气管插管与喉罩对院外心搏骤停患者复苏效果的Meta分析

Meta-analysis of the effects between endotracheal intubation and laryngeal mask airway for patients with out-of-hospital cardiac arrest

目的综合评价气管插管（ETI）与喉罩通气（LMA）对院外心搏骤停（OHCA）患者的复苏效果。方法检索Cochrane Library、PubMed、Embase、Ebsco、Elsevier、OVID、Springer、Proquest及中国生物医学文献数据库（CBMdisc）、中国知网（CNKI） 、万方数据库、中国科技期刊全文数据库、维普中文生物医学期刊数据库等，从建库至2017年12月发表的所有关于对比ETI与LMA对OHCA成人患者重建有效气道效果的前瞻性或回顾性研究；效果判定指标包括：复苏成功率、复苏成功后1个月存活率和神经系统预后。对纳入文献进行质量评价后，应用RevMan 5.3软件进行敏感性和异质性分析，并采用固定效应模型或随机效应模型计算合并后的综合效应。结果共纳入9篇病例对照研究，其中英文文献7篇，中文文献2篇；前瞻性研究5篇，回顾性研究4篇；纳入文献质量均较高，纽卡斯尔-渥太华量表（NOS）得分7～9分。Meta分析结果显示，ETI较LMA对OHCA患者具有较高的复苏成功率〔优势比（OR）＝1.51，95%可信区间（95%CI）＝1.42～1.62，Z＝12.35，P〈0.01〕和1个月存活率（OR＝1.16，95%CI＝1.06～1.26，Z＝3.41，P〈0.01），但对复苏成功后1个月神经功能恢复率的影响效果差异无统计学意义（OR＝1.13，95%CI＝0.96～1.32，Z＝1.49，P＝0.14）。结论对于OHCA成人患者的抢救，使用ETI较LMA具有更高的复苏成功率和存活率，但对神经系统的改善还不明确。

ObjectiveTo comprehensively evaluate the resuscitation effect of endotracheal intubation （ETI） ventilation and laryngeal mask airway （LMA） for out-of-hospital cardiac arrest （OHCA）.MethodsDatabases such as Cochrane Library, PubMed, Embase, Ebsco, Elsevier, OVID, Springer, Proquest, and China biomedical literature database （CBMdisc）, CNKI, Wanfang database, Chinese Science and Technology Journal Full-text Database, VIP Chinese biomedical journal database were searched from the establishment of literature database to December 2017 to study the difference of effects between ETI and LMA for patients with OHCA. The effect determination indexes included the return of spontaneous circulation （ROSC） rate, 1-month survival and 1-month neurological recovery. After evaluation of the quality of included studies and extraction of the data, the software of RevMan 5.3 was used to analyze those outcomes.ResultsA total of 9 articles, including 7 English, 2 Chinese; 5 prospective studies and 4 retrospective studies were included. All of the literatures had high quality, and the Newcastle Ottawa scale （NOS） scored 7-9 points. The Meta-analysis showed that ETI was significantly more beneficial than LMA in improving the rate of ROSC [odds ratio （OR） = 1.51, 95% confidence interval （95%CI） = 1.42-1.62, Z = 12.35,P 〈 0.01], and 1-month survival （OR = 1.16, 95%CI = 1.06-1.26, Z = 3.41, P 〈 0.01）, and there was no significant difference in 1-month neurological recovery （OR = 1.13, 95%CI = 0.96-1.32, Z = 1.49, P = 0.14）.ConclusionETI has higher recovery success rate and survival rate than LMA for the rescue of OHCA adult patients, but the improvement of the nervous system is unclear.