Deleterious hemodynamic effects of lidocaine in severe congestive heart failure.
Deleterious hemodynamic effects of lidocaine in severe congestive heart failure.
复制标题
利多卡因对严重充血性心力衰竭的有害血流动力学影响。
DOI：
10.1016/0002-8703(89)90278-0
复制
发表时间：
1989
影响因子：
4.8
通讯作者：
Packer,M
中科院分区：
文献类型：
--
作者：
Gottlieb,SS;Packer,M
室性心律失常在充血性心力衰竭患者中极为常见，这些患者通常被认为是抗心律失常药物治疗的候选者。然而，左心室功能不全的患者特别可能经历抗心律失常药物的不良血流动力学和电生理效应。利多卡因是一种抗心律失常药物，被认为具有最小的（如果有的话）促心律失常或心脏功能。2尽管这种局部麻醉剂可以降低体外心脏收缩力，3但尚未报道该药物对心脏病患者的心输出量或心室充盈压产生临床显著变化，即使是有充血性心力衰竭病史的患者。1'2然而，在心力衰竭患者中，利多卡因诱导的中枢神经系统毒性的风险增加，因为这种疾病状态降低了药物的表观分布容积和肝脏清除率。4因此，给予常规治疗剂量的利多卡因可能会产生非常高的血清药物水平。尽管药代动力学发生了这种改变，但从未有报道称利多卡因会使左心室功能障碍患者的心力衰竭症状恶化。我们观察到一位严重慢性充血性心力衰竭的病人，当他用利多卡因治疗时，他的循环状态反复恶化，停药后迅速好转。为了确定利多卡因是否会引起这些不良临床反应，我们在患者心脏右侧插入球囊漂浮导管后再次使用利多卡因进行激发。一名56岁的男性，患有继发于缺血性心脏病的严重心肌病，被转诊至西奈山医院治疗严重慢性心力衰竭。在冠状动脉搭桥术和围手术期心肌梗死后3年，尽管接受了洋地黄和利尿剂治疗，但患者仍出现呼吸困难和静息时疲乏症状（纽约心脏协会功能分级IV级）。左心室射血分数为22%，
Ventricular arrhythmias are extremely common in patients with congestive heart failure, and these patients are frequently considered to be candidates for antiarrhythmic drug therapy. Yet patients with left ventricular dysfunction are particularly likely to experience adverse hemodynamic and electrophysiologic effects from antiarrhythmic agents. Lidocaine is an antiarrhythmic drug that is thought to exert minimal (if any) proarrhythmic or cardiodepressant effects.‘, 2 Although this local anesthetic agent can decrease cardiac contractility in vitro, 3 the drug has not been reported to produce clinically significant changes in cardiac output or ventricular filling pressures in patients with heart disease, even in those with a history of congestive heart failure. 1’2 The risk of lidocaine-induced central nervous system toxicity is increased in patients with heart failure, however, since this disease state reduces the apparent volume of distribution and the hepatic clearance of the drug. 4 Accordingly, the administration of the usual therapeutic doses of lidocaine may produce very high serum levels of the drug. In spite of such altered pharmacokinetics, lidocaine has never been reported to produce worsening symptoms of heart failure in patients with left ventricular dysfunction. We observed a patient with severe chronic congestive heart failure whose circulatory status deteriorated repeatedly when he was treated with lidocaine and who improved rapidly upon withdrawal of the drug. In order to determine whether lidocaine caused these adverse clinical effects, we rechallenged the patient with lidocaine after the insertion of a balloon-flotation catheter in the right side of the heart.A 56year-old man with severe cardiomyopathy secondary to ischemic heart disease was referred to Mount Sinai Hospital for the treatment of severe chronic heart failure. Three years after coronary artery bypass surgery and a perioperative myocardial infarction, he had symptoms of dyspnea and fatigue at rest (New York Heart Association functional class IV) despite treatment with digitalis and diuretics. The left ventricular ejection fraction was 22% by