尼非卡兰与胺碘酮治疗严重室性心律失常近期疗效及安全性的对比研究
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摘要
目的:本研究旨在对比尼非卡兰和胺碘酮在治疗严重室性心律失常患者中的疗效和安全性。方法:本研究为单中心回顾性观察研究。收集2015-10-2018-02于泰达国际心血管病医院心内重症监护病房住院治疗,并出现持续性室性心动过速(室速)/心室颤动(室颤)患者共84例。据药物治疗方案分为胺碘酮组(42例)和尼非卡兰组(42例)。对有效率、转复时间、24h生存率、1个月生存率、转复前后的收缩压、舒张压、心率及左心室射血分数、不良反应和无效患者死亡的原因等指标应用SPSS 22.0软件进行统计学分析。结果:尼非卡兰较胺碘酮可有效转复持续性室速/室颤(P<0.05),并可缩短转复时间(P<0.01),并提高24h生存率、1个月生存率(P<0.05)。两者的不良反应发生率、转复无效患者的死亡原因无明显统计学差异(P=0.51)。另外,尼非卡兰对舒张压(P=0.13)、收缩压(P=0.09)、心率(P=0.15)无明显影响,可有效升高左心室射血分数(P<0.01)。结论:静脉应用尼非卡兰治疗持续性室速/室颤时,疗效优于胺碘酮,且安全性高。
Objective:To compare the effectiveness and tolerance of nifekalant and amiodarone in patients with severe ventricular arrythmia.Method:We included 84 patients with persistent ventricular tachycardia or ventricular fibrillation admitted into cardiac intensive care unit(CCU)of TEDA International Cardiovascular Hospital from October 2015 to February 2018.According anti-arrythma drugs which used by patient,we divided patients into nifekalant group and amiodarone group.We analysed the efficiency,systolic blood pressure,left ventricular eject fraction,24-hour survival rate,30-day survival rate,adverse reactions,causes of invalid patients' death by SPSS 22.0software.Result:Nifekalant was more effective than amiodarone in the recovery of persistent ventricular tachycardia/ventricular fibrillation,and the difference was statistically significant(P<0.01).Compared with amiodarone,nifekalant could shorten the recovery time and improve the 24-hour survival rate and 30-day survival rate,and the difference was statistically significant(P<0.01).There was no significant difference in the incidence of adverse reaction and the causes of death between nifekalant and amiodarone(P>0.05).The effect of nifekalant on blood pressure and cardiac function was small,and the difference was statistically significant(P<0.05).Otherwise,nifekalant was effective in increasing left ventricular ejection fraction(P<0.01),and had no significant effect on diastolic pressure(P=0.13),systolic blood pressure(P=0.09)and heart rates(P=0.15).Conclusion:The application of nifekalant to treat persistent ventricular tachycardia/ventricular fibrillation is superior to amiodarone in this study.
Objective:To compare the effectiveness and tolerance of nifekalant and amiodarone in patients with severe ventricular arrythmia.Method:We included 84 patients with persistent ventricular tachycardia or ventricular fibrillation admitted into cardiac intensive care unit(CCU)of TEDA International Cardiovascular Hospital from October 2015 to February 2018.According anti-arrythma drugs which used by patient,we divided patients into nifekalant group and amiodarone group.We analysed the efficiency,systolic blood pressure,left ventricular eject fraction,24-hour survival rate,30-day survival rate,adverse reactions,causes of invalid patients' death by SPSS 22.0software.Result:Nifekalant was more effective than amiodarone in the recovery of persistent ventricular tachycardia/ventricular fibrillation,and the difference was statistically significant(P<0.01).Compared with amiodarone,nifekalant could shorten the recovery time and improve the 24-hour survival rate and 30-day survival rate,and the difference was statistically significant(P<0.01).There was no significant difference in the incidence of adverse reaction and the causes of death between nifekalant and amiodarone(P>0.05).The effect of nifekalant on blood pressure and cardiac function was small,and the difference was statistically significant(P<0.05).Otherwise,nifekalant was effective in increasing left ventricular ejection fraction(P<0.01),and had no significant effect on diastolic pressure(P=0.13),systolic blood pressure(P=0.09)and heart rates(P=0.15).Conclusion:The application of nifekalant to treat persistent ventricular tachycardia/ventricular fibrillation is superior to amiodarone in this study.
引文
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[8] Igarashi M,Fujino T,Toyoda M,et al.Defibrillation effects of intravenous nifekalant in patients with outof-hospital ventricular fibrillation[J].Pacing Clin Electrophysiol,2005,28:S155-157.
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[10]Yoshioka K,Amino M,Morita S,et al.Can nifekalant hydrochloride be used as a first-line drug for cardiopulmonary arrest(CPA)?:comparative study of outofhospital CPA with acidosis and in-hospital CPA without acidosis[J].Circ J,2006,70(1):21-27.
[11]Tahara Y,Kimura K,Kosuge M,et al.Comparison of nifekalant and lidocaine for the treatment of shock-refractory ventricular fibrillation[J].Circ J,2006,70(4):442-446.
[12]Yusu S,Ikeda T,Mera H,et al.Effects of intravenous nifekalant as a lifesaving drug for severe ventricular tachyarrhythmias complicating acute coronary syndrome[J].Circ J,2009,73(11):2021-2028.
[13]Shiga T,Tanaka K,Kato R,et al.Nifekalant versus lidocaine for in-hospital shock-resistant ventricular fibrillation or tachycardia[J].Resuscitation,2010,81(1):47-52.
[14]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.室性心律失常中国专家共识[J].中国心脏起搏与心电生理杂志,2016,30(4):283-325.
[15]李奇,杨俊.室性心律失常与解剖因素关系的研究进展[J].临床心血管病杂志,2018,34(5):441-444.
[16]Murakawa Y,Yamashita T,Kanese Y,et al.Effect of a classⅢantiarrhythmic drug on the configuration of dose response curve for defibrillation[J].Pacing Clin Electrophysiol,1999,22(4):479-486.
[17]Lindquist DE,Rowe AS,Heidel E,et al.Evaluation of the hemodynamic effects of intravenous amiodarone formulations during the maintenance phase infusion[J].Ann Pharmacother,2015,49(10):1317-1321.
[18] Martí-Carvajal AJ,Simancas-Racines D,Anand V,et al.Prophylactic lidocaine for myocardial infarction[J].Cochrane Database Syst Rev,2015,8:CD008553.
[19]Lindquist DE,Rowe AS,Heidel E,et al.Evaluation of the hemodynamic effects of intravenous amiodarone formulations during the maintenance phase infusion[J].Ann Pharmacother,2015,49(12):1317-1321.
[20]Yu Huang,Qing He,Min Yang,et al.Antiarrhythmia drugs for cardiac arrest:a systemic review and meta-analysis[J].Critical Care,2013,17(4):R173.
[21]Dorian P,Cass D,Schwartz B,et al.Amiodarone as compared with lidocaine for shock-resisitant ventricular fibrillation[J].N Engl J Med,2002,346(12):884-890.
[22]Pantazopoulos IN,Troupis GT,Pantazopoulos CN,et al.Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias[J].World J Cardiol,2011,3(6):169-176.
[23]Marinelli A,Capucci A.Amiodarone(Nexterone)injection for the treatment and prophylaxis of frequently recurring ventricular fibrillation[J].Expert Opin Pharmacother,2012,13(4),573-584.
[24]Kleinman ME,Brennan EE,Goldberger ZD,et al.Part5:adult basic life support and cardiopulmonary resuscitation quality:2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2015,132(18suppl 2):S414-435.
[25]Japan Resuscitation Council.Part 2:Adult Basic Life Support and Cardiopulmonary Resuscitation Quality[J].Japan Resuscitation Council Guideline,2015,112(12):1222-1228.
[26] Amino M.Nifekalant hydrochloride and amiodarone hydrochloride result in similar improvement for 24-hour survival in cardiopulmonary arrest patients:the SOS-KANTO 2012study[J].Cardiovasc Pharmacol,2015,66(5),600-609.
[27] Kudenchuk PJ.Amiodarone.lidocaine,or placebo in out-of-hospital cardiac arrest[J].N Engl J Med,2016,374(12):1711-1722.
[28]Masato F,Susumu O,Hisao Y,et al.Development of recombinant cell line co-expressing mutated Nav1.5,Kir2.1,and hERG for the safety assay of drug candidates[J].J Biomol Screen,2016,17(6):773-784.
[29]郭牧,田树光,宋昱.尼非卡兰的临床应用[J].临床心血管病杂志,2017,33(2):188-190.
[30]中国老年学学会心脑血管病专业委员会、中国医师协会心血管内科医师分会.注射用盐酸尼非卡兰临床应用中国专家共识[J].中国循环杂志,2017,32(1):32-35.
[31]Sato S,Zamami Y,Imai T,et al.Meta-analysis of the efcacies of amiodarone and nifekalant in shock-resistant ventricular fbrillation and pulseless ventricular tachycardia[J].Sci Rep,2017,7(1):12683.
[32]Harayama N,Nihei S,Nagata K,et al.Comparison of nifekalant and amiodarone for resuscitati out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation[J].J Anesth,2014,28(4):587-592.
[2] Link MS,Berkow LC,Kudenchuk PJ,et al.Adult advanced cardiovascular life support:2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J].Circulation,2015,132(18suppl 2):S444-464.
[3] Kodama I,Kamiya K,Toyama J.Amiodarone:ionic and cellular mechanisms of action of the most promising classⅢagent[J].Am J Cardiol,1999,84(9A):20
[4] Dorian P,Cass D,Schwartz B,et al.Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation[J].N Engl J Med,2002,346(12):884-890.
[5] Kudenchuk PJ,Cobb LA,Copass MK,et al.Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation[J].N Engl J Med,1999,341(12):871-878.
[6] Lindquist DE,Rowe AS,Heidel E,et al.Evaluation of the hemodynamic effects of intravenous amiodarone formulations during the maintenance phase infusion[J].Ann Pharmacother,2015,49(12):1317-1321.
[7] Katoh T,Mitamura H,Matsuda N,et al.Emergency treatment with nifekalant,a novel classⅢantiarrhythmic agent,for life-threatening refractory ventricular tachyarrhythmias:post-marketing special investigation[J].Circ J,2005,69(10):1237-1243.
[8] Igarashi M,Fujino T,Toyoda M,et al.Defibrillation effects of intravenous nifekalant in patients with outof-hospital ventricular fibrillation[J].Pacing Clin Electrophysiol,2005,28:S155-157.
[9] Katoh T,Mitamura H,Matsuda N,et al.Emergency treatment with nifekalant,a novel classⅢanti-arrhythmic agent,for life-threatening refractory ventricular tachyarrhythmias:post-marketing special investigation[J].Circ J,2005,69(10):1237-1243.
[10]Yoshioka K,Amino M,Morita S,et al.Can nifekalant hydrochloride be used as a first-line drug for cardiopulmonary arrest(CPA)?:comparative study of outofhospital CPA with acidosis and in-hospital CPA without acidosis[J].Circ J,2006,70(1):21-27.
[11]Tahara Y,Kimura K,Kosuge M,et al.Comparison of nifekalant and lidocaine for the treatment of shock-refractory ventricular fibrillation[J].Circ J,2006,70(4):442-446.
[12]Yusu S,Ikeda T,Mera H,et al.Effects of intravenous nifekalant as a lifesaving drug for severe ventricular tachyarrhythmias complicating acute coronary syndrome[J].Circ J,2009,73(11):2021-2028.
[13]Shiga T,Tanaka K,Kato R,et al.Nifekalant versus lidocaine for in-hospital shock-resistant ventricular fibrillation or tachycardia[J].Resuscitation,2010,81(1):47-52.
[14]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会.室性心律失常中国专家共识[J].中国心脏起搏与心电生理杂志,2016,30(4):283-325.
[15]李奇,杨俊.室性心律失常与解剖因素关系的研究进展[J].临床心血管病杂志,2018,34(5):441-444.
[16]Murakawa Y,Yamashita T,Kanese Y,et al.Effect of a classⅢantiarrhythmic drug on the configuration of dose response curve for defibrillation[J].Pacing Clin Electrophysiol,1999,22(4):479-486.
[17]Lindquist DE,Rowe AS,Heidel E,et al.Evaluation of the hemodynamic effects of intravenous amiodarone formulations during the maintenance phase infusion[J].Ann Pharmacother,2015,49(10):1317-1321.
[18] Martí-Carvajal AJ,Simancas-Racines D,Anand V,et al.Prophylactic lidocaine for myocardial infarction[J].Cochrane Database Syst Rev,2015,8:CD008553.
[19]Lindquist DE,Rowe AS,Heidel E,et al.Evaluation of the hemodynamic effects of intravenous amiodarone formulations during the maintenance phase infusion[J].Ann Pharmacother,2015,49(12):1317-1321.
[20]Yu Huang,Qing He,Min Yang,et al.Antiarrhythmia drugs for cardiac arrest:a systemic review and meta-analysis[J].Critical Care,2013,17(4):R173.
[21]Dorian P,Cass D,Schwartz B,et al.Amiodarone as compared with lidocaine for shock-resisitant ventricular fibrillation[J].N Engl J Med,2002,346(12):884-890.
[22]Pantazopoulos IN,Troupis GT,Pantazopoulos CN,et al.Nifekalant in the treatment of life-threatening ventricular tachyarrhythmias[J].World J Cardiol,2011,3(6):169-176.
[23]Marinelli A,Capucci A.Amiodarone(Nexterone)injection for the treatment and prophylaxis of frequently recurring ventricular fibrillation[J].Expert Opin Pharmacother,2012,13(4),573-584.
[24]Kleinman ME,Brennan EE,Goldberger ZD,et al.Part5:adult basic life support and cardiopulmonary resuscitation quality:2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care[J].Circulation,2015,132(18suppl 2):S414-435.
[25]Japan Resuscitation Council.Part 2:Adult Basic Life Support and Cardiopulmonary Resuscitation Quality[J].Japan Resuscitation Council Guideline,2015,112(12):1222-1228.
[26] Amino M.Nifekalant hydrochloride and amiodarone hydrochloride result in similar improvement for 24-hour survival in cardiopulmonary arrest patients:the SOS-KANTO 2012study[J].Cardiovasc Pharmacol,2015,66(5),600-609.
[27] Kudenchuk PJ.Amiodarone.lidocaine,or placebo in out-of-hospital cardiac arrest[J].N Engl J Med,2016,374(12):1711-1722.
[28]Masato F,Susumu O,Hisao Y,et al.Development of recombinant cell line co-expressing mutated Nav1.5,Kir2.1,and hERG for the safety assay of drug candidates[J].J Biomol Screen,2016,17(6):773-784.
[29]郭牧,田树光,宋昱.尼非卡兰的临床应用[J].临床心血管病杂志,2017,33(2):188-190.
[30]中国老年学学会心脑血管病专业委员会、中国医师协会心血管内科医师分会.注射用盐酸尼非卡兰临床应用中国专家共识[J].中国循环杂志,2017,32(1):32-35.
[31]Sato S,Zamami Y,Imai T,et al.Meta-analysis of the efcacies of amiodarone and nifekalant in shock-resistant ventricular fbrillation and pulseless ventricular tachycardia[J].Sci Rep,2017,7(1):12683.
[32]Harayama N,Nihei S,Nagata K,et al.Comparison of nifekalant and amiodarone for resuscitati out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation[J].J Anesth,2014,28(4):587-592.