摘要
Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
目的:系统评估胺碘酮、利多卡因或安慰剂对心脏手术中主动脉结扎松解(ACC)后再灌注性室颤(VF)发生的影响。创新点:胺碘酮、利多卡因对于预防ACC后再灌注VF的效果,目前相关的随机对照试验(RCTs)并无统一的结论,本研究综合之前RCTs进行荟萃分析。方法:遵循PRISMA和Cochrane系统评估手册对PubMed、EMBASE及Cochrane进行文献检索(图1),荟萃分析符合要求的RCTs。结论:当前的证据表明胺碘酮和利多卡因在开胸心脏手术中预防再灌注VF的效果两者之间并无显著差异,但均明显优于安慰剂;在随后需要电除颤的患者的比例上,胺碘酮、利多卡因及安慰剂三者间无统计学差异。
