Noneman J W, Rogers J F
Medicine (Baltimore). 1978 Nov;57(6):501-15. doi: 10.1097/00005792-197811000-00002.
Primary ventricular fibrillation (PVF) occurs in approximately 3--10% of uncomplicated acute myocardial infarction (AMI) patients. The major reason for this variability in incidence appears to be population diferences in the time from symptom onset to admission. Other risk factors have not been consistently shown to influence the risk of PVF. Warning arrhythmias do not warn of impending PVF in from 20--80% of AMI patients; thus, antiarrhythmic therapy reserved for those with warning arrhythmias may fail to prevent PVF in a significant number of patients. Although a review of 13 controlled trials of lidocaine prophylaxis shows only two suggesting a protective effect from this drug, only one study was free of major defects in trial design. This trial showed a striking decrease in PVF incidence when lidocaine was employed. Lidocaine should probably be administered to all uncomplicated AMI patients during the first 48 hours after infarction. Its utility in preventing ventricular fibrillation in complicated AMI patients and in the very early AMI period is unclear.
原发性心室颤动（PVF）发生在大约3%-10%的无并发症急性心肌梗死（AMI）患者中。发病率存在这种差异的主要原因似乎是从症状发作到入院的时间存在人群差异。尚未一致表明其他危险因素会影响PVF的风险。在20%-80%的AMI患者中，预警心律失常并不能预示即将发生PVF；因此，为有预警心律失常的患者保留的抗心律失常治疗可能无法在大量患者中预防PVF。尽管对13项利多卡因预防性对照试验的综述显示只有两项试验表明该药物有保护作用，但只有一项研究在试验设计中没有重大缺陷。该试验表明使用利多卡因时PVF发病率显著降低。利多卡因可能应该在梗死发生后的头48小时内给予所有无并发症的AMI患者。其在预防复杂AMI患者和极早期AMI患者心室颤动方面的效用尚不清楚。
