静脉注射利多卡因预防围术期咳嗽：系统评价与回顾性分析
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Intravenous Lidocaine for the Prevention of Cough: Systematic Review and Meta-analysis of Randomized Controlled Trials
背景与目的
围术期麻醉引起的咳嗽短暂且具有自限性，可防治误吸，但咳嗽也可增加围术期快速心律失常、动脉高压、上呼吸道并发症等发生率，并可能增加颅内压、腹内压和眼压，对于某些高危患者，预防咳嗽是必要的。静脉注射利多卡因是气管插管期间预防咳嗽的一种方法，但目前尚不清楚对阿片类引起的咳嗽是否同样有效，对成人和儿童是否都有效，以及是否存在剂量敏感性和危害风险。
方 法
在电子数据库中收集2017年1月1日以前的手术患者静脉注射利多卡因和安慰剂预防咳嗽的随机对照试验。咳嗽发生率作为主要结果。用随机效应模型分析数据，并用风险比(RR) 和需要治疗人数(NNT)表示为95%置信区间。
结 果
样本中有20例成人试验（n = 3062）、5例儿童试验（n = 445）静脉注射利多卡因0.5～2 mg/kg预防插管、拔管或阿片类引起的咳嗽。其中有22例ASAⅠ～Ⅱ级患者，3例（n = 99）ASA Ⅲ级患者。无论剂量和咳嗽病因如何，与安慰剂组相比，利多卡因组成人和儿童的咳嗽发生率更低。成人试验数据显示咳嗽具有剂量敏感性：静脉注射利多卡因0.5mg/kg，RR为0.66(0.50～0.88)，NNT为8(5.4–14.3)；静脉注射利多卡因1mg/kg，RR为0.58(0.49～0.69)，NNT为7(4.6～8.9)；静脉注射利多卡因1.5mg/kg，RR为0.44(0.33～0.58)，NNT为5(3.3～5.2)；静脉注射利多卡因2 mg/kg，RR为0.39 (0.24～0.62)，NNT为3 (2.0～3.4)。不良反应报告极少。
结 论
静脉注射0.5～2 mg/kg的利多卡因，可呈剂量依赖性预防成人和儿童插管、拔管及阿片类引起的咳嗽，NNTs波动于8～3之间，但对高危患者的危害风险尚不清楚。
原始文献摘要
Sara C，Alessandro P，Martin RT，et al.Intravenous Lidocaine for the Prevention of Cough: Systematic Review and Meta-analysis of Randomized Controlled Trials[J].Anesth Analg，2018.
BACKGROUND: It remains unclear to what extent intravenous lidocaine prevents cough and whether there is dose-responsiveness and risk of harm.
METHODS: We searched electronic databases to January 1, 2017 for randomized trials comparing intravenous lidocaine with placebo for the prevention of cough in surgical patients. Primary outcome was the incidence of cough. Data were analyzed using a random-effects model and were expressed as risk ratio (RR) and number needed to treat (NNT) with 95% confidence interval.
RESULTS: In 20 trials in adults (n = 3062) and 5 trials in children (n = 445), intravenous lidocaine 0.5–2 mg·kg−1 was tested for the prevention of intubation-, extubation-, or opioid-induced cough. Twenty-two trials included only American Society of Anesthesiologists I or II patients; 3 trials (n = 99) also included American Society of Anesthesiologists III patients. Lidocaine was associated with a lower incidence of cough compared to placebo in adults and children, irrespective of dosage and cough etiology. Data from adults suggested dose-responsiveness; with 0.5 mg·kg−1, RR was 0.66 (0.50–0.88) and NNT was 8 (5.4–14.3); with 1 mg·kg−1, RR was 0.58 (0.49–0.69) and NNT was 7 (4.6–8.9); with 1.5 mg·kg−1, RR was 0.44 (0.33–0.58) and NNT was 5 (3.3–5.2); and with 2 mg·kg−1, RR was 0.39 (0.24–0.62) and NNT was 3 (2.0–3.4). Adverse effect reporting was sparse.
CONCLUSIONS: Within a range of 0.5–2 mg·kg−1, intravenous lidocaine dose dependently prevents intubation-, extubation-, and opioid-induced cough in adults and children with NNTs ranging from 8 to 3. The risk of harm in high-risk patients remains unknown.
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