喉罩与气管插管在小儿全身麻醉气道管理中价值的Meta分析

目的比较喉罩与气管插管在小儿全身麻醉气道管理中的疗效和安全性。方法计算机检索PubMed、Cochrane Library、EMbase、CBM、VIP、CNKI和万方数据库中相关的随机对照试验(RCT)。检索时间均从建库至2010年11月。由两位研究者按照纳入与排除标准选择试验、提取资料,并根据Cochrane系统评价员手册5.0提供的质量评价标准评价纳入研究质量后,采用RevMan 5.0软件进行Meta分析。结果共纳入39个RCT,共2612例患儿。Meta分析结果显示:与气管插管相比,喉罩可以降低苏醒期和术后呛咳RR=0.21,95%CI(0.15,0.28),P<0.00001]、喉/支气管痉挛RR=0.37,95%CI(0.18,0.77),P=0.008]、躁动RR=0.14,95%CI(0.09,0.22),P<0.00001]、术后咽喉痛RR=0.32,95%CI(0.19,0.55),P<0.0001]、声音嘶哑RR=0.09,95%CI(0.03,0.27),P<0.0001]、恶心呕吐的发生率RR=0.46,95%CI(0.26,0.80),P=0.006];喉罩组插入期心率改变SMD=–1.18,95%CI(–1.59,–0.77),P<0.00001]、拔除时心率改变SMD=–1.29,95%CI(–1.72,–0.86),P<0.00001]、拔除后心率改变SMD=–1.51,95%CI(–2.15,–0.87),P<0.00001],以及插入时MAP改变SMD=–1.21,95%CI(–1.39,–1.02),P<0.00001]、拔除时MAP改变SMD=–1.31,95%CI(–1.77,–0.85),P<0.00001]、拔除后MAP改变SMD=–0.85,95%CI(–1.24,–0.46),P<0.0001]均小于气管插管组,而在术后反流误吸RR=3.00,95%CI(0.62,14.61),P=0.17]、首次置入成功率RR=0.99,95CI(0.94,1.05),P=0.84]方面两组差异无统计学意义。结论现有证据显示,小儿全麻时应用喉罩,其苏醒期及术后并发症少于气管插管,且喉罩置入或拔除的血流动力学较气管插管稳定。因此,喉罩是一种可供选择的、安全有效的小儿气道管理工具。

Laryngeal Mask Airway versus Endotracheal Tubes for Airway Management during General Anesthesia in Children: A Meta-analysis

Objective To assess the effectiveness and safety of laryngeal mask airway(LMA) and endotracheal tube(ETT) for airway management in pediatric general anesthesia.Methods Randomized controlled trials were collected through electronic searches of the PubMed,The Cochrane Library,EMbase,CBM,WanFang Data,VIP,CNKI from the date of establishment to November 2010.All the related data that matched the standards were abstracted by two reviewers independently.The quality of the included trials was evaluated according to...