利多卡因、奥布卡因与丁卡因在喉镜诊疗中表面麻醉效果的系统评价

Systematic Review of Topical Anesthesia Effects of Lidocaine,Oxybuprocaine and Tetracaine in Electronic Laryngoscopy

目的:基于荟萃分析(Meta分析)方法,比较利多卡因、奥布卡因与丁卡因在喉镜诊疗中的表面麻醉效果。方法:系统检索PubMed、Embase、the Cochrane Library、中国知网和万方数据库,筛选利多卡因或奥布卡因与1%丁卡因在喉镜诊疗中表面麻醉效果比较的随机对照试验,检索时间跨度为自建库至2020年12月。由2名研究者独立、严格进行纳入研究的质量评价和资料提取,采用RevMan 5.3软件进行Meta分析。结果:最终纳入13篇文献,共4303例患者。Meta分析结果显示,2%利多卡因超声雾化表面麻醉的显效率、总有效率明显优于1%丁卡因喷雾(显效率:RR=1.37,95%CI=1.28~1.46,P<0.00001;总有效率:RR=1.09,95%CI=1.06~1.13,P<0.00001),差异均有统计学意义;2%利多卡因超声雾化表面麻醉的显效率、总有效率与1%丁卡因超声雾化相当(显效率:RR=1.00,95%CI=0.96~1.03,P=0.94;总有效率:RR=1.00,95%CI=0.98~1.02,P=0.76),差异均无统计学意义;0.4%奥布卡因滴眼液表面麻醉在显效率方面具有优于1%丁卡因的趋势(RR=1.23,95%CI=0.87~1.73,P=0.25);奥布卡因凝胶表面麻醉的显效率优于1%丁卡因(RR=1.16,95%CI=1.00~1.34,P=0.05);0.4%奥布卡因滴眼液、奥布卡因凝胶表面麻醉的总有效率均与1%丁卡因相当(0.4%奥布卡因滴眼液:RR=1.01,95%CI=0.99~1.04,P=0.32;奥布卡因凝胶:RR=1.06,95%CI=0.88~1.27,P=0.53),差异均无统计学意义;奥布卡因凝胶的药品不良反应发生率明显低于1%丁卡因,差异有统计学意义(RR=0.10,95%CI=0.01~0.77,P=0.03)。结论:在喉镜诊疗中,采用2%利多卡因超声雾化、0.4%奥布卡因滴眼液及奥布卡因凝胶进行表面麻醉,其显效率、总有效率均稍优于或者相当于1%丁卡因;另外,奥布卡因凝胶比1%丁卡因表面麻醉更安全。

OBJECTIVE:To compare the topical anesthesia effects of lidocaine,oxybuprocaine and tetracaine in electronic laryngoscopy.METHODS:PubMed,Embase,the Cochrane Library,CNKI and Wanfang database were retrieved to extract the randomized clinical trials of the topical anesthesia effects of lidocaine or oxybuprocaine and 1%tetracaine in the electronic laryngoscopy.The retrieval time was from the establishment of the database to Dec.2020.Two researchers independently screened the literature according to the inclusion and exclusion criteria,and evaluated the methodological quality of included studies.Meta-analysis was performed by using RevMan 5.3 software.RESULTS:Thirteen articles were collected,including 4303 patients.Meta-analysis results showed that the significant effective rate and total effective rate of 2%lidocaine ultrasonic atomization topical anesthesia were significantly better than 1%tetracaine spray(significant effective rate:RR=1.37,95%CI=1.28-1.46,P<0.00001;total effective rate:RR=1.09,95%CI=1.06-1.13,P<0.00001),the differences were statistically significant.The significant effective rate and total effective rate of 2%lidocaine ultrasonic atomization topical anesthesia were similar to 1%tetracaine ultrasonic atomization(significant effective rate:RR=1.00,95%CI=0.96-1.03,P=0.94;total effective rate:RR=1.00,95%CI=0.98-1.02,P=0.76),the difference was not statistically significant.The significant effective rate of topical anesthesia with 0.4%oxybuprocaine eye drops was better than that with 1%tetracaine(RR=1.23,95%CI=0.87-1.73,P=0.25).The significant effective rate of topical anesthesia with oxybuprocaine gel was better than 1%tetracaine(RR=1.16,95%CI=1.00-1.34,P=0.05).The total effective rates of topical anesthesia in 0.4%oxybuprocaine eye drops and oxybuprocaine gel were similar to that of 1%tetracaine(0.4%oxybuprocaine eye drops:RR=1.01,95%CI=0.99-1.04,P=0.32;oxybuprocaine gel:RR=1.06,95%CI=0.88-1.27,P=0.53),with no statistically significant difference.The incidence of adverse drug reactions of obucaine gel was significantly lower than that of 1%tetracaine,and the difference was statistically significant(RR=0.10,95%CI=0.01-0.77,P=0.03).CONCLUSIONS:The significant effective rate and total effective rate of 2%lidocaine ultrasonic atomization,0.4%oxybuprocaine eye drops and oxybuprocaine gel are slightly superior or equivalent to 1%tetracaine in topical anesthesia effects of the electronic laryngoscopy.In addition,oxybuprocaine gel is safer than 1%tetracaine in topical anesthesia.