Manolis A S, Smith E, Payne D, Rastegar H, Cleveland R, Estes N A
Department of Medicine, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts 02111.
Clin Cardiol. 1990 Mar;13(3):177-81. doi: 10.1002/clc.4960130306.
To compare the therapeutic efficacy and safety of intravenous tocainide with that of intravenous lidocaine in patients with ventricular arrhythmias after cardiac surgery, 25 patients were randomized to either agent in a double-blind manner. Tocainide was given in 16 patients as a 250 mg bolus followed by a loading infusion of 500 mg over 15 minutes and a maintenance infusion of 33.3 mg/min. Lidocaine was administered in 9 patients as a 100 mg bolus followed by a loading infusion of 60 mg over 15 minutes and a maintenance infusion of 1.4 mg/min. Therapy was continued for 24 hours in initially responding patients. With analysis of 24-h taped electrocardiograms it was found that single premature ventricular complexes (PVCs) were suppressed by tocainide by more than 80% in 94% of patients and by lidocaine in 75% of patients (p = NS). Couplets and ventricular tachycardia events were eliminated in all patients by either drug. Multiform PVCs were abolished in 94% of the patients after tocainide and in 75% after lidocaine (p = NS). Average overall success over the 24 hours with more than 80% suppression of single PVCs and simultaneous elimination of higher forms of arrhythmia was 71% with tocainide and 59% with lidocaine (p = NS). Adverse effects were negligible, with only one patient in the lidocaine group developing diaphoresis without necessitating termination of therapy. Treatment rapidly produced and then maintained blood levels of 4-10 mg/l for tocainide and 1-4 mg/l for lidocaine. We conclude that intravenous tocainide is well tolerated and has comparable efficacy to lidocaine in the acute therapy of postcardiac surgery ventricular arrhythmias.
为比较静脉注射妥卡尼与静脉注射利多卡因对心脏手术后室性心律失常患者的治疗效果及安全性，25例患者以双盲方式随机分为两组，分别接受这两种药物治疗。16例患者接受妥卡尼治疗，先静脉推注250mg，随后在15分钟内静脉滴注500mg进行负荷输注，维持输注速度为33.3mg/分钟。9例患者接受利多卡因治疗，先静脉推注100mg，随后在15分钟内静脉滴注60mg进行负荷输注，维持输注速度为1.4mg/分钟。初始有反应的患者持续治疗24小时。通过分析24小时的心电图记录发现，妥卡尼可使94%的患者单形室性早搏（PVC）抑制率超过80%，利多卡因可使75%的患者达到这一效果（P值无统计学意义）。两种药物均可消除所有患者的成对室性早搏和室性心动过速事件。妥卡尼治疗后94%的患者多形性PVC消失，利多卡因治疗后这一比例为75%（P值无统计学意义）。在24小时内，单形PVC抑制率超过80%且同时消除更高形式心律失常的总体平均成功率，妥卡尼为71%，利多卡因为59%（P值无统计学意义）。不良反应可忽略不计，仅利多卡因组有1例患者出现出汗，但无需终止治疗。治疗后迅速达到并维持妥卡尼血药浓度为4 - 10mg/L，利多卡因血药浓度为1 - 4mg/L。我们得出结论，静脉注射妥卡尼耐受性良好，在心脏手术后室性心律失常的急性治疗中与利多卡因疗效相当。
