MacMahon S, Collins R, Peto R, Koster R W, Yusuf S
Nuffield Department of Clinical Medicine, Radcliffe Infirmary, University of Oxford, England.
JAMA. 1988 Oct 7;260(13):1910-6.
The effects of prophylactic lidocaine hydrochloride on early ventricular fibrillation and death in patients with suspected acute myocardial infarction were investigated in an overview of 14 randomized trials. During follow-up intervals of one to four hours in the trials of intramuscular lidocaine infusion (6961 patients) and 24 to 48 hours in the trials of intravenous lidocaine injection (2194 patients), a total of 103 cases of ventricular fibrillation and 137 deaths were recorded. Overall, allocation to lidocaine was associated with a reduction in the odds of ventricular fibrillation of about one third, with a 95% confidence interval that ranged from a 3% to a 56% reduction. There was no evidence of any beneficial effect on early mortality; indeed, the odds of early death were about one third greater among patients allocated lidocaine, though this difference was not statistically significant (95% confidence interval, 2% reduction to 95% increase). Because of the small numbers of reported events, the short follow-up periods, and the unavailability of data for some specific causes of death, even an overview of all the trial results does not provide good evidence as to whether prophylactic lidocaine is likely to be helpful or harmful. To answer this question reliably, future trials will need to involve large numbers of patients and prolonged follow-up.
在一项对14项随机试验的综述中，研究了预防性使用盐酸利多卡因对疑似急性心肌梗死患者早期心室颤动和死亡的影响。在肌肉注射利多卡因试验（6961例患者）的1至4小时随访期以及静脉注射利多卡因试验（2194例患者）的24至48小时随访期内，共记录到103例心室颤动和137例死亡。总体而言，分配到利多卡因组与心室颤动几率降低约三分之一相关，95%置信区间为降低3%至56%。没有证据表明对早期死亡率有任何有益影响；实际上，分配到利多卡因组的患者早期死亡几率约高约三分之一，尽管这一差异无统计学意义（95%置信区间，降低2%至增加95%）。由于报告事件数量少、随访期短以及某些特定死因的数据无法获取，即使对所有试验结果进行综述也不能很好地证明预防性使用利多卡因是有益还是有害。为了可靠地回答这个问题，未来的试验需要纳入大量患者并进行长期随访。
