利多卡因复合罗哌卡因组方麻醉有效性与安全性的系统评价

Effectiveness and Safety of Combination Prescription of Lidocaine with Ropivacaine for Anesthesia:A Systematic Review

目的:系统评价利多卡因复合罗哌卡因组方麻醉有效性与安全性,为研发新的复方麻醉制剂提供循证参考。方法:从中国期刊全文数据库,万方数据库、中文科技期刊数据库、Pub Med、EBSCO中检索利多卡因复合罗哌卡因对比单用利多卡因或单用罗哌卡因进行手术麻醉的随机对照试验(RCT),提取资料并评价质量后,采用Cochrane协作网提供的Rev Man 5.0统计软件进行Meta分析。结果:共纳入30项RCT,合计2 442例患者。Meta分析结果显示,利多卡因+罗哌卡因vs.利多卡因:起效时间6.77min vs.7.11 min[MD=-0.29,95%CI(-0.43,-0.16),P<0.001],维持时间5.11 h vs.2.11 h[MD=3.13,95%CI(3.02,3.25),P<0.001],不良反应发生率28.6%vs.44.6%[MD=0.43,95%CI(0.31,0.62),P<0.001];利多卡因+罗哌卡因vs.罗哌卡因:起效时间9.49 min vs.15.85 min[MD=-4.43,95%CI(-4.63,-4.22),P<0.001],维持时间4.84 h vs.6.79 h[MD=-0.61,95%CI(-0.71,-0.51),P<0.001],不良反应发生率44.8%vs.48.1%[MD=0.82,95%CI(0.56,1.19),P=0.30]。敏感性分析显示结果均呈稳定性。结论:利多卡因复合罗哌卡因进行手术麻醉具有起效快、维持时间长的特点,可减少两者单用的不良反应,发挥各自的优点。

OBJECTIVE:To systematically review the effectiveness and safety of combination prescription of lidocaine withropivacaine for anesthesia,and provide evidence-based reference for developing new compound preparation. METHODS:Retrievedfrom CJFD,Wanfang Database,VIP,PubMed and EBSCO,randomized controlled trials(RCT)about lidocaine combined withropivacaine versus lidocaine alone or ropivacaine alone for anesthesia were collected. Meta-analysis was performed by using RevMan 5.0 software provided by the Cochrane Collaboration after data extracting and quality evaluating. RESULTS:Totally 30 RCTwere included,involving 2 442 patients. Results of Meta-analysis showed,lidocaine+ropivacaine vs. lidocaine:onset time was 6.77min vs. 7.11 min [MD=-0.29,95%CI(-0.43,-0.16),P<0.001],maintenance time was 5.11 h vs. 2.11 h [MD=3.13,95%CI(3.02,3.25),P<0.001] and the incidence of adverse reactions was 28.6% vs. 44.6% [MD=0.43,95% CI(0.31,0.62),P<0.001];lidocaine+ropivacaine vs. ropivacaine:onset time was 9.49 min vs. 15.85 min [MD=-4.43,95%CI(-4.63,-4.22),P<0.001];maintenance time was 4.84 h vs. 6.79 h [MD=-0.61,95%CI(-0.71,-0.51),P<0.001];the incidence of adverse reactionswas 44.8% vs. 48.1% [MD=0.82,95%CI(0.56,1.19),P=0.30]. Sensitivity analysis showed that the results were in stability.CONCLUSIONS:Lidocaine combined with ropivacaine shows rapid onset and long duration in anesthesia,and it can reduce adversereactions play their respective advantages.