摘要目的 观察硫酸镁和葡萄糖酸钙在低剂量芬太尼麻醉中对心脏瓣膜置换术患者心房颤动（房颤）转复的影响。方法200例美国麻醉医师协会Ⅱ～Ⅲ级、术前伴有房颤的心脏瓣膜置换术患者，随机均分为2组：低剂量芬太尼组（Ⅰ组）：芬太尼5～7 μg/kg和2.5～10.0.μg/kg分别用于麻醉诱导和麻醉维持；低剂量芬太尼复合镁、钙组（Ⅱ组）。麻醉诱导和维持同Ⅰ组，体外循环前收缩压稍高于基础值时分次给予硫酸镁（总量50 mg/kg）；主动脉开放后如心电图出现结性或窦性心动过缓(心率＜60次/min)分次静脉注射葡萄糖酸钙1～3g。记录停机(T1)、送入ICU(T2)和出院时(T3)的心律、窦性心律的维持时间，停机后血Mg2+和Ca2+浓度。结果 Ⅱ组停机后血Mg2+、Ca2+浓度为(0.9±0.2) mmol/L和(1.6±0.29) mmol/L，显著高于Ⅰ组[(0.6±0.1)mmol/L和(1.2±0.2)mmol/L]，差异有统计学意义(P＜0.05)。Ⅰ组在T1和T3时窦性心律患者的发生率分别为75％和20％，而Ⅱ组分别为82％和23％，两组差异有统计学意义(P＜0.05)。两组窦性心律的维持时间为(51.0±31.1)h和(52.0±28.9)h，差异无统计学意义（P＞0.05）。T3时两组窦性心律患者的左心房内径均显著小于同组房颤患者，差异有统计学意义（P＜0.05）；窦性心律患者的左心房内径Ⅱ组稍大于Ⅰ组，差异无统计学意义(P＞0.05)。结论 心脏瓣膜置换术中低剂量芬太尼麻醉复合钙、镁有助于提高术后房颤的转复，左心房小的患者效果更显著。

abstractsObjective To evaluate the effect of low dose of fentanyl combined with magnesium sulfate and calcium gluconate on the conversion of atrial fibrillation (AF) in patients with valve replacement. Methods There were 200 patients with AF who underwent valve replacement with the cardiac function of American Society of Anesthesiologists Class Ⅱ or Class Ⅲ. The patients were randomly divided into two groups, 100 in each group. Low dose group (group Ⅰ ) , anesthesia was induced by fentanyl 5 ～ 7 μg/kg, and maintained with fentanyl 2. 5 ～ 10. 0μg/kg. Low dose of fentanyl combined with calcium and magnesium group (group Ⅱ ) ,the peri-operational anesthesia was the same in both groups, a special management applied: magnesium sulfate was given during operation when the blood pressure was higher than baseline, up to total dose of 50 mg/kg; after clamp off, calcium gluconate 1 ～ 3 g were given when sinus or junctional rhythm less than 60 beat/min. The cardiac rhythm was recorded and compared at different periods as wean from the cardiac pulmonary bypass(CPB)(T1), arriving to ICU (T2 )and discharge from hospital( T3 ). The lasting time of sinus rhythm was also analyzed in both groups. The blood concentrations of Mg2+ and Ca2+ were recorded after wean of CPB. Results The blood concentrations of Mg2+and Ca2+ in group Ⅱ [(0. 9±0. 2) mmol/L and ( 1.6±0. 29) mmol/L]were higher than that in group Ⅰ [(0. 6±0. 1 ) mmoL/L and ( 1.2±0. 2) mmol/L],P＜0. 05. At the time period of wean from CPB and discharge from hospital,the ratios of sinus rhythm in group Ⅰ and group Ⅱ were 75％ ,20％,and 82％ ,23％, respectively,P＜0. 05 respectively. The lasting times of sinus rhythm in group Ⅰ and Ⅱ were 51 ±31.1 and 52±28.9 hour. At the time of arriving to ICU ,in both groups,the left atrial diameter in patients of sinus rhythm was significantly smaller than that in patients of AF,P＜0. 05 respectively. Conclusion Low dose of fentanyl anesthesia combined with magnesium and calcium can further improve conversion rate of AF in patients with valve replacement. The patients with the smaller left atrium diameter, might have the better AF conversion.