Hargarten K, Chapman P D, Stueven H A, Waite E M, Mateer J R, Haecker P, Aufderheide T P, Olson D W
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee.
Ann Emerg Med. 1990 Nov;19(11):1274-9. doi: 10.1016/s0196-0644(05)82287-5.
The purpose of our study was to determine the morbidity and mortality in initially stable patients presenting to paramedics with chest pain; to examine possible beneficial effects of its use, including reduction of sudden death syndrome in the prehospital and emergency department setting; and to determine if prophylactic lidocaine is associated with adverse effects in this patient population.
This was a randomized, prospective study using prophylactic lidocaine in patients complaining of chest pain who presented to our paramedic system between January 1984 and January 1988.
All patients aged 18 years or older with chest pain of suspected cardiac origin who presented to paramedics during the study period were included. Excluded were patients presenting with warning arrhythmias, second- or third-degree heart block, bradycardias of less than 50, hypotension of less than 90 mm Hg systolic, or known allergy to lidocaine.
Patients were randomized into two groups, the lidocaine-treated group and the control group. An initial bolus of 1 mg/kg IV lidocaine was administered to the lidocaine-treated group. A simultaneous 2 mg/min IV drip was established. Ten minutes after the first dose of lidocaine, a second bolus of 0.5 mg/kg was administered.
During the study period, 1,427 patients were entered; 704 received lidocaine, and 723 did not. Discharge diagnoses included acute myocardial infarction (31%), unstable angina (33%), other cardiac problems (7%), and noncardiac problems (29%); overall mortality rate was 7.4%. There was an equal distribution of deaths between the lidocaine-treated group (57) and the control group (48). Six patients had a cardiac arrest in the prehospital setting, and 15 had a cardiac arrest in the ED. Malignant ventricular arrhythmias as the precipitating arrest rhythm in patients with acute myocardial infarctions were similar for the lidocaine-treated and control groups. The incidence of adverse effects, including hypotension, bradycardias, second- or third-degree heart blocks, tinnitus, and altered mental status, was similar in both groups.
There are no benefits from the administration of prehospital prophylactic lidocaine in stable patients with chest pain; therefore, routine use in this setting appears unwarranted.
我们研究的目的是确定最初病情稳定的胸痛患者呼叫护理人员后的发病率和死亡率；研究其使用可能产生的有益效果，包括在院前和急诊科环境中降低猝死综合征的发生率；并确定预防性利多卡因在该患者群体中是否会产生不良反应。
这是一项随机、前瞻性研究，对1984年1月至1988年1月期间向我们的护理系统主诉胸痛的患者使用预防性利多卡因。
纳入所有在研究期间呼叫护理人员的、年龄在18岁及以上且胸痛疑似心脏源性的患者。排除有警示性心律失常、二度或三度心脏传导阻滞、心率低于50次/分钟的心动过缓、收缩压低于90 mmHg的低血压或已知对利多卡因过敏的患者。
患者被随机分为两组，利多卡因治疗组和对照组。给利多卡因治疗组静脉注射初始剂量为1 mg/kg的利多卡因。同时建立2 mg/分钟的静脉滴注。在首次注射利多卡因10分钟后，给予第二次剂量为0.5 mg/kg的推注。
在研究期间，共纳入1427例患者；704例接受了利多卡因治疗，723例未接受。出院诊断包括急性心肌梗死（31%）、不稳定型心绞痛（33%）、其他心脏问题（7%）和非心脏问题（29%）；总死亡率为7.4%。利多卡因治疗组（57例）和对照组（48例）的死亡分布相同。6例患者在院前发生心脏骤停，15例在急诊科发生心脏骤停。利多卡因治疗组和对照组中，急性心肌梗死患者因恶性室性心律失常作为心脏骤停的诱发节律情况相似。两组不良反应的发生率相似，包括低血压、心动过缓、二度或三度心脏传导阻滞、耳鸣和精神状态改变。
对于病情稳定的胸痛患者，院前预防性使用利多卡因并无益处；因此，在此情况下常规使用似乎没有必要。
