静脉注射利多卡因预防成人术后气道并发症：系统回顾和meta分析

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静脉注射利多卡因预防成人术后气道并发症：系统回顾和meta分析

翻译：唐剑  编辑：冯玉蓉  审校：曹莹

背景：在接受全身麻醉的手术患者中，拔管时咳嗽很常见，可导致潜在的危险并发症。我们进行了系统回顾和meta分析，以评估围术期静脉输注利多卡因预防咳嗽和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及检索系统、医学文摘数据库和Cochrane中心登记的对照试验记录，比较了成人全身麻醉手术患者围手术期使用利多卡因的随机对照试验。采用偏倚风险评估对RCT进行评估，采用推荐、评估、发展和评价分级(GRADE)对证据质量进行评估。

结果：在16个试验中(n =1516)，与安慰剂组或不治疗组相比，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）以及术后1小时咽喉痛发生率（RR 0.46；95%CI 0.32~0.67）。各组之间喉痉挛的发生率（RD 0.02；95%CI -0.07~0.03）或与利多卡因使用相关的不良事件发生率没有差异。

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。

文献来源： Yang SS, Wang NN, Postonogova T,et al.Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis.Br J Anaesth 2020 Mar;1243(3).

Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis

Abstract

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.

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