利多卡因乳膏与阴茎背神经阻滞在包皮环切术中麻醉效果比较的系统评价

摘要

Objective To compare the anesthetic effect of lidocaine cream and dorsal penile nerve block in circumcision.Methods Randomized controlled trials on the anesthetic effects of lidocaine cream and dorsal penile nerve block in circumcision were searched in Pubmed,Cochrane Library,Web of Science,CNKI,Wanfang database over the period from the inception of the databases to Feb.2017.All data were extracted critically and independently by two reviewers.Meanwhile,references from each literature were further retrieved.Results A total of 9 trials involving 1 583 patients were selected according to the inclusion criteria.The results of systematic review showed that,for children over 2 years old,dorsal penile nerve block had a longer anesthesia time,compared with lidocaine cream;for infants,lidocaine cream had a higher score in Neonatal Infant Pain Scale (P ＜0.001).Changes in the heart rate and respiratory rate also confirmed that dorsal penile nerve block had better anesthetic effect.Conclusion The current evidence indicates that lidocaine cream has no anesthetic advantage over dorsal penile nerve block.%目的 系统评价利多卡因乳膏与阴茎背神经阻滞在包皮环切术中的麻醉效果的比较.方法 计算机检索PubMed、Cochrane Library、Web of Science、知网、万方数据库的所有有关利多卡因乳膏和阴茎背神经阻滞在包皮环切术中麻醉效果比较的随机对照试验的文献;同时,手动检索纳入文献的参考文献.检索时间均为建库时间至2017年2月1日.由2位研究员独立对每一篇符合纳入标准的文献进行质量评价和资料提取,并交叉核对.结果 最终纳入9个随机对照试验,共1 583例患儿,结果显示在儿童(＞2岁)中,阴茎背神经阻滞组患者的麻醉持续时间较利多卡因乳膏组患儿长;在新生儿当中,利多卡因乳膏组患儿疼痛评估量表的评分高于阴茎背神经阻滞患儿(P＜0.001),加上术中心率或呼吸频率等多项比较,均表明阴茎背神经阻滞的麻醉效果优于利多卡因乳膏.结论 现有的研究没有足够证据证明利多卡因乳膏的麻醉效果优于阴茎背神经阻滞.