Millin Michael G, Kim Samuel, Schmidt Terri A, Daya Mohamud R, Fujisaki Brad
Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, OR, USA.
Prehosp Emerg Care. 2006 Jul-Sep;10(3):403-8. doi: 10.1080/10903120600726023.
To determine the effectiveness and safety, in an emergency medical services setting, of intermittent bolus dosing of lidocaine versus a bolus followed by a drip.
This was a prechange and postchange observational study, following a protocol change. Patients 18 years or older treated with lidocaine for cardiac dysrhythmia were included in the study. Patients were excluded for lidocaine for intubation, cardiac arrest without return of spontaneous circulation, trauma, interhospital transport, and incomplete charts. Patients were divided into two groups. The drip group (January 1, 2002, to January 14, 2003) was treated with lidocaine 1.0-1.5 mg/kg intravenous bolus up to 3 mg/kg until the dysrhythmia resolved and then a 2-4 mg/min drip. The bolus group (January 15, 2003 to December 31, 2003) was treated with lidocaine 1.5 mg/kg intravenous bolus, followed by 0.75 mg/kg bolus every five minutes up to 3 mg/kg until the dysrhythmia resolved; once the dysrhythmia resolved, intermittent boluses of 0.75 mg/kg every 10 minutes were adminstered. Outcome variables studied were maintenance of rhythm of nonventricular origin, occurrence of complications, and adherence to written protocols. Complications considered were seizures, respiratory depression, and cardiac arrest.
The study included 146 patients in the drip group and 113 patients in the bolus group. Overall, 119 of 146 patients (81.5%) in the drip group and 101 of 113 patients (89.3%) in the bolus group maintained a rhythm of nonventricular origin (p = 0.079). There was no statistical difference between the two groups in complications or protocol variance: one of 146 patients (0.7%) in the drip group and one of 113 patients (0.9%) in the bolus group had a serious complication; 64 of 146 patients (43.8%) in the drip group and 54 of 113 patients (47.8%) in the bolus group had a protocol variance.
Intermittent bolus dosing protocol was associated with an equivalent effectiveness in maintaining rhythms of nonventricular origin without an increase in complications.
在紧急医疗服务环境中，确定间歇性推注利多卡因与先推注后滴注相比的有效性和安全性。
这是一项在方案变更后进行的变更前和变更后观察性研究。纳入18岁及以上因心律失常接受利多卡因治疗的患者。排除因插管、无自主循环恢复的心脏骤停、创伤、院间转运及病历不完整而使用利多卡因的患者。患者分为两组。滴注组（2002年1月1日至2003年1月14日）先静脉推注1.0 - 1.5mg/kg利多卡因，最大剂量3mg/kg，直至心律失常得到缓解，然后以2 - 4mg/min的速度滴注。推注组（2003年1月15日至2003年12月31日）先静脉推注1.5mg/kg利多卡因，随后每5分钟推注0.75mg/kg，最大剂量3mg/kg，直至心律失常缓解；一旦心律失常缓解，每10分钟间歇性推注0.75mg/kg。研究的结果变量为维持非室性起源的心律、并发症的发生及对书面方案的依从性。所考虑的并发症包括癫痫发作、呼吸抑制和心脏骤停。
研究包括滴注组146例患者和推注组113例患者。总体而言，滴注组146例患者中的119例（81.5%）和推注组113例患者中的101例（89.3%）维持了非室性起源的心律（p = 0.079）。两组在并发症或方案差异方面无统计学差异：滴注组146例患者中的1例（0.7%）和推注组113例患者中的1例（0.9%）发生严重并发症；滴注组146例患者中的64例（43.8%）和推注组113例患者中的54例（47.8%）存在方案差异。
间歇性推注给药方案在维持非室性起源心律方面具有同等有效性，且并发症未增加。
