Warren J V, Lewis R P
Am J Cardiol. 1976 Jan;37(1):68-72. doi: 10.1016/0002-9149(76)90501-4.
The current widespread interest in early (pre-hospital) coronary care has raised questions regarding the safety and efficacy of the use of atropine in these circumstances. Although reports from early coronary care systems have been favorable, serious questions of safety have been raised on the basis of experimental animal studies and isolated case reports. A sample of the experience of a large scale emergency coronary care system in Columbus, Ohio has therefore been reviewed. A group of 70 patients who, during the early phases of myocardial infarction, exhibited bradyarrhythmia (less than 60 beats/min) was identified. When this group was further categorized on the basis of arterial pressure at the time of initial observation, patients with normal or elevated blood pressure had low mortality rates whether treated with atropine or not. In patients with hypotension the mortality rate was 75 percent without therapy, and 25 percent with therapy. Indeed, when normal hemodynamics were restored, the mortality rate was only 11 percent. Unexpected ventricular fibrillation occurred in 1 of 45 treated patients and 2 of 25 untreated patients. Although the study was not controlled, the data strongly suggest that atropine is both beneficial and safe for use in treating bradyarrhythmia and hypotension in the early phase of acute myocardial infarction.
目前对早期（院前）冠心病护理的广泛关注引发了关于在这些情况下使用阿托品的安全性和有效性的问题。尽管早期冠心病护理系统的报告是积极的，但基于实验动物研究和个别病例报告，人们对其安全性提出了严重质疑。因此，对俄亥俄州哥伦布市一个大型紧急冠心病护理系统的经验样本进行了回顾。确定了一组70例在心肌梗死早期出现缓慢性心律失常（心率低于60次/分钟）的患者。当根据初次观察时的动脉压对该组患者进一步分类时，血压正常或升高的患者无论是否接受阿托品治疗，死亡率都很低。低血压患者未经治疗的死亡率为75%，接受治疗的死亡率为25%。事实上，当恢复正常血流动力学时，死亡率仅为11%。45例接受治疗的患者中有1例发生意外心室颤动，25例未接受治疗的患者中有2例发生意外心室颤动。尽管该研究没有进行对照，但数据强烈表明，阿托品用于治疗急性心肌梗死早期的缓慢性心律失常和低血压既有益又安全。
