胺碘酮与利多卡因在心脏骤停患者中的疗效比较:系统综述与Meta分析  

Comparative Efficacy of Amiodarone and Lidocaine in Patients with Cardiac Arrest:A Systematic Review and Meta⁃analysis

作　　者：李直懋 王丹頔 张挺 梅琦敏 刘业成[1,3,4] 朱华栋 LI Zhimao;WANG Dandi;ZHANG Ting;MEI Qimin;LIU Yecheng;ZHU Huadong(Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Graduate School,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Health Care,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院急诊科,北京100730 [2]中国医学科学院北京协和医学院研究生院,北京100730 [3]中国医学科学院北京协和医院疑难重症及罕见病国家重点实验室,北京100730 [4]中国医学科学院北京协和医院保健医疗部,北京100730

出　　处：《协和医学杂志》2025年第2期406-415,共10页Medical Journal of Peking Union Medical College Hospital

基　　金：中央高水平医院临床科研专项(2022-PUMCH-B-110);中国医学科学院医学与健康科技创新工程(2023-I2M-C&T-B-025)。

摘　　要：目的探讨胺碘酮与利多卡因在心脏骤停患者中的疗效。方法计算机检索PubMed、Embase、Cochrane Library和Web of Science数据库,检索时限为建库至2024年1月1日,纳入比较利多卡因、胺碘酮或安慰剂治疗心脏骤停过程中心律失常(顽固性无脉性室性心动过速或心室颤动)的所有相关研究,采用Meta分析方法比较胺碘酮与利多卡因在心脏骤停中的疗效,主要结局指标为患者出院生存率,次要结局指标为24 h生存率/入院生存率。结果共纳入3篇随机对照试验(randomized controlled trial,RCT)研究和7篇非随机干预性研究。在RCT研究中,相较于安慰剂,胺碘酮可提高患者24 h生存率/入院生存率(OR=1.32,95%CI:1.12~1.54);而在非随机干预性研究中,未见二者存在显著差异(OR=0.79,95%CI:0.39~1.61)。在RCT和非随机干预性研究中,相较于安慰剂,胺碘酮均未改善患者的出院生存率(OR=1.19,95%CI:0.98~1.44;OR=1.14,95%CI:0.44~2.99)。在非随机干预性研究中,相较于安慰剂,利多卡因既可改善患者24 h生存率/入院生存率(OR=2.36,95%CI:1.47~3.80),也可改善出院生存率(OR=2.10,95%CI:1.21~3.64)。在RCT研究中,未发现胺碘酮与利多卡因在改善患者24 h生存率/入院生存率方面存在显著差异(OR=1.37,95%CI:0.61~3.06);而在非随机干预性研究中,胺碘酮在改善患者24 h生存率/入院生存率(OR=0.72,95%CI:0.53~0.98)和出院生存率(OR=0.81,95%CI:0.76~0.87)方面均劣于利多卡因。结论关于比较胺碘酮与利多卡因疗效的RCT研究数量有限;在RCT研究中,胺碘酮与利多卡因在改善患者24 h生存率/入院生存率方面无显著差异;而在非随机干预性研究中,相较于胺碘酮和安慰剂,利多卡因可提高患者24 h生存率/入院生存率和出院生存率。Objective To investigate the efficacy of amiodarone and lidocaine in cardiac arrest patients.Methods We searched the PubMed,Embase,Cochrane Library,and Web of Science databases through to Jan⁃uary 1,2024.All studies comparing lidocaine,amiodarone,and placebo for cardiac arrest were included.Meta⁃a⁃nalysis was performed,and the primary outcome was survival to hospital discharge.Secondary outcomes was sur⁃vival to 24 h or hospital admission.Results Three RCTs and seven non⁃randomized intervention studies were in⁃cluded.Compared with placebo,amiodarone can improve the likelihood of survival to 24 h/hospital admission(OR=1.32,95%CI:1.12-1.54)in RCTs,while this significance was not found in non⁃randomized interven⁃tion studies(OR=0.79,95%CI:0.39-1.61).In both RCTs and non⁃randomized intervention studies,amioda⁃rone did not significantly improve discharge survival rate compared with placebo(OR=1.19,95%CI:0.98-1.44 and OR=1.14,95%CI:0.44-2.99).Lidocaine was more effective than placebo in improving both survival to 24 h/hospital admission(OR=2.36,95%CI:1.47-3.80)and discharge from hospital(OR=2.10,95%CI:1.21-3.64)in non⁃randomized intervention studies.Amiodarone showed no significant difference in improving survival to 24 h/admission to hospital compared with lidocaine in RCTs,while amidoraone was inferior to lidocaine in improving 24 h/admission survival rate(OR=0.72,95%CI:0.53-0.98)and discharge survival rate(OR=0.81,95%CI:0.76-0.87)in non⁃randomized intervention study.Conclusion Limited RCTs di⁃rectly compared amiodarone and lidocaine.No significant difference was found between amiodarone and lidocaine in improving 24 h/admission survival rate in RCTs.While compared to amiodarone and placebo,lidocaine can improve 24 h/admission survival rate and discharge survival rate in non⁃randomized intervention studies.

关 键 词：利多卡因 胺碘酮 心脏骤停 心肺复苏 META分析 

分 类 号：R541.78[医药卫生—心血管疾病] R605.975[医药卫生—内科学]