研究背景：抗心律失常药物在心脏骤停中的疗效仍存在争议。因此，本文采用传统荟萃分析与网状荟萃分析的方法，来比较抗心律失常药物在心脏骤停患者顽固性无脉性室性心动过速或心室颤动中的疗效。

方法：计算机检索了PubMed、Embase、Cochrane图书馆和Web of Science数据库，截止至2025年1月1日，纳入所有比较利多卡因、胺碘酮、尼非卡兰、药物联合应用或安慰剂治疗心脏骤停中心律失常的研究。主要结果是出院生存情况，次要结果为入院生存情况。

结果：本文纳入14篇原始研究进行了荟萃分析，研究中的患者分别接受了胺碘酮、利多卡因、尼非卡兰、胺碘酮和利多卡因的联合用药或安慰剂的治疗，复苏场景包括院内和院外。对比安慰剂，胺碘酮并未能改善患者的短期存活率（OR 1.10，95%CI：0.67～1.80）和出院存活率（OR 1.21，95%CI：0.64～2.27）。对比安慰剂，利多卡因可显著改善复苏后患者的出院存活率（OR 1.88，95%CI：1.02～3.45）。对比利多卡因，胺碘酮并未能改善患者的短期存活率（OR 0.88，95%CI：0.61～1.29）。胺碘酮在改善患者的出院存活率方面较利多卡因效果更差（OR 0.83，95%CI：0.78～0.88），并具有显著性。利多卡因在改善短期存活率方面劣于尼非卡兰（OR 0.18，95%CI：0.07～0.48）。网状荟萃分析结果显示对比安慰剂，各组在改善复苏后患者的预后并无显著优势。SUCRA累积排名曲线显示，在改善短期还是长期生存率方面，尼非卡兰可能是最优的选择。

结论：传统荟萃分析中，对比安慰剂及胺碘酮，利多卡因可显著改善患者的出院存活率，而尼非卡兰较于利多卡因可以改善患者的短期生存率。网状荟萃分析的SUCRA累积排名曲线提示未来可进一步研究尼非卡兰在心肺复苏中的应用。

Background: The efficacy of antiarrhythmic drugs in cardiac arrest remains controversial. This study amied to compare the efficacy of antiarrhythmic drugs in cardiac arrest patients presenting with refractory pulseless ventricular tachycardia or ventricular fibrillation with pairwise meta-analysis and network meta-analysis.

Methods: We searched the PubMed, Embase, Cochrane Library, and Web of Science databases through to January 1, 2025. All studies comparing lidocaine, amiodarone, nifekalant and placebo for cardiac arrest were included. The primary outcome was survival to hospital discharge, and the secondary outcome was survival to hospital admission.

Results: Fourteen studies were included in this study. resuscitation settings included both in-hospital and out of hospital cardiac arrest. Amiodarone did not improve short-term survival (OR 1.10, 95%CI: 0.67～1.80) or survival to discharge (OR 1.21, 95%CI: 0.64～2.27) compared to placebo. Lidocaine significantly improved the likelihood of survival to hospital discharge compared to placebo (OR 1.88, 95%CI: 1.02~3.45). Compared to lidocaine, amiodarone showed no benefit in short term survival (OR 0.88, 95%CI: 0.61～1.29) and was associated with a worse outcome of survivaling to discharge (OR 0.83, 95%CI: 0.78～0.88). While nifekalant showed a better benfit for improving survival to hospital admission or 24 hours compared to lidocaine (OR 0.18，95%CI：0.07～0.48). Network meta-analysis shows no significant benifits compared with placebo. The surface under the cumulative ranking curves suggested that nifekalant may be the optimal choice for improving both short and long term survival.  

Conclusions: In pairwise meta-analysis, lidocaine significantly improved survival to hospital discharge compared with placebo and amiodarone. Nifikalant was assoiciated with a better outcome of survivaling to 24 hours or hospital admission compared to lidocaine. SUCRA curves of network meta-analysis highlighted the potential of nifekalant, warranting a further investigation into its role in cardiopulmonary resuscitation.