中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (15): 2838-2841.doi: 10.3969/j.issn.1673-8225.2011.15.043

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

利多卡因对心脏术后脑保护效果的Meta分析

王东进1，聂  岭2，王映纯3   

  1. 1南京中医药大学中西医结合鼓楼临床医学院胸心外科，江苏省南京市  210008
    2南京大学医学院附属鼓楼医院胸心外科，江苏省南京市  210008
    3南方医科大学中医药学院，广东省广州市  510515
  • 收稿日期:2010-10-06 修回日期:2010-11-29 出版日期:2011-04-09 发布日期:2013-11-06
  • 通讯作者: 聂岭，主治医师，主要从事胸心外科方面的临床研究。南京大学医学院附属鼓楼医院胸心外科，江苏省南京市 210008
  • 作者简介:王东进☆，博士，硕士生导师，主任医师，主要从事心脏心血管病外科的临床研究。 dong-jinwang@ hotmail.com

Cerebral protection with lidocaine following cardiac surgery: A meta-analysis

Wang Dong-jin1, Nie Ling2, Wang Ying-chun3   

  1. 1Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing  210008, Jiangsu Province, China
    2Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing  210008, Jiangsu Province, China
    3School of Traditional Chinese Medicine, Southern Medical University, Guangzhou  510515, Guangdong Province, China
  • Received:2010-10-06 Revised:2010-11-29 Online:2011-04-09 Published:2013-11-06
  • Contact: Nie Ling, Attending physician, Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
  • About author:Wang Dong-jin☆, Doctor, Master’s supervisor, Chief physician, Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210008, Jiangsu Province, China dong-jinwang@ hotmail.com

PDF

365

被引次数

7

摘要：

背景：虽然心脏手术日趋成熟，但术后认知障碍发生率仍然较高。利多卡因对脑的保护效应的研究结果不一。
目的：分析利多卡对心脏术后脑保护效果。
方法：在PubMed，Cochrane databases，CNKI和Ovid等数据库中系统检索有关利多卡因、心脏手术及脑保护的前瞻性的随机对照研究。提取术后认知障碍发生率及脑代谢相关的指标用于疗效评价，结果以优势比(OR)、加权均数差(WMD)和 95%可信区间(CI)表示。提取的资料采用Review Manager Version 5软件进行分析。
结果与结论：共有5篇含有术前和术后的神经心理学测试的文献及2篇关于术中脑代谢测量的文献入选。合并后的结果显示认术后的认知障碍和术前的差异无显著性意义，但在亚组分析中显示低年龄组和低剂量组的术后认知障碍较术前减少 (P < 0.05)。术中应用利多卡因能够在手术中降低动脉-颈内静脉血氧含量差，脑氧摄取率)及脑乳酸产生量(P < 0.05)。死亡及退出患者总数差异无显著性意义。结果说明现有证据不足以证明利多卡因有脑保护的作用，但应用在合适的临床情况下，利多卡因是有脑保护的作用的。

关键词: 利多卡因, Meta分析, 心脏手术, 脑保护, 随机对照研究

Abstract:

BACKGROUND: Although cardiac surgery becomes more mature, the ratio of cognitive deficits after surgery is still remains high. Some reports showed that lidocaine has neuroprotective effect, but their results are not totally identical.
OBJECTIVE: To assess the neuroprotective effect of lidocaine in cardiac surgery.
METHODS: A systematic literature search of PubMed, Cochrane databases, CNKI and Ovid was performed to identify relevant prospective randomized studies. The therapeutic effect and difference were evaluated using the odds ratio, weighted mean difference and 95% confidence interval. Review Manager Version 5 Software was used for the analysis of extracted data.
RESULTS AND CONCLUSION: Seven literatures were searched, including 5 addressing neuropsychological testing before and after surgery and 2 concerning cerebral metabolism. The pooled statistics showed lidocaine could not decrease in cognitive deficits, but there was a statistically significant decline of cognitive deficits in younger subgroup, low dose subgroup (P < 0.05). A decrease effect of lidocaine on Ca-jvO2, CERO2 and AVDL was observed during the whole CPB (P < 0.05). The incidence of death and withdraw showed no significant difference. There is no sufficient evidence to prove lidocaine is neuroprotective. But used in appropriate dosage regimens in specific clinical situations, lidocaine has neuroprotective effect.

中图分类号: