空气与液体阻力消失法定位硬膜外间隙效果的比较：Meta分析

Effects of air versus liquid in a loss of resistance technique for identification of the epidural space ： a Metaanalysis

目的 采用Meta分析法比较气体或液体阻力消失法定位硬膜外间隙的效果.方法 检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊、万方数字化期刊群等数据库,分别收集空气或液体阻力消失法定位硬膜外间隙的前瞻性临床随机对照研究.采用Cochrane系统评价法评价纳入文献的质量.收集两组患者资料采用RevMan 5.0.1软件进行Meta分析.结果 共纳入7项研究,包括5183例患者.分为空气阻力消失法组（A组）和液体阻力消失法组（L组）.与A组比较,L组困难置管发生率、置管误入血管发生率、阻滞不全发生率和术后头痛发生率降低（P＜0.05）,一过性异感发生率和穿破硬膜发生率差异无统计学意义（P＞0.05）.结论 与空气阻力消失法比较,液体阻力消失法可更准确地定位硬膜外间隙,阻滞效果更好,且并发症较少.

Objective To systematically review the effects of air or liquid in a loss of resistance technique for identification of the epidural space. Methods We searched the Cochrane Library, PubMed, EMBASE, Chinese Biomedical Database （CBM）, CNKI, VIP and ChinaInfo for studies on the effects of air versus liquid in a loss of resistance technique for identification of the epidural space. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration＇s RevMan 5.0.1 software. Results Seven prospective randomized controlled trials involving 5183 patients were included in our meta-analysis. The patients were randomly allocated into 2 groups according to the technique by which the epidural space was identified： loss of resistance with air group （group air, n = 2534） and loss of resistance with liquid group （group lidocaine, n = 2649）. The results showed that the incidences of difficult catheterization, intravascular catheter insertion, incomplete block and post-operative headache were significantly lower in group liquid than in group air （P 〈 0.05）. There were no significant differences in the incidences of transient abnormal sense and accidental dural puncture between group liquid and air. Conclusion Loss of resistance with liquid can identify the epidural space more correctly than with air, with fewer complications and better analgesic efficacy.