视频辅助胸腔镜手术中的静脉静脉利多卡因:随机对照试验的系统审查和元分析
Mohammad Abir Mamun1, Yumna Saleem1, Yahya El-Tahlawy1
1Brighton and Sussex Medical School, Brighton, United Kingdom.
Journal of cardiothoracic and vascular anesthesia
|February 27, 2026
概括
静脉注射利多卡因在视频辅助胸腔镜手术 (VATS) 后不会改善术后疼痛或阿片类药物使用. 然而,它有效地降低了VATS患者的手术后恶心和吐 (PONV),这表明它对恶心管理具有特定的益处.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 视频辅助胸腔镜手术 (VATS) 后的术后恢复通常会因疼痛,肺部衰退以及术后恶心和吐 (PONV) 而复杂化.
- 静脉注射利多卡因因其阿片类药物缓解,止痛和抗过敏药物特性而被探索为辅助剂,但其在VATS中的有效性尚未得到充分证实.
研究的目的:
- 系统地审查和元分析现有的随机对照试验 (RCT),评估静脉注射利多卡因在接受VATS的患者中的作用.
- 评估静脉注射利多卡因对术后疼痛,阿片类药物消耗和PONV在VATS后的影响.
主要方法:
- 一项对31项已确定研究的系统综述和元分析,包括9项涉及672名患者的RCT.
- 关于阿片类药物使用,疼痛评分,手术内麻醉要求和PONV发病率的数据的定量和定性综合.
主要成果:
- 静脉注射利多卡因在24或48小时后没有显著降低术后吗啡消耗.
- 在24小时和48小时内,在利多卡因和对照组之间没有观察到聚合运动疼痛得分的显著差异.
- 随着利多卡因的使用,人们始终观察到PONV发病率的显著降低,尽管手术内使用雷米芬坦尼尔减少,但异质性微不足道.
结论:
- 静脉注射利多卡因是安全的,并且在VATS患者中表现出可重现的抗效应,显著降低了PONV.
- 目前的证据表明,利多卡因在VATS中没有改善术后疼痛或阿片类药物消耗.
- 需要进行更大规模的标准化试验,以探索特定患者亚组的潜在益处,或用于胸部微创手术的多种剂量策略.
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