静脉输注利多卡因对常规治疗类风湿关节炎效果的影响

Effect of intravenous infusion of lidocaine on efficacy of conventional treatment for rheumatoid arthritis

目的:评价静脉输注利多卡因对常规治疗类风湿关节炎效果的影响。方法:选取2019年9月至2020年9月类风湿关节炎患者44例,性别不限,年龄32~85岁,体重40~76 kg,按照随机数字表法分为2组(n=22):对照组(C组)和利多卡因组(L组)。2组患者均给予常规治疗,当患者VAS评分≥5分时,口服糖皮质激素和非甾体抗炎药物,维持VAS评分≤4分;L组在常规治疗的基础上静脉输注0.2%盐酸利多卡因注射液3 mg/kg(0.9%氯化钠注射液500 ml稀释),输注速率25 ml/h,持续时间2 h,1次/d,连续5 d。于治疗前(T_(1))、治疗后1周(T_(2))、4周(T_(3))和8周(T_(4))时记录VAS评分、28个关节疾病活动度评分(DAS28评分)、简化的疾病活动性指数评分(SDAI评分)、糖皮质激素和非甾体抗炎药的用量,观察药物不良反应的发生情况。T_(1)和T_(2)时测定患病关节痛区温度。结果:与T_(1)时比较,2组患者各时点VAS评分、DAS28评分和SDAI评分降低,T_(2)时患者患病关节痛区温度降低(P<0.05);2组患者各时点VAS评分、DAS28评分和SDAI评分比较差异无统计学意义(P>0.05);与C组比较,L组患者糖皮质激素和非甾体抗炎药用量减少,T_(2)时患者双手背和右足背患病关节痛区温度及不良反应发生率降低(P<0.05)。结论:静脉输注利多卡因可优化常规治疗类风湿关节炎的效果。

Objective To evaluate the effect of intravenous infusion of lidocaine on the efficacy of conventional treatment for rheumatoid arthritis.Methods Forty-four patients with rheumatoid arthritis of either sex,aged 32-85 yr,weighing 40-76 kg,who were admitted to the Department of Pain and Nephrology in our hospital from September 2019 to September 2020,were divided into 2 groups(n=22 each)according to the random number table method:control group(C group)and lidocaine group(L group).Both groups received conventional treatment.When visual analogue scale(VAS)score≥5,glucocorticoid(GC)and non-steroidal anti-inflammatory drugs(NSAIDs)were taken orally to maintain the VAS score≤4.In group L,0.2%lidocaine hydrochloride injection 3 mg/kg(diluted with 0.9%sodium chloride injection 500 ml was intravenously infused at a rate of 25 ml/h for 2 h,once a day,for 5 consecutive days,based on the conventional treatment.The VAS score,28-joint Disease Activity Score(DAS28 score),simplified disease activity index score(SDAI score),consumption of GC and NSAIDs and adverse reactions were recorded before treatment(T_(1))and at 1,4 and 8 weeks after treatment(T_(2-4)).The temperature of the pain area of the affected joint was evaluated through infrared thermal imaging at T_(1) and T_(2).Results Compared with the baseline at T_(1),VAS score,DAS28 score and SDAI score were significantly decreased at each time point,and the temperature of the pain area of the affected joint at T_(2) was decreased in the two groups(P<0.05).There were no significant differences in VAS score,DAS28 score and SDAI score at each time point between two groups(P>0.05).Compared with group C,the consumption of GC and NSAIDs was significantly decreased,and the temperature of the pain area of the dorsum of both hands and the dorsum of right foot at T_(2) and incidence of adverse reactions were decreased in group L(P<0.05).Conclusions Intravenous infusion of lidocaine can optimize the efficacy of conventional treatment for rheumatoid arthritis.