目的 系统评价持续静脉应用利多卡因对术后谵妄发生率的影响。方法 计算机系统检索CNKI、万方、PubMed、Embase、Cochrane图书馆及中华医学会数据库,检索时间截至2025年12月。中文检索词包括“利多卡因”“术后谵妄”“术后认知功能障碍”“术后谵妄症” ,英文检索词包括“Lidocaine”或“ Lidocaine Hydrocarbonate”或“Xyloneural”和“Postoperative delirium”或“delirium after surgery”或“delirium after surgical intervention”或“delirium after surgical repair”等。采用主题词与自由词相结合的方式进行检索。由两名研究人员独立进行文献筛选、数据提取及质量评价,采用Review Manager 5.3及Stata16.0软件进行统计分析。结果 共纳入6篇随机对照试验研究,共计患者530例。Meta分析结果显示,与对照组比较,利多卡因组术后谵妄(RR=0.35,95%CI:0.24~0.52,P<0.001) 的发生率明显降低,术后1 d血清IL-6浓度(MD=-13.94,95%CI:-15.86～-12.02,P＜0.001)和TNF-α浓度也明显降低(MD=-11.00,95%CI:-16.24～-5.75,P＜0.001)。结论 围手术期持续静脉应用利多卡因能降低术后谵妄发生风险,降低患者术后1 d血清IL-6浓度和TNF-α浓度。
Abstract
Objective To systematically evaluate the effect of continuous intravenous application of lidocaine on the incidence of postoperative delirium. Methods Computerized searches were conducted in CNKI, Wanfang Data, PubMed, Embase, Cochrane Library, and the Chinese Medical Association Database, and the search period ended in December 2025. English search terms included “Lidocaine”, “Lidocaine Hydrocarbonate”, or “Xyloneural”, combined with “Postoperative delirium”, “delirium after surgery”, “delirium after surgical intervention”, or “delirium after surgical repair”, etc. A combination of subject terms and free-text words was used, supplemented by manual screening of the reference lists of included studies. Two researchers independently performed the literature screening, data extraction, and quality assessment. Statistical analysis was conducted using Review Manager 5.3 and Stata 16.0. Results A total of 6 randomized controlled trials were included, involving 530 patients. Meta-analysis showed that compared with the control group, the lidocaine group had a significantly lower incidence of postoperative delirium (RR=0.35, 95%CI: 0.24-0.52, P<0.001). Serum levels of IL-6 (MD=-13.94, 95%CI:-15.86 to -12.02, P<0.001) and TNF-α (MD=-11.00, 95%CI: -16.24 to -5.75, P<0.001) on postoperative day 1 were also significantly reduced. Conclusions Continuous perioperative intravenous administration of lidocaine can reduce the risk of postoperative delirium and decrease serum concentrations of IL-6 and TNF-α on postoperative day.
关键词
利多卡因 /
术后谵妄 /
静脉 /
Meta分析 /
研究
Key words
lidocaine /
postoperative delirium /
intravenous /
Meta-analysis /
research
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参考文献
[1] Thedim M, Vacas S. Postoperative delirium and the older adult: untangling the confusion[J]. J Neurosurg Anesthesiol, 2024, 36(3):184-189.
[2] 哈拉哈提·哈尔肯, 苏 涛, 喇宏玲, 等. 老年患者术后谵妄危险因素的研究进展[J]. 中国现代医生, 2024, 62(34):96-99.
[3] Bellelli G, Morandi A, Santo S G, et al. "Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool[J]. BMC Med, 2016, 14: 106.
[4] Inouye S K, Westendorp R G, Saczynski J S. Delirium in elderly people[J]. Lancet, 2014, 383(9920):911-922.
[5] Yan E, Veitch M, Saripella A, et al. Association between postoperative delirium and adverse outcomes in older surgical patients: a systematic review and meta-analysis[J]. J Clin Anesth, 2023, 90: 111221.
[6] Zhuang X, He Y, Liu Y, et al. The effects of anesthesia methods and anesthetics on postoperative delirium in the elderly patients: a systematic review and network meta-analysis[J]. Front Aging Neurosci, 2022, 14: 935716.
[7] 高升润,李 芸,李雨衡,等.基于机器学习算法构建术后谵妄风险预测模型的研究进展[J].武警医学,2024,35(2):181-184.
[8] 居热提·库德热提, 艾力克木·艾合买提, 张宇轩, 等. 利多卡因通过HMGB1/RAGE信号改善缺血性卒中大鼠血-脑脊液屏障通透性研究[J]. 脑与神经疾病杂志, 2023, 31(11):687-692.
[9] 陈红生, 沈 莹, 丁伟峰. 手术麻醉中静脉持续应用利多卡因对老年结直肠肿瘤手术患者术后肠道功能恢复及谵妄发生的影响[J]. 现代肿瘤医学, 2023, 31(3):481-484.
[10] 孙 阳. 不同麻醉药物对老年腹腔镜手术患者术后谵妄的影响[D]. 大连:大连医科大学, 2018.
[11] 郭红利. 不同剂量利多卡因对老年胸腔镜肺切除术患者术后谵妄的影响[D]. 重庆:西南医科大学, 2018.
[12] 王 萍, 李亚丽, 罗耀文, 等. 静注利多卡因对老年胸腔镜肺叶切除患者术后谵妄的影响[J]. 实用医学杂志, 2015, 31(16):2740-2742.
[13] Li X, Wu J, Lan H, et al. Effect of intraoperative intravenous lidocaine on postoperative delirium in elderly patients with hip fracture: a prospective randomized controlled trial[J]. Drug Des Devel Ther, 2023, 17: 3749-3756.
[14] Lai Y, Chen Q, Xiang C, et al. Comparison of the effects of dexmedetomidine and lidocaine on stress response and postoperative delirium of older patients undergoing thoracoscopic surgery: a randomized controlled trial[J]. Clin Interv Aging, 2023, 18: 1275-1283.
[15] Lahat A, Ben-horin S, Lang A, et al. Lidocaine down-regulates nuclear factor-kappaB signalling and inhibits cytokine production and T cell proliferation[J]. Clin Exp Immunol, 2008, 152(2): 320-327.
[16] Xiao M Z, Liu C X, Zhou L G, et al. Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: a review[J]. Medicine (Baltimore), 2023, 102(8): e32991.
[17] 崔应辉,王金伙,郭建荣. 基于Web of Science数据库2015年至2023年术后谵妄研究的文献计量学分析[J]. 国际麻醉学与复苏杂志,2025,46(5):476-484.
[18] Zhang C, Xie C, LU Y. Local Anesthetic lidocaine and cancer: insight into tumor progression and recurrence[J]. Front Oncol, 2021, 11:669746.
[19] 丁 浩, 符永健, 郑丽蓉, 等. 利多卡因对兔蛛网膜下腔出血后早期脑损伤的保护机制研究[J]. 四川大学学报(医学版), 2017, 48(2):230-233.
[20] 关婷婷, 吴新民. 利多卡因对DNP引发的电压依赖性钠电流变化的影响[J]. 解放军医学杂志, 2006, 31(8):809-810.
[21] Dorian P, Cass D, Schwartz B, et al. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation[J]. N Engl J Med, 2002, 346(12): 884-890.
[22] Dale G J, Phillips S, Falk G L. The analgesic efficacy of intravenous lidocaine infusion after laparoscopic fundoplication: a prospective, randomized, double blind, placebo controlled trial[J]. Local Reg Anesth, 2016, 9: 87-93.
[23] Lee I W, Schraag S. The use of intravenous lidocaine in perioperative medicine: anaesthetic, analgesic and immune modulatory aspects[J]. J Clin Med, 2022, 11(12):3568.
[24] Foo I, Macfarlane J R, Srivastava D, et al. The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety[J]. Anaesthesia, 2021, 76(2): 238-250.
[25] 牛 丽, 陈 晖. 高龄患者骶管麻醉引发短暂意识障碍1例[J]. 武警医学, 2024, 35(4):347-348.
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