Ⅱ代引流型喉管与Proseal喉罩在择期手术中应用评价

Comparison of Laryngeal Tube SuctionⅡand LMA-Proseal for Airway Management in Elective Surgery:Asystematic Review

目的:评价Ⅱ代引流型喉管(LTSⅡ)和Proseal喉罩(PLMA)在择期手术中应用效果。方法:检索了Cochrane图书馆(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相关Ⅱ代引流型喉管(LTSⅡ)和Proseal喉罩在择期手术中应用的随机对照试验(RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,根据指标相应异质性进行描述性分析或Meta分析(RevMan 5.0)。结果:共纳入3个RCT,共244例研究对象,文献质量均为B级。3个RCT的结果显示与PLMA相比,LTSⅡ具有相似的首次置入成功率(P=0.45)、术毕即刻上呼吸道损伤发生率(P=1.00)、术后24 h咽痛发生率(P=0.81)、术后24 h吞咽困难发生率(P=0.12)。2个RCT的结果显示两组引流管置入均较容易。1个RCT的结果显示两组的操作者主观评价相近(OR=1.86,95%CI 0.39～8.99)。气道封闭效果由于采用方法学差异性较大,指标也不尽相同,尚不能得出准确结果。结论:LTSⅡ在择期手术中用于气道管理具有较好的前景。但是现时仍不宜用于需在择期术中进行控制通气的病人。关于气道封闭效果,尚需采用更合理规范的指标、更高质量的研究设计进一步研究。

Objective：To assess the efficacy of laryngeal tube suctionⅡ（LTSⅡ） and LMA-Proseal（PLMA） for airway management in elective surgery.Methods：We searched Cochrane Library（2009）,Pubmed（1950-2009 ）、EM-Base （1989-2009）,CNKI（1979-2009）,VIP（1989-2009）,CBM（1978-2009）.The quality of the trials was assessed by two reviewers independently.RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results：Three studies involving 244 participants were included.Same rates of fist successful attempt（P=0. 45）,upper airway trauma（P=1.00）,sore throat（P=0.81） and dysphagia（P = 0.12） were observed in LTSⅡand PLMA in all studies.Two studies indicated that the insertion of gastric tube was easy in both groups.The similarity of subjective maneuverability in two groups was reported in one study（OR=1.86,95%CI 0.39 to 8.99）.The correct result of effectiveness of airway seal could not be made because of various methods and measurements.Conclusion：LTSⅡhave a good perspective in the airway management.Otherwise,it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal.More RCTs of high quality need to be undertaken in the future.