Zhang Chengyuan, Foo Irwin
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Anaesthesia, Western General Hospital, Edinburgh, UK.
Ann Med Surg (Lond). 2020 Sep 11;59:72-75. doi: 10.1016/j.amsu.2020.09.008. eCollection 2020 Nov.
A best evidence topic was constructed using a described protocol. The three-part question addressed was: In patients undergoing cardiac surgery, does intravenous lidocaine exert a cardioprotective effect against postoperative myocardial ischaemia and reperfusion injury? Using the reported search, 461 papers were found, of which 5 studies represented the best evidence to answer the question. In 3 studies, lidocaine was associated with a postoperative fall in biomarkers of myocardial injury. An additional study lacked power, but the difference in biomarkers was marginally non-significant with a trend in favour of lidocaine. A final study evaluating ischaemic changes on continuous and 12 lead ECG found no benefit with lidocaine. The limited evidence suggests that lidocaine may be cardioprotective, although no study has demonstrated improvement in clinical outcomes. Furthermore, all trials were small studies with a multitude of dosing regimens in heterogenous patient populations. There is insufficient data to correlate dose with effect and not all studies measured plasma lidocaine concentration. The narrow therapeutic index and our current evidence base does not support lidocaine prophylaxis.
使用所述方案构建了一个最佳证据主题。所提出的三部分问题是：在接受心脏手术的患者中，静脉注射利多卡因是否对术后心肌缺血和再灌注损伤具有心脏保护作用？通过报告的检索，找到了461篇论文，其中5项研究代表了回答该问题的最佳证据。在3项研究中，利多卡因与术后心肌损伤生物标志物下降有关。另一项研究缺乏效力，但生物标志物的差异略无统计学意义，且有支持利多卡因的趋势。最后一项评估连续和12导联心电图缺血变化的研究未发现利多卡因有益。有限的证据表明利多卡因可能具有心脏保护作用，尽管没有研究证明临床结局有所改善。此外，所有试验都是小型研究，在异质患者群体中有多种给药方案。没有足够的数据将剂量与效果相关联，并非所有研究都测量了血浆利多卡因浓度。窄治疗指数和我们目前的证据基础不支持利多卡因预防。
