胰腺癌切除术患者术中静脉输注利多卡因与生存率的关系：回顾性研究
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Association between intraoperative intravenous lidocaine infusion and survival in patients undergoing pancreatectomy for pancreatic cancer: a retrospective study
背景与目的
静脉注射利多卡因已被证实可以减少阿片类药物的使用，并与术后良好的预后相关。在本研究中，我们探讨了术中输注利多卡因是否减少了胰腺癌手术中阿片类药物的使用和住院时间(LOS)，并改善了胰腺癌术后的长期生存率。
方 法
本项回顾性研究纳入了2014年1月至2017年12月接受胰腺切除术的2239名患者。将患者分为非利多卡因组和利多卡因组(麻醉诱导时一次性注射1.5 mg kg-1，术中持续输注2mg kg-1 h-1)。记录术后紧急镇痛阿片类用量和LOS的总体情况。倾向性评分匹配用于最小化偏差，并比较两组之间的无癌生存率和总生存率。
结 果
倾向性评分匹配后，两组患者特征无显著性差异。利多卡因组术中舒芬太尼用量及术后紧急镇痛的用量均显著低于非利多卡因组。两组之间的LOS相似。两组间无癌生存率无显著性差异（危险比[HR]=0.913；95% CI 0.821~1.612；P=0.316）。利多卡因组1年和3年总生存率显著高于非利多卡因组（68.0% vs 62.6%, P<0.001; 34.1% vs 27.2%, P=0.011）。多变量分析显示术中输注利多卡因与总生存期延长有关（HR=0.616; 95% CI, 0.290~0.783; P=0.013）。
结 论
术中静脉输注利多卡因可改善胰腺癌切除术患者的总生存率。
原始文献来源及摘要
Zhang H, Yang L, Zhu X, et al. Association between intraoperative intravenous lidocaine infusion and survival in patients undergoing pancreatectomy for pancreatic cancer: a retrospective study.[J].Br J Anaesth,2020 May 28. pii: S0007-0912(20)30304-4. doi: 10.1016/j.bja.2020.03.034.
Abstract
Background: Intravenous lidocaine has been shown to reduce opioid consumption and is associated with favourable outcomes after surgery. In this study, we explored whether intraoperative lidocaine reduces intraoperative opioid use and length of stay (LOS) and improves long-term survival after pancreatic cancer surgery.
Methods: This retrospective study included 2239 patients who underwent pancreatectomy from January 2014 to December 2017. The patients were divided into non-lidocaine and lidocaine (bolus injection of 1.5 mg kg-1 at the induction of anaesthesia followed by a continuous infusion of 2 mg kg-1 h-1 intraoperatively) groups. The overall use of postoperative rescue analgesia and LOS were recorded. Propensity score matching was used to minimise bias, and disease-free survival and overall survival were compared between the two groups.
Results: After propensity score matching, patient characteristics were not significantly different between groups. Intraoperative sufentanil consumption and use of postoperative rescue analgesia in the lidocaine group were significantly lower than those in the non-lidocaine group. The LOS was similar between groups. There was no significant difference in disease-free survival between groups (hazard ratio [HR]=0.913; 95% confifidence interval [CI], 0.821~1.612; P=0.316). The overall survival rates at 1 and 3 yr were significantly higher in the lidocaine group than in the non-lidocaine group (68.0% vs 62.6%, P<0.001; 34.1% vs 27.2%, P=0.011). The multivariable analysis indicated that intraoperative lidocaine infusion was associated with a prolonged overall survival (HR=0.616; 95% CI, 0.290~0.783; P=0.013).
Conclusion: Intraoperative intravenous lidocaine infusion was associated with improved overall survival in patients undergoing pancreatectomy.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：曹莹