静脉注射利多卡因预防成年患者术后气道并发症:系统回顾与meta分析
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Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis
背景与目的
在施行全身麻醉的外科患者中，拔管时咳嗽是很常见的，并可能导致潜在的危险并发症。本项系统回顾与meta分析旨在评估围术期静脉注射利多卡因预防咳嗽及其他气道并发症的有效性和安全性。
方 法
我们检索了医学文献分析和检索系统、医学文摘数据库和Cochrane中对照试验记录，以进行随机对照试验，比较于全身麻醉下施行手术的成年患者中静脉注射利多卡因与对照组的围术期预后。采用偏差风险评估法筛选随机对照试验，并用推荐、评估、发展和评价（GRADE）分级法评估数据质量。
结 果
在16个试验（n=1516）中，与安慰剂组或无处理组相比，静脉注射利多卡因可显著减少拔管后咳嗽（RR 0.64；95%CI 0.48~0.86）和术后1h咽喉痛（RR 0.46；95%CI 0.32~0.67）。喉痉挛发生率（RD 0.02；95%CI -0.07~0.03）或使用利多卡因相关不良事件发生率组间比较并无差异。
结 论
围术期静脉注射利多卡因可减少咳嗽和咽喉痛等呼吸道并发症，且相关的伤害风险并无增加。
原始文献摘要
Yang SS, Wang NN, Postonogova T, et al. Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis.[J].Br J Anaesth,2020 Jan 27. pii: S0007-0912(19)30971-7. doi: 10.1016/j.bja.2019.11.033.
Background: In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications.
Methods: We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results: In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR]: 0.64; 95% confifidence interval [CI]: 0.48~0.86) and in postoperative sore throat at 1 h (RR: 0.46; 95% CI: 0.32~0.67). There was no difference in incidence of laryngospasm (risk difference [RD]: 0.02; 95% CI: -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine.
Conclusions: The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：王贵龙