无创局部麻醉在小儿静脉穿刺中应用的随机对照试验的meta分析  

The application of noninvasive local anesthesia for venipuncture in children:a metaanalysis of randomized controlled trials

作　　者：蒋运兰[1] 胡月 李慧敏 李雪 周玲 李健琼[1] 王会芳[1] 杨淑艳[1] 沈音丽 唐欣[1] JIANG Yunlan;HU Yue;LI Huimin;LI Xue;ZHOU Ling;LI Jianqiong;WANG Huifang;YANG Shuyan;SHEN Yinli;TANG Xin(Department of Nursing,Affiliated Hospital of Chengdu University of TCM,Chengdu,Sichuan 610075,P.R.China;Department of Nursing,Chengdu Women’s and Children’s Central Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu,Sichuan 611731,P.R.China)

机构地区：[1]成都中医药大学附属医院护理部,成都610075 [2]电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院护理部,成都611731

出　　处：《华西医学》2021年第7期940-948,共9页West China Medical Journal

基　　金：四川省卫生和计划生育委员会重点项目(17ZD032);四川省教育厅重点项目(17ZA0142)。

摘　　要：目的系统评价局部麻醉(局麻)在小儿静脉穿刺中应用的有效性及安全性,为相关的护理实践提供证据参考。方法计算机检索Web of Science、PubMed、Cochrane Library、Embase、中国知网、万方、中国生物医学文献数据库和维普网数据库,检索时限均为建库至2021年6月25日,收集所有局麻在小儿静脉穿刺中应用的高质量随机对照试验(randomized controlled trial,RCT)。由2名研究者独立筛选文献、提取资料并评价偏倚风险。应用RevMan 5.3软件进行meta分析。结果共纳入19篇RCT,包括2566例患者,均为SCI或Medline收录的高质量英文文献。Meta分析结果显示:局麻组的穿刺无痛率[比值比(odds ratio,OR)=3.80,95%置信区间(confidence interval,CI)(1.88,7.66),P=0.0002]、满意度[OR=2.12,95%CI(1.27,3.54),P=0.004]高于无局麻组,疼痛评分则低于无局麻组[均数差=-0.62分,95%CI(-0.77,-0.48)分,P<0.00001]。两组间首针成功率[OR=1.14,95%CI(0.77,1.68),P=0.52]、一过性皮肤反应发生率[OR=1.15,95%CI(0.67,1.95),P=0.62]、穿刺部位苍白发生率[OR=1.11,95%CI(0.57,2.15),P=0.76]、穿刺部位水肿发生率[OR=0.64,95%CI(0.21,1.96),P=0.44]比较,差异均无统计学意义。结论局麻在小儿静脉穿刺中能有效降低疼痛,提高患儿满意度,且具备良好的临床安全性,可供护理人员在临床实践需要时选用。Objective To systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children,and to provide evidence for related nursing practice.Methods Web of Science,PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,Wanfang Data,Chinese Biomedical Database and VIP databases were searched for randomized controlled trials(RCTs)about the application of local anesthesia in venipuncture in children till June 25 th,2021.Two reviewers independently reviewed the literature,extracted data,and assessed the risk of bias of included RCTs.RevMan 5.3 software was used for meta-analysis.Results A total of 19 RCTs were included,comprising2566 patients.All of them were high-quality English articles included in SCI or Medline.The results of meta-analysis showed that:the painless rate[odds ratio(OR)=3.80,95%confidence interval(CI)(1.88,7.66),P=0.0002]and satisfaction rate of venipuncture[OR=2.12,95%CI(1.27,3.54),P=0.004]in the local anesthesia group were higher than those in the non-anesthesia group,and the pain score[mean difference=-0.62,95%CI(-0.77,-0.48),P<0.00001]in the local anesthesia group was lower than that in the non-anesthesia group.There was no statistically significant difference between the two groups in the success rate of the first puncture[OR=1.14,95%CI(0.77,1.68),P=0.52],the incidence of transient skin reactions[OR=1.15,95%CI(0.67,1.95),P=0.62],the incidence of paleness[OR=1.11,95%CI(0.57,2.15),P=0.76],or the incidence of edema at the puncture site[OR=0.64,95%CI(0.21,1.96),P=0.44].Conclusions Local anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture,and has good clinical safety.It can be used by nursing staff in clinical practice.

关 键 词：静脉穿刺 小儿 局部麻醉 META分析 随机对照试验 

分 类 号：R726.1[医药卫生—儿科]