975(01)02898-3
  16. Weglicki, W. B., T. M. Phillips and A. M. Fredman. 1992. Magnesium deficiency elevate circulatory levels of inflammatory cytokines and endothelin. Mol. Cell Biochem. 110, 169-173. https://doi.org/10.1007/BF02454195