胺碘酮与利多卡因治疗急性心肌梗死并室性心动过速疗效及安全性的Meta分析

The clinical effect of amiodarone versus lidocaine on the myocardial infarction patients complicated with ventricular tachycardia:A Meta-analysis

目的运用Meta分析比较胺碘酮和利多卡因对急性心肌梗死合并室性心动过速的疗效。方法计算机检索PubMed、Cochrane、EMBASE、MEDL.INE、中国知网(CNKI)数据库、万方数据库,查找自建库以来至2011年12月公开发表的比较胺碘酮和利多卡因治疗心肌梗死合并室性心动过速临床随机对照试验(RCT),按纳入排除标准进行RCT的筛选、资料提取和质量评价,使用RevMan 5.0软件进行数据统计学分析。结果共纳入10项研究、1381例患者。(1)胺碘酮组治疗有效率显著高于利多卡因组(RR=1.27,95%CI 1.12～1.44,P=0.0002);(2)胺碘酮组与利多卡因组药物不良反应发生率差异无统计学意义(RR=0.79,95%CI 0.42～1.48,P:0.46);(3)胺碘酮组患者病死率高于利多卡因组(RR=0.48,95%CI 0.27～0.85,P=0.01)。结论与利多卡因相比,胺碘酮治疗心肌梗死合并室性心动过速更有效,且不增加药物不良反应发生率,能够显著降低患者病死率。

Objective To retrospectively compare the therapeutic effectiveness of amiodarone and lidocaine in the treatment of ventricular arrhythmia after acute myocardial infarction.Methods PubMed,Cochrane,EMBASE,MEDLINE, CNKI,Wanfang data were searched from the time of self-build library to December 2011 for randomized clinical trials（RCT） of amiodarone vs.lidocaine on the myocardial infarction patients complicated with ventricular tachycardia.Two investigators independently screened these data.Pooled estimates were calculate with usage of RevMan 5.0 software.Results Ten trials were included in the analysis（1381 patients）.（1）The effective rate in amiodarone group was higher than that in lidocaine group（RR=1.27,95%CI 1.12~1.44,P=0.0002）.（2）Regardless of the effect of other medicines,the side effects of amiodarone was similar as lidocaine（RR=0.79,95%CI 0.42～1.48,P=0.46）.（3）The mortality rate in amiodarone group was higher than that in lidocaine group（RR=0.48,95%CI 0.27-0.85,P=0.01）.Conclusion The results of this Meta-analysis provide strong evidence that preferable effective of amiodarone therapy on the myocardial infarction patients complicated with ventricular arrhythmia,amiodarone can significantly decrease the incidence of ventricular tachycardia without increase the side effects,and decrease the mortality rate.