利多卡因能改善术后认知功能障碍？

摘要译文（供参考）

静脉注射利多卡因改善腹腔镜结直肠手术患者术后认知：

一项随机、双盲、对照研究

背景：

腹腔镜手术中术后认知功能障碍（postoperative cognitive dysfunction，POCD）的风险不容忽视。静脉注射利多卡因可以减少腹腔镜手术患者的围手术期炎症反应，而术中静脉注射利多卡因对腹腔镜结直肠癌癌症手术患者术后认知功能的影响尚未得到很好的研究。我们研究了腹腔镜结直肠癌根治术后术中利多卡因是否改善术后认知功能。

方法：

我们进行了一项前瞻性、随机、双盲对照试验，研究静脉注射利多卡因对腹腔镜癌症根治术患者术后快速康复的影响。

试验流程如下

患者被随机分配接受静脉注射利多卡因（麻醉前30分钟静脉注射2mg/kg利多卡因，术中泵注利多卡因2mg/kg/h直至手术结束）或生理盐水（相同时间点，相同剂量，相同速度）。

主要结果是认知功能障碍，即在术后第3天和第7天，从术前到术后，简易精神状态量表（Mini-Mental State Examination，MMSE）评分下降≥2。

次要结果是MMSE原始评分和患者术后恢复的参数，如躁动和在麻醉后复苏单元（post-anaesthesia care unit，PACU）的停留时间、住院时间、炎症标志物（白细胞计数和CRP）和并发症发生率。

结果：

利多卡因组73名患者和对照组77名患者完成了试验。

利多卡因组的认知功能障碍发生率低于对照组，术后第3天（每组分别为18.57%和63.64%；RR=0.26，95%CI=0.19-0.32；p<0.001）和第7天（每组各为12.33%和53.25%；RR=0.28，95%CI=0.22-0.35；p<0.001）

利多卡因组术后MMSE评分高于对照组，术后第3天中位数分别为25和24，术后第七天中位数分别26和24。

此外，利多卡因组患者在术后第1天的白细胞计数低于对照组（8.5±2.7 vs.10.4±3.3；p＜0。001）。

其他次要结果、术中用药情况没有差异。

术后恢复方面两组无显著统计学差异

结论：

腹腔镜癌症根治术患者术中静脉注射利多卡因可显著改善术后认知功能。

试验注册：

中国临床试验注册中心（2022年1月16日，注册号：ChiCTR220055683）。

关键词：

腹腔镜结直肠手术；利多卡因；术后认知功能障碍；随机对照试验。

Intravenous lidocaine improves postoperative cognition in patients undergoing laparoscopic colorectal surgery: a randomized, double-blind, controlled study

Abstract

Background:The risk of postoperative cognitive dysfunction(POCD) in laparoscopic surgery should not be overlooked. Intravenous lidocaine can reduce perioperative inflammatory response in patients undergoing laparoscopic surgery, while the effect of intraoperative intravenous lidocaine on postoperative cognitive function in patients undergoing laparoscopic colorectal cancer surgery has not been well studied. We investigated whether intraoperative lidocaine improves postoperative cognitive function after laparoscopic radical resection for colorectal cancer.

Methods:We conducted a prospective, randomized double blinded controlled trial to investigate the effect of intravenous lidocaine on rapid postoperative recovery in patients undergoing laparoscopic radical resection of colorectal cancer. The patients were randomly assigned to receive either intravenous lidocaine or saline. The primary outcome was cognitive dysfunction defined by a decrease from pre- to postoperative ≥ 2 of the Mini-Mental State Examination (MMSE) score, at the 3rd and the 7th postoperative days. Secondary outcomes were the MMSE raw score and parameters of the patients' postoperative recovery such as agitation and length of stay in the post-anaesthesia care unit (PACU), length of hospital stay, markers of inflammation (white blood cell count and CRP), and incidence of complications.

Results:Seventy-three patients in the lidocaine group and 77 patients in the control group completed the trial. The rate of cognitive dysfunction was lower in the lidocaine group than that in the control group, both at the 3rd (18.57% vs. 63.64% for each group respectively; RR = 0.26, 95%CI = 0.19-0.32; p < 0.0001) and at the 7th postoperative day (12.33% vs. 53.25% for each group respectively; RR = 0.28, 95%CI = 0.22-0.35; P < 0.001). The postoperative MMSE scores were also higher in the lidocaine group than in the control group both at the 3rd (median 25 vs. 24 respectively) and at the 7th postoperative day (26 vs. 24 respectively). Also, patients in the lidocaine group displayed a lower white blood cell count than the control group at the 1st postoperative day (8.5 ± 2.7 vs. 10.4 ± 3.3; p < 0. 001). No differences were evidenced for the other secondary outcomes.

Conclusions:Intraoperative intravenous lidocaine can significantly improve postoperative cognitive function in patients undergoing laparoscopic radical resection of colorectal cancer.

Trial registration:Chinese Clinical Trial Registry (16/1/2022, registration number: ChiCTR2200055683).

Keywords:Laparoscopic colorectal surgery; Lidocaine; Postoperative cognitive dysfunction; Randomized controlled trial.