静脉输注利多卡因对结直肠肿瘤患者围手术期预后影响的meta分析  

Effect of intravenous lidocaine on perioperative outcomes in patients with colorectal cancer:a meta-analysis

作　　者：纪文焘 张笑婷 王贤冬 刘佳[1] 孙国林 卞金俊[1] 薄禄龙[1] JI Wen-tao;ZHANG Xiao-ting;WANG Xian-dong;LIU Jia;SUN Guo-lin;BIAN Jin-jun;BO Lu-long(Faculty of Anesthesiology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)第一附属医院麻醉学部,上海200433

出　　处：《海军军医大学学报》2022年第6期653-662,共10页Academic Journal of Naval Medical University

基　　金：上海市青年科技启明星计划(19QA1408500);海军军医大学(第二军医大学)第一附属医院“234学科攀峰计划”(2020YXK053)。

摘　　要：目的 通过meta分析评价静脉输注利多卡因对结直肠肿瘤患者围手术期预后的影响。方法 计算机检索2021年2月18日前Pub Med、Embase、Web of Science、中国知网、中国生物医学文献服务系统(Sino Med)及万方数据库等收录的探究静脉输注利多卡因对结直肠肿瘤患者围手术期预后影响的随机对照试验(RCT)研究。按照纳入与排除标准筛选文献、提取数据并进行方法学质量评估,采用Rev Man 5.4软件对数据进行meta分析。结果 共纳入12篇文献616例患者(307例静脉输注利多卡因,309例为安慰剂对照或空白对照)。与对照组相比,静脉输注利多卡因可降低结直肠肿瘤患者术后4、12和24 h的疼痛视觉模拟量表评分[均数差(MD)=-0.85,95%CI-1.29~-0.42,P=0.000 1;MD=-0.63,95%CI-0.89~-0.38,P<0.000 01;MD=-0.42,95%CI-0.81~-0.04,P=0.03],缩短患者术后首次排气时间(MD=-9.48,95%CI-12.17~-6.78,P<0.000 01)和首次排便时间(MD=-7.60,95%CI-10.63~-4.57,P<0.000 01),降低患者术后恶心呕吐发生率(RR=0.39,95%CI0.26~0.58,P<0.00001),但并不缩短患者住院总时长(MD=-1.04,95%CI-2.26~0.19,P=0.10)。结论 围手术期静脉应用利多卡因可减轻结直肠肿瘤患者术后疼痛程度、缩短患者术后排气和排便时间、降低术后恶心呕吐发生率,为其临床应用提供了循证依据。Objective To evaluate the effect of intravenous lidocaine on perioperative outcomes in patients with colorectal cancer by a meta-analysis. Methods Pub Med, Embase, Web of Science, Chinese National Knowledge Infrastructure(CNKI), Sino Med and Wanfang databases were electronically retrieved to include randomized controlled trials(RCTs) on the effect of intravenous lidocaine on perioperative outcomes in patients with colorectal cancer before Feb. 18, 2021. The literatures were screened according to the inclusion and exclusion criteria, and then the data were extracted and the methodological quality was assessed. The data were analyzed using Rev Man 5.4 software. Results A total of 12 studies involving 616 patients were included(307 cases with intravenous lidocaine and 309 cases as placebo control or blank control). Compared with the control group, intravenous lidocaine significantly reduced the scores of visual analogue scale(VAS) at 4 h(mean difference [MD] =-0.85, 95% confidence interval [CI]-1.29 to-0.42, P=0.000 1), 12 h(MD=-0.63, 95% CI-0.89 to-0.38, P<0.000 01), and 24 h(MD=-0.42, 95% CI-0.81 to-0.04, P=0.03) after surgery, shortened the time to pass the first flatus(MD=-9.48, 95% CI-12.17 to-6.78, P<0.000 01) and defecation(MD=-7.60, 95% CI-10.63 to-4.57, P<0.000 01), and decreased the incidence of postoperative nausea and vomiting(relative risk [RR] =0.39, 95% CI 0.26 to 0.58, P<0.000 01);however, there was no significant difference in the hospital stay(MD=-1.04, 95% CI-2.26 to 0.19, P=0.10). Conclusion Perioperative intravenous lidocaine can relieve the postoperative pain of patients with colorectal cancer, shorten the postoperative exhaust and defecation time, and reduce the incidence of nausea and vomiting, providing evidence-based basis for its clinical application.

关 键 词：利多卡因 结直肠肿瘤 预后 META分析 系统评价 随机对照试验 

分 类 号：R735.3[医药卫生—肿瘤]