拔管前应用利多卡因预防血流动力学变化的Meta分析

Prevention of hemodynamics response to tracheal extubation by administration of lidocaine prior to extubation: a meta-analysis

目的系统评价全身麻醉后气管拔管前应用利多卡因预防血液动力学变化的效果。方法计算机检索PubMed、Ovid、Web of Science、EMbase、The Cochrane Library、CBM、CNKI、VIP和WanFang Data数据库,搜集有关全麻手术后拔管前应用利多卡因预防血流动力学变化的随机对照试验(RCT),检索时限均从建库至2018年10月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3和Stata13.0软件进行Meta分析。结果共纳入10个RCTs,包括525例患者。Meta分析结果显示:相对于空白对照,利多卡因可降低气管拔管后5 min平均动脉压升高[MD=–5.10,95%CI(–9.41,–0.79),P=0.02]、减弱拔管前至拔管后5 min由拔管引起的收缩压升高[拔管前:MD=–7.22,95%CI(–10.34,–4.11),P<0.000 01;拔管时:MD=–14.02,95%CI(–19.42,–8.62),P<0.000 01;拔管后1 min:MD=–15.82,95%CI(–22.20,–9.45),P<0.000 01;拔管后3 min:MD=–12.55,95%CI(–20.36,–4.74),P=0.002;拔管后5 min:MD=–12.05,95%CI(–20.35,–3.74),P=0.004]、抑制拔管时由拔管引起的舒张压升高[MD=–9.71,95%CI(–16.57,–2.86),P=0.005]。此外,利多卡因可抑制其他时刻(除拔管前和拔管后10 min)的心率加快。结论当前证据表明,拔管前应用利多卡因在大部分时间点能抑制拔管引起的血压升高和心率加快。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia. Methods PubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials(RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October,2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then,meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software. Results A total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce m ean arterial pressure in 5 min after extubation(MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation(before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01;at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01;1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01;3 minutes after extubation: MD=–12.55,95%CI –20.36 to –4.74, P=0.002;and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation(MD=–9.71, 95%CI –16.57 to –2.86,P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation. Conclusions Current evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.