【作者】 陈妍；

【导师】 王娜；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2024， 硕士

【摘要】 目的:对目前已有的关于全身麻醉患者在围术期是否静脉输注利多卡因的随机对照试验(Randomized Controlled Trial,RCT)进行荟萃分析,进一步明晰围术期静注利多卡因对患者术后镇痛以及术后康复等方面是否有益及效益大小,以期为多模式镇痛提供更多的可能性。方法:通过对Web of Science、Pub Med、Scopus、Cochrane Library,Google Scholar等外文数据库以及中国知网(CNKI)、维普、万方等中文数据库有关静脉输注利多卡因对患者围手术期疼痛及恢复影响的RCT进行检索。由两名检索人员根据检索策略以及纳入、排除标准独立进行检索和筛选,由作者独立提取数据并反复核对。按照Cochrane Handbook系统RCT偏倚风险评估工具评价法对纳入文献进行质量评价,采用Rev Man5.3软件进行质量评价和数据分析。主要结局指标包括术后2h、4h、6h、8h、12h、24h、48h视觉模拟评分(Visual Analogue Scale,VAS)、术后恢复质量评分(Quality of Recovery Score,QoRs)、术后恶心呕吐(Postoperative Nausea Vomiting,PONV)发生率;次要结局指标包括术中阿片药物总剂量、术后24h阿片类药物应用剂量及总剂量、镇痛泵按压总次数(Frequency of Pushing the Button of Patient-controlled Analgesia,FPB)、术后首次镇痛时间、术后镇痛需求、住院时间、术后寒战发生率。结果:纳入符合标准的RCT 32篇,共计2263例患者(1129例患者接受静脉输注利多卡因为实验组,1134例患者接受同样方法输注生理盐水作为对照组)纳入本次分析。在术后疼痛方面,利多卡因组和生理盐水对照组在术后2h、4h、6h、8h、12h、24h、48h的VAS方面均存在显著差异,利多卡因组明显优于对照组,疼痛评分降低,差异具有统计学意义(P<0.05);术中以及术后阿片类药物用量利多卡因组均少于对照组[术中SMD=-0.84,95%CI(-1.19,-0.50);术后24h SMD=-1.35,95%CI(-1.94,-0.76);术后总SMD=-1.29,95%CI(-1.89,-0.68),P均小于0.05];利多卡因组的FPB及术后镇痛需求少于对照组[MD=-18.78,95%CI(-28.47,-9.09),P=0.0001;RR=0.38,95%CI(0.27,0.52),P<0.0001];术后首次要求镇痛的时间两组的差异也具有统计学意义,利多卡因组的时间晚于对照组[MD=1.79,95%CI(1.08,2.51),P<0.00001]。术后恢复方面,相对于对照组,利多卡因组的QoR-40总分[MD=10.84,95%CI(5.03,16.65),P<0.00001]及其中三个维度的评分[身体舒适度SMD=1.13,95%CI(0.46,1.81);情绪状态SMD=0.96,95%CI(0.49,1.44);疼痛SMD=1.80,95%CI(0.91,2.96),P均小于0.05]显著升高;PONV发生率大大降低[RR=0.53,95%CI(0.45,0.63),P<0.00001];住院时间显著缩短[MD=-0.67,95%CI(-1.16,-0.19),P<0.01],差异均具有统计学意义。结论:1、全身麻醉患者在围术期静脉输注利多卡因可以改善术后各个时间点的急性疼痛,减轻疼痛程度,降低术后的镇痛需求,减少术中及术后阿片类药物的用量。2、围术期静脉输注利多卡因可以降低全身麻醉患者PONV发生率,提高术后恢复质量评分,改善患者的情绪状态及术后舒适度,缩短住院时间。更多还原

【Abstract】 Objective:This meta-analysis was conducted on randomized controlled trials of perioperative intravenous infusion of lidocaine or not during general anesthesia,in order to further clarify the effectiveness and benefits of perioperative intravenous infusion of lidocaine for postoperative pain and its rehabilitation.To provide more possibilities for multimodal analgesia.Method:Retrieve randomized controlled trials about the effects of intravenous infusion of lidocaine on perioperative pain and prognosis in foreign language databases such as Web of Science,Pub Med,Scopus,Cochrane Library,Google Scholar,as well as Chinese databases such as CNKI,VIP Database,and Wan Fang Database.Two searchers independently conducted search selection based on search strategy and criteria of inclusion and exclusion.The authors independently screened the literature,extracted data,and double checked.We evaluate the quality of the included literature using the Cochrane Handbook system RCT bias risk assessment tools and use Rev Man5.3 for quality evaluation and data analysis.The main outcomes include postoperative pain score at 2,4,6,8,12,24,and 48 hours,QoR-40 score,and incidence of PONV;Secondary outcomes include the total dose of opioids during surgery,the dosage of 24 hours after surgery and total dose of opioid drugs applied,FPB,the time of initial postoperative analgesia,postoperative pain need,hospital stay,and the incidence of postoperative chills.Results:32 randomized controlled trails that fit in the criteria were included,with a total of2263 patients(1129 patients receiving intravenous infusion of lidocaine as the experimental group,and 1134 patients receiving the same method of infusion of physiological saline as the control group)included in this analysis.In terms of postoperative pain,there were significant differences in pain scores between lidocaine group and saline control group at 2 hours,4 hours,6 hours,8 hours,12 hours,24 hours,and 48 hours after surgery,the lidocaine group was significantly better than the control group with statistical significance(P<0.05).The intraoperative and postoperative opioid dosage(24h postoperative dosage and total postoperative dosage)in the lidocaine group was lower than that in the control group [SMD=-0.84,95%CI(-1.19,-0.50);24-hour SMD=-1.35,95% CI(-1.94,-0.76);total SMD=-1.29,95% CI(-1.89,-0.68),P<0.05].The FPB and postoperative analgesic needs in the lidocaine group were lower than those in the control group [MD=-18.78,95% CI(-28.47,-9.09),P=0.0001;RR=0.38,95% CI(0.27,0.52),P<0.0001],and there was a statistically significant difference in the time required for first postoperative analgesia between the two groups.The lidocaine group had a later time than the control group[MD=1.79,95% CI(1.08,2.51),P<0.00001].In terms of recovery,compared with control group,the total score of QoR-40 in the lidocaine group [MD=10.84,95% CI(5.03,16.65),P<0.00001] and other dimensional scores [physical comfort SMD=1.13,95% CI(0.46,1.81);emotional state SMD=0.96,95% CI(0.49,1.44);pain SMD=1.80,95%CI(0.91,2.96),P<0.05] were significantly higher;The incidence of PONV was significantly reduced [RR=0.53,95%CI(0.45,0.63),P<0.00001];The hospitalization time was significantly shortened[MD=-0.67,95% CI(-1.16,-0.19),P<0.01],and the difference was statistically significant.Conclusions:1.Intravenous infusion of lidocaine during the perioperative period in general anesthesia patients can improve acute pain at various time points after surgery alleviating pain severity,reduce postoperative pain demand and the use of opioids during and after surgery.2.Intravenous infusion of lidocaine during the perioperative period in general anesthesia patients can reduce the incidence rate of PONV,improve postoperative rehabilitation scores,improve patients’ emotional state and postoperative comfort,and shorten the length of hospital stay.更多还原