Rinne T, Kaukinen S
Department of Anaesthesia and Intensive Care, Tampere University Hospital, Finland.
Acta Anaesthesiol Scand. 1998 Sep;42(8):936-40. doi: 10.1111/j.1399-6576.1998.tb05353.x.
Lidocaine has been used as the primary antiarrhythmic agent for ventricular arrhythmias during acute myocardial infarction (MI) and open heart surgery. Its cardioprotective effects have been studied in experimental settings and also during angioplastic reperfusion and coronary revascularisation. The basic mechanism of action, probably also involved with cardioprotection, has been demonstrated to be blockade of cardiac sodium channels. In this open study we investigated the contribution of continuous lidocaine infusion to cardioprotection during coronary revascularisation with blood cardioplegia.
During coronary revascularisation with cold blood cardioplegia, a study group of 50 patients received a prophylactic lidocaine infusion for 20 h started with a bolus dose before aortic clamping; another group of 50 patients without the infusion served as a control group. Serum troponin T concentration, serum creatine kinase MB activity and electrocardiography were the main parameters recorded.
Serial measurement of Troponin T (P = 0.06) and CK-MB values: (P = 0.09) were slightly lower in the lidocaine group, but the differences were not statistically significant.
Lacking statistically significant evidence of improved cardioprotection, lidocaine infusion cannot be recommended as a routine treatment during coronary revascularisation.
利多卡因一直被用作急性心肌梗死（MI）和心脏直视手术期间室性心律失常的主要抗心律失常药物。其心脏保护作用已在实验环境中以及血管成形术再灌注和冠状动脉血运重建过程中得到研究。已证实其基本作用机制可能也与心脏保护有关，即阻断心脏钠通道。在这项开放性研究中，我们调查了在冷血心脏停搏液冠状动脉血运重建过程中持续输注利多卡因对心脏保护的作用。
在冷血心脏停搏液冠状动脉血运重建过程中，一个由50名患者组成的研究组在主动脉钳夹前先给予一次推注剂量，然后持续输注利多卡因20小时；另一组50名未输注利多卡因的患者作为对照组。记录的主要参数为血清肌钙蛋白T浓度、血清肌酸激酶MB活性和心电图。
利多卡因组肌钙蛋白T（P = 0.06）和肌酸激酶MB值（P = 0.09）的系列测量值略低，但差异无统计学意义。
由于缺乏改善心脏保护的统计学显著证据，不建议在冠状动脉血运重建期间将输注利多卡因作为常规治疗。
