阿替卡因与利多卡因在牙科麻醉中的疗效比较：随机对照试验的荟萃分析

摘要(中文译文)

背景：尽管阿替卡因和利多卡因被广泛使用，但两者的疗效比较仍存在争议。方法：系统检索了PubMed、Web of Science、Cochrane Library和Embase，检索截止至2025年7月。结局按麻醉技术分层：浸润麻醉和神经阻滞麻醉。主要结局包括麻醉起效时间、麻醉持续时间、疼痛强度（视觉模拟量表，VAS）和麻醉成功率。连续变量以均数差（MD）及95%置信区间（CI）表示。对于二分类结局，计算风险比（RR）及95%CI。结果：共纳入36项随机对照试验（RCT），涉及3,088例病例。在浸润麻醉中，与利多卡因相比，阿替卡因起效更短（MD = −1.34 min；95%CI [-2.21, -0.47]；P = 0.002；I²=98%；低确定性），持续时间更长（MD = 18.68 min；95%CI [3.05, 34.30]；P = 0.02；I²=97%；中等确定性），疼痛评分更低（MD = −4.41；95%CI [-7.62, -1.21]；P = 0.007；I²=63%；中等确定性），而麻醉成功率无显著差异（RR = 1.03；95%CI [0.98, 1.08]；P = 0.30；I²=15%；中等确定性）。在神经阻滞麻醉中，与利多卡因相比，阿替卡因起效更短（MD = −0.27 min；95%CI [-0.40, -0.13]；P < 0.001；I²=69%；中等确定性），持续时间更长（MD = 53.63 min；95%CI [29.64, 77.62]；P < 0.001；I²=96%；高确定性），而两种麻醉药在疼痛强度（MD = 1.13；95%CI [−0.49, 2.75]；P = 0.17；I²=0%；中等确定性）和麻醉成功率（RR = 1.06；95%CI [0.90, 1.24]；P = 0.49；I²=33%；低确定性）方面表现相似。亚组分析表明，对于浸润麻醉，与利多卡因相比，阿替卡因在前磨牙中起效时间更短（P < 0.001）、持续时间更长（P = 0.003），在磨牙中疼痛评分更低（P < 0.001）。对于神经阻滞，常规剂量阿替卡因比利多卡因起效时间更短（P = 0.02）、持续时间更长（P < 0.001），而高剂量阿替卡因在持续时间上无差异（P = 0.07），且按研究方法学质量分层（SCI收录期刊与非SCI收录期刊）时，关键发现的方向一致。结论：与利多卡因相比，阿替卡因在浸润麻醉和神经阻滞麻醉中均与起效略快和麻醉持续时间更长相关，并在浸润麻醉中与更低的疼痛评分相关。然而，两种药物在各技术和亚组间的麻醉成功率相当。PROSPERO注册号：CRD420251110177

Abstract

BACKGROUND: Despite widespread use of articaine and lidocaine, their comparative efficacy remains debated. METHODS: A systematic search of PubMed, Web of Science, Cochrane Library, and Embase was conducted through July 2025. Outcomes were stratified by anesthesia technique: infiltration anesthesia and nerve block anesthesia. Primary outcomes included anesthetic onset time, anesthetic duration, pain intensity (Visual Analog Scale, VAS), and anesthetic success rate. Continuous variables were expressed as mean differences (MD) with 95% confidence intervals (CI). For dichotomous outcomes, risk ratio (RR) with 95%CI were computed. RESULTS: Thirty-six randomized controlled trials (RCTs) with 3,088 cases were included. In infiltration anesthesia, articaine showed shorter onset (MD = − 1.34 min; 95%CI [-2.21, -0.47]; P = 0.002; I²=98%; Low certainty), longer duration (MD = 18.68 min; 95%CI [3.05, 34.30]; P = 0.02; I²=97%; Moderate certainty), and lower pain scores (MD = − 4.41; 95%CI [-7.62, -1.21]; P = 0.007; I²=63%; Moderate certainty) than lidocaine, with no significant difference in anesthetic success rate (RR = 1.03; 95%CI [0.98, 1.08]; P = 0.30; I²=15%; Moderate certainty). In nerve block anesthesia, articaine showed shorter onset (MD = − 0.27 min; 95%CI [-0.40, -0.13]; P < 0.001; I²=69%; Moderate certainty) and longer duration (MD = 53.63 min; 95%CI [29.64, 77.62]; P < 0.001; I²=96%; High certainty) than lidocaine, while the two anesthetics performed similarly in terms of pain intensity (MD = 1.13; 95%CI [− 0.49, 2.75]; P = 0.17; I²=0%; Moderate certainty) and anesthetic success rate (RR = 1.06; 95%CI [0.90, 1.24]; P = 0.49; I²=33%; Low certainty). Subgroup analyses indicated that, for infiltration anesthesia, articaine had shorter onset time (P < 0.001) and longer duration (P = 0.003) in premolars, and lower pain scores in molars (P < 0.001) compared with lidocaine. For nerve block, conventional-dose articaine had shorter onset time (P = 0.02) and longer duration (P < 0.001) than lidocaine, while high-dose articaine showed no difference in duration (P = 0.07), and the direction of key findings was consistent when stratified by study methodological quality (SCI-indexed journals vs. non-SCI-indexed journals). CONCLUSIONS: Compared with lidocaine, articaine was associated with slightly faster onset and longer anesthetic duration in both infiltration and nerve block anesthesia, and with lower pain scores in infiltration anesthesia. However, anesthetic success rates were comparable between the two agents across techniques and subgroups. PROSPERO ID: CRD420251110177

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