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首页> 外文期刊>Journal of cardiology >Efficacy of Nifekalant hydrochloride for life-threatening ventricular tachyarrhythmias in patients with resistance to lidocaine: a study of patients with out-of-hospital cardiac arrest
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Efficacy of Nifekalant hydrochloride for life-threatening ventricular tachyarrhythmias in patients with resistance to lidocaine: a study of patients with out-of-hospital cardiac arrest

机译：盐酸奈非卡那特对利多卡因耐药的危及生命的室性快速性心律失常的疗效：院外心脏骤停患者的研究

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OBJECTIVES: Class I antiarrhythmic agents are not always effective in the treatment of life-threatening ventricular tachycardia/ventricular fibrillation (VT/VF) especially in patients with cardiopulmonary arrest. Nifekalant hydrochloride(NIF) is a novel class III antiarrhythmic agent for malignant VT/VF. This study prospectively evaluated NIF efficacy for life-threatening VT/VF observed after cardiopulmonary arrest. METHODS: Thirty-two of 145 patients who were transferred to the emergency room in Tokai University Hospital showed VT/VF after resuscitation from cardiopulmonary arrest from June 2000 to March 2001. These 32 patients were treated with 12 mg (mean) epinephrine and 1.0-2.0 mg/kg lidocaine following direct current application(200 to 360J), and then classified into two groups. Eleven patients received intravenous 0.15 to 0.3 mg/kg NIF followed by intravenous infusion of 0.3 to 0.4 mg/kg/hr NIF(NIF group). The other 21 patients received 1.0 to 2.0 mg/kg of lidocaine(non-NIF group). RESULTS: Sinus rhythm was restored in the nine patients(82%) in the NIF group but only four patients (19%) in the non-NIF group. QTc was not prolonged(0.45 +/- 0.04 sec, n = 9) and no torsades de pointes was observed in the NIF group. Two patients survived but the remaining nine patients died in the NIF group. Five patients died of cardiac standstill following sinus bradycardia and repeated sinus arrest within 2 to 27 hr after admission, two patients died of sudden cardiac arrest from sinus rhythm, and two patients died of persistent VT/VF. In contrast, all 21 patients in the non-NIF group died. Seventeen patients died of persistent VT/VF before hospitalization, one patient died of recurrent VT/VF, and three patients died of cardiac standstill following sinus bradycardia. CONCLUSIONS: NIF effectively suppresses VT/VF which is refractory to direct current shock in patients with cardiopulmonary arrest. However, NIF may rather worsen electrophysiological function in the sinus node after administration of high doses of epinephrine, and may induce sinus bradycardia and/or sinus arrest. Careful observation, such as monitoring of electrocardiography and blood pressure and temporary cardiac pacemaker use, is needed to prevent death in patients surviving after cardiopulmonary arrest if NIF is administered following high dose epinephrine infusion.
机译：目的：I类抗心律不齐药在治疗危及生命的室性心动过速/心室纤颤（VT / VF）方面并不总是有效，尤其是在心肺骤停的患者中。 Nifekalant hydrochloride（NIF）是一种用于恶性VT / VF的新型III类抗心律不齐药物。这项研究前瞻性评估了NIF对心肺骤停后观察到的危及生命的VT / VF的疗效。方法：2000年6月至2001年3月，从心肺骤停复苏后的145名转移到东海大学医院急诊室的患者中，有VT / VF。这32例患者接受了12 mg（平均）肾上腺素和1.0-直流电（200至360J）施用2.0 mg / kg利多卡因，然后分为两组。 11例患者接受0.15至0.3 mg / kg NIF静脉注射，然后静脉输注0.3至0.4 mg / kg / hr NIF（NIF组）。其他21例患者接受1.0至2.0 mg / kg的利多卡因（非NIF组）。结果：NIF组9例患者（82％）恢复窦性心律，非NIF组仅有4例患者（19％）恢复窦性心律。 NIF组未延长QTc（0.45 +/- 0.04秒，n = 9），也未观察到扭转尖端。 NIF组中有2名患者存活，但其余9名患者死亡。 5例患者因窦性心动过缓而死于心脏停顿，并在入院后2至27小时内反复窦性停搏，两名患者因窦性心律突然心脏骤停而死亡，两名患者死于持续性VT / VF。相反，非NIF组中的所有21名患者均死亡。住院前有17例患者死于持续性VT / VF，一名患者死于复发性VT / VF，三名患者死于窦性心动过缓后的心脏停顿。结论：NIF有效抑制了心肺骤停患者的直流电休克所难治的VT / VF。但是，在大剂量肾上腺素给药后，NIF可能会使窦房结的电生理功能恶化，并可能导致窦性心动过缓和/或窦性停搏。如果在大剂量肾上腺素输注后使用NIF，需要仔细观察，如监测心电图和血压以及临时使用心脏起搏器，以防止心肺停搏后幸存的患者死亡。

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