Objective:To systematic evaluate the anesthesia efficacy of supply 2% ariticaine infiltration for 4%lidocaine IANB in patients with irreversible pulpitis in mandibular posterior teeth.Methods:Searched databases up to December 31 2013 such as:Cochrane Central Register Trials;Pubmed;EMbase;OVID;CBM;VIP;Wan Fang;CNKI,as well as retrieved special j ournals;conference proceedings and the references of those studies.Collected all of random control trials (RCT)about comparing anesthesia efficacy of articaine and lidocaine in patients with irre-versible pulpits.Studies should provided Related Risk (RR).Performed meta-analysis by using Review Manager 5 . 1 ,employed GRADE profiler 3 .6 to evaluate the evidence’quality afterwards.Results:Within 4 RCT,according to Meta-analysis,supply 2%ariticaine infiltration for 4%lidocaine IANB have a probability of achieving successful an-esthesia superior to that of solo 2% lidocaine local anesthesia in patients with irreversible pulpitis in mandibular pos-terior teeth(RR=1.51,95%CI:1.23~1.87,P=0.0001).There into,the subgroup analysis show that supply 4%ariticaine infiltration for 2% lidocaine IANB not only have a superiority in success of anesthesia than that of solo 2%lidocaine IANB in patients with irreversible pulpitis in mandibular posterior teeth(RR=1.69,95%CI:1.09~2.62, P=0.02),but also the same to 2% lidocaine IANB supply with 2% lidocaine infiltrationRR=1.44,95%CI:1.14~1.82,P=0.002).All the evidence are at level of very low when based on GRADE system.Conclusion:The current evidence supporting using supply 4% ariticaine infiltration for 2% lidocaine IANB vs.solo 2% lidocaine local anes-thesia in patients with irreversible pulpitis in mandibular posterior teeth are very low,particularly considering the lack of the related research in China,further high quality RCT are in need in the future.%目的：：系统评价在下颌后牙不可逆牙髓炎治疗中,2%利多卡因行下牙槽神经阻滞联合4%阿替卡因局部浸润和仅用2%利多卡因的局部麻醉效果差异。方法：计算机检索 Cochrane 图书馆、Pubmed、Embase、OVID、CBM、维普、万方、中国知网,同时检索相关专业杂志,会议记录,以及相关文献的参考文献,纳入相关利多卡因和阿替卡因在不可逆牙髓炎中比较的所有随机对照试验,时间截止至2013年12月31日。采用Cochrane手册中提供偏倚风险评价方法对文献进行方法学质量评价。使用 GRADE 系统评估证据质量等级。结果：共纳入4个随机对照试验,Meta分析结果显示,利多卡因联合阿替卡因组的麻醉成功率优于仅使用利多卡因组(RR=1.51,95%CI：1.23,1.87,P=0.0001),其中亚组分析利多卡因下牙槽神经阻滞联合阿替卡因局部浸润的麻醉效果也优于仅用利多卡因下牙槽神经阻滞[(RR=1.69,95%CI：1.09,2.62,P=0.02)或利多卡因下牙槽神经阻滞联合利多卡因局部浸润组(RR=1.44,95%CI：1.14,1.82,P=0.002)。GRADE 系统评价显示证据水平均为极低级。结论：在下颌后牙不可逆牙髓炎中,当前支持利多卡因联合阿替卡因的麻醉效果优于仅使用利多卡因的证据等级极低,且缺乏中国地区的相关研究,未来需更多高质量随机对照试验以进一步论证。
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