Chamberlain D A
Cardiology. 1987;74 Suppl 2:10-23. doi: 10.1159/000174283.
Progress in understanding the epidemiology and mechanism of sudden cardiac death (SCD) has been rapid over the past two decades. This, together with the availability of drugs with actions that potentially may counter the pathophysiology of sudden death, has led to myriad trials aimed at prolonging life for high-risk individuals. European countries have contributed a major share both to the development of these drugs and to subsequent tests of their efficacy. Ventricular fibrillation (VF), either unheralded or secondary to fresh myocardial ischemia, is by far the most common cause of SCD. The classes of drugs with profiles that might be expected to influence the occurrence of VF directly are antiarrhythmics, calcium channel blockers, platelet-active agents, and beta-adrenoceptor antagonists. Twenty-four of the European trials that employed agents from these groups have special significance because of their design and size. Studies of two of the calcium channel blockers have not demonstrated any life-saving potential to date. One platelet-active agent - aspirin - has shown favorable trends. Results with the use of antiarrhythmic agents have been disappointing, probably because their adverse effects, including arrhythmogenesis in some patients, have countered the antiarrhythmic effects that other patients have achieved. Nevertheless, evidence suggests that lidocaine can reduce the incidence of VF; this can reasonably be equated with life-saving potential whenever defibrillation is not available. Trials with beta-blocking drugs have been the most encouraging; seven of the 11 trials that have been considered demonstrated a significant reduction in sudden death, which was variously defined, and a strong trend toward reduction was observed with another. None of the trials showed an unfavorable trend. The results of completed trials now offer practical guidance to physicians with responsibility for the care of patients with ischemic heart disease, especially those who have features that indicate high risk.
在过去二十年中，对心脏性猝死（SCD）的流行病学和机制的理解取得了迅速进展。这一点，再加上有一些药物可能具有对抗猝死病理生理过程的作用，导致了无数旨在延长高危个体生命的试验。欧洲国家在这些药物的研发以及随后的疗效测试中都做出了重大贡献。心室颤动（VF），无论是无前兆的还是继发于新鲜心肌缺血的，都是迄今为止SCD最常见的原因。可能预期会直接影响VF发生的药物类别包括抗心律失常药、钙通道阻滞剂、血小板活性药物和β肾上腺素能受体拮抗剂。欧洲进行的24项使用这些药物组药物的试验因其设计和规模具有特殊意义。目前，对两种钙通道阻滞剂的研究尚未显示出任何挽救生命的潜力。一种血小板活性药物——阿司匹林——已显示出有利的趋势。抗心律失常药物的使用结果令人失望，可能是因为它们的不良反应，包括一些患者发生心律失常，抵消了其他患者所获得的抗心律失常作用。尽管如此，有证据表明利多卡因可以降低VF的发生率；在无法进行除颤的情况下，这可以合理地等同于挽救生命的潜力。β受体阻滞剂的试验最令人鼓舞；在11项被考虑的试验中，有7项显示猝死显著减少，猝死的定义各不相同，另一项试验也观察到了明显的减少趋势。没有一项试验显示出不利趋势。现已完成的试验结果为负责护理缺血性心脏病患者的医生，尤其是那些具有高风险特征的患者，提供了实际指导。
