喉罩与气管插管在患儿全身麻醉气道管理中的安全性Meta分析

目的采用Meta分析比较喉罩与气管插管在患儿全身麻醉气道管理中的安全性及有效性。方法计算机检索Cochrane、Pubmed、Web of Science、Embase、万方和中国知网等数据库,检索时间从建库到2019年7月,纳入比较喉罩与气管插管在患儿全身麻醉气道管理中应用的临床随机对照试验(RCT)。由两位研究员按照纳入与排除标准选择试验、提取资料,并根据Cochrane系统手册提供的质量评价标准评价纳入研究质量,采用RevMan 5.2软件进行Meta分析。主要结局指标包括术后喉痉挛及咽喉疼痛的发生率,次要结局指标包括术后咳嗽、声嘶的发生率、MAP和HR的波动等。结果最终纳入35项RCT,共3 010例患儿,其中喉罩组1 502例,气管插管组1 508例。Meta分析结果显示:与气管插管组比较,喉罩组术后喉痉挛(RR=0.36,95%CI 0.24～0.54,P0.001)、咽喉疼痛(RR=0.32,95%CI 0.25～0.42,P0.001)的发生率明显降低;喉罩组支气管痉挛、术后咳嗽、低氧血症及术后声嘶的发生率明显降低(P0.005);喉罩组麻醉诱导期间MAP和HR的波动明显较小(P0.001)。两组术后黏膜损伤、恶心呕吐、反流误吸、胃肠胀气及一次置入成功率差异无统计学意义。结论患儿全身麻醉时选择喉罩可以有效降低喉痉挛和咽喉疼痛,且对患儿的血压、心率影响较小。

Safety of laryngeal mask airway versus endotracheal tubes for airway management during general anesthesia in Children: a meta-analysis

Objective To evaluate the safety and effectiveness of laryngeal mask airway (LMA) and endotracheal tube (ETT) for airway management in pediatric general anesthesia.
Methods The relevant randomized controlled trials (RCT) were searched in Cochrane Library, PubMed, Web of Science, Embase, WanFang Data and CNKI from the date of their establishment to July 2019. All the related data which met the inclusion criteria were abstracted by two independent reviewers. The quality of the included trials were evaluated according to the Cochrane Handbook 5.0. The RevMan 5.2 software was used for meta-analysis. The incidence of postoperative laryngeal spasm and laryngopharyngeal pain were included in the primary outcomes, while the incidence of postoperative cough and hoarseness, and the fluctuation of MAP and HR were included in the secondary outcomes.
Results A total of 35 RCT were included, involving 3 010 children. Among them, 1 502 children were in the LMA group, 1 508 children were in the ETT group. Compared with the ETT group, the LMA group could decrease the incidence of laryngospasm (RR = 0.36, 95% CI 0.24-0.54, P < 0.001), sore throat (RR = 0.32, 95% CI 0.25-0.42, P < 0.001); the LMA group can decrease the incidence of bronchospasm, postoperative cough, hypoxemia, postoperative hoarseness (P < 0.05), and reduce heart rate and mean arterial pressure fluctuations during the anesthesia induction (P < 0.001). However, there were no significant differences of the incidence of postoperative mucous injury, postoperative nausea and vomiting (PONV), aspiration, flatulence and success rate of the first attempt between two groups.
Conclusion LMA is superior to ETT in terms of fewer complications during general anesthesia as well as stable hemodynamic changes.