摘要:
目的 探讨胺碘酮与利多卡因在心脏骤停患者顽固性无脉性室性心动过速或心室颤动中的疗效。方法 计算机检索PubMed、Embase、Cochrane图书馆和Web of Science数据库，检索时限为建库至2024年1月1日，纳入比较利多卡因、胺碘酮或安慰剂治疗心脏骤停过程中心律失常的所有相关研究，采用Meta分析方法比较胺碘酮与利多卡因在心脏骤停中的疗效，主要结局指标为患者出院生存率，次要结局指标为24 h生存率/入院生存率。结果 共纳入3篇随机对照试验（ randomized controlledtrial,RCT）研究和7篇非随机干预性研究。在RCT研究中，相较于安慰剂，胺碘酮可提高患者24 h生存率/入院生存率（ OR=1.32，95% CI： 1.12～1.54）；而在非随机干预性研究中，未见二者存在显著差异（ OR=0.79，95% CI： 0.39～1.61）；在RCT和非随机干预性研究中，胺碘酮均未显著改善患者的出院生存率（ OR=1.19，95% CI： 0.98～1.44； OR=1.14，95% CI： 0.44～2.99）。在非随机干预性研究中，相较于安慰剂，利多卡因既可改善患者24 h生存率/入院生存率（ OR=2.36，95% CI： 1.47～3.80） ，也可改善出院生存率（ OR=2.10，95% CI： 1.21～3.64）；在RCT研究中，相较于胺碘酮，利多卡因并未改善患者24 h生存率/入院生存率（ OR=1.37，95% CI： 0.61～3.06）；而在非随机干预性研究中，利多卡因既可改善患者24 h生存率/入院生存率（ OR=0.72，95% CI： 0.53～0.98），也可改善患者出院生存率（ OR=0.81，95% CI： 0.76～0.87）。结论 关于比较胺碘酮与利多卡因疗效的RCT研究数量有限；在RCT研究中，胺碘酮和利多卡因在改善患者24 h生存率/入院生存率方面无显著差异；而非随机干预性研究中，相较于胺碘酮和安慰剂，利多卡因可提高患者24 h生存率/入院生存率和出院生存率。
Abstract:
Objective To compare the efficacy of amiodarone and lidocaine in cardiac arrest patients with pulseless ventricular tachycardia (pVT) or ventricular fibrillation (VF). Methods The PubMed, Embase, Cochrane Library, and Web of Science databases were searched from its establishment to January 1, 2024. All studies comparing lidocaine, amiodarone, and placebo for cardiac arrest were included. The primary outcome was survival to hospital discharge. Secondary outcomes were 24 h / survival to hospital admission. Results Three RCTs and seven observational studies were included. Compared with placebo, amiodarone improved 24 h /admission survival rate (OR 1.32, 95% CI 1.12-1.54) in RCTs, but this significance was not found in observational studies (OR 0.79, 95% CI 0.39-1.61). In both RCTs and observational studies, amiodarone did not significantly improve discharge survival rate (OR 1.19, 95% CI 0.98- 1.44 and OR 1.14, 95% CI 0.44-2.99). Compared with placebo, lidocaine improved both 24 h /admission survival (OR 2.36, 95% CI 1.47-3.80) and discharge survival (OR 2.10, 95% CI 1.21- 3.64) in observational studies. Lidocaine did not improve 24 h /admission survival rate in RCTs (OR 1.37, 95% CI 0.61-3.06) compared with amiodarone, while in observational studies lidocaine was more effective in both 24 h/admission survival rate (OR 0.72, 95% CI 0.53-0.98) and discharge survival rate (OR 0.81, 95% CI 0.76-0.87). Conclusions The research was limited by the number of included RCTs. In RCTs no significant difference was found between amiodarone and lidocaine in improving 24 h /admission survival rate； in observational studies, lidocaine improved 24 h /admission survival rate and discharge survival rate compared to amiodarone and placebo.
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