利多卡因预防丙泊酚注射痛效果的Meta分析

Efects of Lidocaine on Preventing Pain on Injection of Propofol:A Meta-Analysis

目的 系统评价利多卡因预防丙泊酚注射痛的效果。方法 计算机检索The Cochrane Library（2012年第4期），PubMed、MEDLINE、Ovid、HighWire、EMbase、CBM和CNKI等数据库，收集采用利多卡因预防丙泊酚注射痛的随机对照试验（RCT），检索时限均为1985年1月～2012年12月，并追溯纳入研究的参考文献。由2位评价者按照纳入与排除标准独立筛选文献、提取资料和评价质量后，采用RevMan 5.1软件进行Meta分析。结果 最终纳入15篇文献，共1 332个患者。Meta分析结果显示：丙泊酚内混入不同剂量利多卡因，患者注射痛的发生率明显低于空白对照组，两组差异有统计学意义［RR=0.36，95%CI（0.30，0.44），P〈0.000 01］；预先给予不同剂量利多卡因，患者注射痛发生率明显低于空白对照组，两组差异有统计学意义［RR=0.59，95%CI（0.47，0.75），P〈0.000 1］；扎止血带后给予不同剂量利多卡因，患者注射痛的发生率明显低于空白对照组，两组差异有统计学意义［RR=0.44，95%CI（0.37，0.52），P〈0.000 01］。结论 利多卡因能减少丙泊酚注射痛。扎止血带后给予40 mg利多卡因是相对有效减少丙泊酚注射痛的方法，且其更适合无术前用药的门诊静脉全麻患者。

Objective To systematically review the effects of lidocaine for preventing pain on injection of propofol. Methods Databases including The Cochrane Library （Issue 4, 2012）, PubMed, MEDLINE, Ovid, HighWire, EMbase, CBM and CNKI were searched electronically to collect literature published from January, 1985 to December, 2012. Randomized controlled trials （RCTs） were indentified about lidocaine for preventing injection pain of propofol. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Fifteen trials involved 1 332 patients were included. The results of meta-analysis indicated that, adding lidocaine into propofol lowered the incidence of pain on injection compared with blank control, with a significant difference （RR=0.36, 95%CI 0.30 to 0.44, P〈0.000 01）; using different doses of lidocaine before injection lowered the incidence of pain on injection compared with blank control, with a significant difference （RR=0.59, 95%CI 0.47 to 0.75, P〈0.000 1）; using different doses of lidocaine after venous occlusion lowered the incidence of pain on injection compared with blank control, with a significant difference （RR=0.44, 95%CI 0.37 to 0.52, P〈0.000 01）. Conclusion Lidocaine could reduce the pain on injection of propofol. Using lidocaine 40 mg after venous occlusion is a relatively effective method to lower the incidence of pain on injection which is more suitable for outpatient who receive intravenous anesthesia without preoperation medication.