非气管插管保留自主呼吸麻醉在电视胸腔镜手术中应用效果的Meta分析

目的 对比非气管插管保留自主呼吸麻醉和传统气管插管全身麻醉在电视胸腔镜手术中的应用效果和安全性。 方法 检索中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Embase、Cochrane Library等中英文数据库中有关比较非气管插管(实验组)和气管插管麻醉(对照组)下胸腔镜手术治疗胸部疾病的研究。对文献质量进行评价后纳入符合标准的文献,提取研究结果,用RevMan5.3软件对手术时间、术中出血量,术中最低血氧饱和度(SpO₂)、术中最高呼气末二氧化碳分压(ETCO₂)、术后胸管留置时间、术后住院天数、术后总并发症发生率等指标进行Meta分析。 结果 共纳入27篇文献、2 019例患者。结果显示:(1)实验组和对照组在手术时间［标准化均数差(SMD)= -0.02,95%CI:-0.26~0.22,P=0.89］和术中最低SpO₂(SMD= -0.10,95%CI:-0.53~0.33,P=0.66)方面差异无统计学意义;(2)在术中出血量(SMD= -0.13,95%CI:-0.24~-0.01,P=0.03)、术后胸管留置时间(SMD= -0.48,95%CI:-0.68~-0.28,P<0.001)、术后住院天数(SMD= -0.69,95%CI:-1.05~-0.33,P<0.001)、术后总并发症发生率［比值比(OR)= 0.42,95%CI:0.25~0.70,P<0.001］等方面,实验组低于对照组;(3)实验组术中最高ETCO₂高于对照组(SMD=1.23,95%CI:0.68~1.78,P<0.001)。 结论 在非气管插管保留自主呼吸麻醉下的胸腔镜手术较传统气管插管全身麻醉具有更短的术后胸管留置时间、更短的术后住院天数、更少的术后总并发症发生率等加速康复优势,该项技术安全可行。

Effect of non-intubated spontaneous ventilation anesthesia used in video-assisted thoracoscopic surgery: a Meta-analysis

Objective To compare the efficacy of non-intubated spontaneous ventilation anesthesia and traditional general anesthesia with tracheal intubation used in video-assisted thoracoscopic surgery. Methods The databases like CNKI, Wangfang, VIP, CBM, PubMed, Embase and Cochrane Library were retrieved for original researches to compare the effect of non-intubated(experimental group)and intubated(control group)video-assisted thoracoscopic surgery. After evaluating the quality of the literatures, the satisfactory literatures were included and the research results were extracted. A Meta-analysis was performed on the operation time, intraoperative bleeding volume, lowest saturation of pulse oxygen(SpO₂)during surgery, intraoperative maximum end-tidal carbon dioxide(ETCO₂), postoperative duration of chest tube, postoperative hospital stays, postoperative total complication rate with RevMan5.3 software. Results A total of 27 studies and 2019 patients were enrolled into this study. The Meta-analysis results showed there was no statistical difference in operation time(SMD=-0.02,95%CI: -0.26-0.22,P=0.89)and lowest SpO₂ during surgery(SMD=-0.10,95%CI: -0.53-0.33,P=0.66)between the experimental group and control group. The intraoperative bleeding volume(SMD=-0.13,95%CI: -0.24 - 0.01,P=0.03), postoperative duration of chest tube(SMD=-0.48, 95%CI: -0.68 - 0.28, P<0.001), postoperative hospital stays(SMD=-0.69, 95%CI: -1.05 - 0.33, P<0.001), postoperative total complication rate(OR=0.42, 95%CI: 0.25-0.70, P<0.001)in experimental group was significantly decreased than those in control group; however, the maximum ETCO₂ in experimental group was higher than that in control group(SMD=1.23, 95%CI: 0.68-1.78, P<0.001). Conclusion Compared with traditional general anesthesia with tracheal intubation, non-intubated spontaneous ventilation anesthesia is safe and feasible with the advantages of shorter duration of chest tube, shorter postoperative hospital stay and fewer postoperative complication rate.