Hanyok J J, Chow M S, Kluger J, Fieldman A
Department of Pharmacy, Hartford Hospital, CT 06115.
Crit Care Med. 1988 Jul;16(7):691-4. doi: 10.1097/00003246-198807000-00009.
Previous CPR studies from our laboratory have shown that a standard iv dose of lidocaine (2 mg/kg) has a rapid antifibrillatory effect, while a standard dose of bretylium (5 mg/kg) produces a delayed but more pronounced effect. In order to determine the optimal doses, we investigated the antifibrillatory effects of a) high dose bretylium (10 mg/kg) and b) a combination of lidocaine (2 mg/kg) and bretylium (5 mg/kg) during CPR in two groups of anesthetized dogs. Ventricular fibrillation threshold (VFT) was determined using a train method and CPR was performed by a pneumatic device. During both a control and drug phase, the VFT was determined in each dog before CPR, and after each of three consecutive 3-min CPR periods. The combination of lidocaine and bretylium (11 dogs) caused a significant increase in VFT compared to the control phase after each of the 3-min CPR periods and maintained this effect for greater than 2 h. Bretylium 10 mg/kg (eight dogs) significantly elevated the VFT only after the third 3-min CPR period. We conclude that the combination of standard doses of lidocaine and bretylium produces a rapid and prolonged antifibrillatory effect and may be the optimal regimen in the CPR setting. High dose bretylium has a delayed onset of effect and appears to produce no greater effect than standard doses of the drug.
我们实验室之前的心肺复苏研究表明，静脉注射标准剂量的利多卡因（2毫克/千克）具有快速的抗纤颤作用，而标准剂量的溴苄铵（5毫克/千克）则产生延迟但更显著的效果。为了确定最佳剂量，我们在两组麻醉犬的心肺复苏过程中，研究了a）高剂量溴苄铵（10毫克/千克）和b）利多卡因（2毫克/千克）与溴苄铵（5毫克/千克）联合使用的抗纤颤效果。使用序列刺激法测定室颤阈值（VFT），并通过气动装置进行心肺复苏。在对照期和给药期，在每只犬进行心肺复苏前以及连续三个3分钟心肺复苏期的每一期之后测定VFT。利多卡因与溴苄铵联合使用组（11只犬）在每3分钟心肺复苏期后，与对照期相比VFT显著升高，并维持该效果超过2小时。10毫克/千克溴苄铵组（8只犬）仅在第三个3分钟心肺复苏期后VFT显著升高。我们得出结论，标准剂量的利多卡因和溴苄铵联合使用可产生快速且持久的抗纤颤效果，可能是心肺复苏中的最佳方案。高剂量溴苄铵起效延迟，且似乎并不比标准剂量的该药产生更大的效果。
