Salem Shebl E, Proudman Chris J, Archer Debra C
Institute of Infection and Global Health, Department of Epidemiology and Population Health, University of Liverpool, Wirral, CH64 7TE, UK.
Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
BMC Vet Res. 2016 Jul 27;12(1):157. doi: 10.1186/s12917-016-0784-7.
Perioperative lidocaine treatment is commonly used in horses that undergo surgical treatment of colic, to prevent or treat postoperative ileus and reduce the effects of intestinal ischaemia-reperfusion injury. However, its clinical efficacy has not been evaluated in a large population of horses undergoing small intestinal surgery. The aim of the current study was to evaluate whether systemic lidocaine administration reduced the prevalence, volume and duration of postoperative reflux and improved rates of survival following surgical treatment of small intestinal lesions. Data were collected as a part of two prospective studies investigating postoperative survival of surgical colic patients admitted to a UK equine referral hospital during the periods 2004-2006 and 2012-2014. Kaplan-Meier plots of cumulative probability of survival and the log-rank test were used to compare survival between horses that did or did not receive lidocaine. The Wilcoxon rank-sum test was used to compare the total reflux volume and duration of reflux between the groups. A multivariable Cox proportional hazards model was used to identify pre- and intraoperative risk factors for non-survival.
Data from 318 horses were included in the final analysis. The overall prevalence of postoperative reflux was 24.5 %. This was significantly higher (34.8 %) in horses admitted in 2012-2014 compared to the 2004-2006 cohort (16.7). Perioperative lidocaine treatment had no effect on total reflux volume, duration of reflux or rates of postoperative survival nor was it a risk factor associated with altered postoperative survival. Variables identified to be associated with increased risk of postoperative mortality included packed cell volume on admission (hazard ratio [HR] 1.03 95 %, 95 % confidence interval [CI] 1.004-1.06, p = 0.024), heart rate on admission (HR 1.014, 95 % CI 1.004-1.024, p =0.008) and duration of surgery (HR 1.007, 95 % CI 1.002-1.01, p = 0.008).
Lidocaine therapy had no effect on the prevalence of postoperative reflux, total reflux volume and duration of reflux nor did it have any effect on postoperative survival in horses undergoing surgical management of small intestinal disease for treatment of colic. There is a need for a well-designed multicentre, prospective randomised controlled trial to fully investigate the efficacy of lidocaine across different hospital populations.
围手术期利多卡因治疗常用于接受结肠手术治疗的马匹，以预防或治疗术后肠梗阻，并减轻肠道缺血再灌注损伤的影响。然而，其临床疗效尚未在大量接受小肠手术的马匹中进行评估。本研究的目的是评估全身给予利多卡因是否能降低术后反流的发生率、量和持续时间，并提高小肠病变手术治疗后的存活率。数据收集作为两项前瞻性研究的一部分，这两项研究调查了2004 - 2006年和2012 - 2014年期间入住英国一家马匹转诊医院的手术性结肠疾病患者的术后存活率。使用Kaplan - Meier生存累积概率图和对数秩检验来比较接受或未接受利多卡因治疗的马匹之间的存活率。使用Wilcoxon秩和检验来比较两组之间的总反流体积和反流持续时间。使用多变量Cox比例风险模型来确定非存活的术前和术中危险因素。
318匹马的数据纳入最终分析。术后反流的总体发生率为24.5%。与2004 - 2006年队列（16.7%）相比，2012 - 2014年入院的马匹术后反流发生率显著更高（34.8%）。围手术期利多卡因治疗对总反流体积、反流持续时间或术后存活率没有影响，也不是与术后存活率改变相关的危险因素。确定与术后死亡风险增加相关的变量包括入院时的红细胞压积（风险比[HR] 1.03，95%，95%置信区间[CI] 1.004 - 1.06，p = 0.024）、入院时的心率（HR 1.014，95% CI 1.004 - 1.024，p = 0.008）和手术持续时间（HR 1.007，95% CI 1.002 - 1.01，p = 0.008）。
利多卡因治疗对术后反流的发生率、总反流体积和反流持续时间没有影响，对接受小肠疾病手术治疗以治疗结肠疾病的马匹的术后存活率也没有任何影响。需要进行一项设计良好的多中心、前瞻性随机对照试验，以全面研究利多卡因在不同医院人群中的疗效。
