喉罩全麻对胸腔镜手术有效性与安全性的Meta分析

Clinical effect and safety of laryngeal mask anesthesia in thoracoscopic surgery: A meta-analysis

目的:系统评价喉罩全麻对胸腔镜手术的有效性与安全性。方法:计算机检索EBSCO、Web of science、Pubmed、Cochrane Library、Embase、ClinicalTrials.gov等英文数据库和SinoMed、中国知网、维普、万方数据库等中文数据库,检索时限均从建库至2018年9月,由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入10篇随机对照研究,696个患者。Meta分析结果显示:喉罩组住院时间[MD=-2.71,95%CI(-3.31,-2.12),P <0.001]、复苏时间[MD=-16.62,95%CI(-21.99,-11.26),P <0.001]、术后胃肠道不适发生率[RR=0.35,95%CI(0.20,0.61),P=0.0002]、术后咽喉不适发生率[RR=0.18,95%CI(0.12,0.28),P <0.0001]低于对照组,手术时间[MD=2.09,95%CI(0.20,3.98),P=0.03]、术中最高呼气末二氧化碳分压(PetCO2)[MD=1.92,95%CI(0.05,3.79),P=0.04]高于对照组,但两者术中出血量、术野满意度、术中最低脉氧饱和度(SPO2)的差异无统计学意义。结论:喉罩全麻用于胸腔镜手术能缩短住院及复苏时间,减轻术后不良反应,不影响手术术野及出血量,但延长手术时间、增加术中最高PetCO2,临床医生要根据患者情况,慎重选择。

Objective: To systematically review the clinical effect and safety of laryngeal mask anesthesia in thoracoscopic surgery. Methods: English databases including EBSCO, Web of Science, PubMed, Cochrane Library, Embase, and ClinicalTrials.gov and Chinese databases including SinoMed, CNKI, VIP, and Wanfang Data were searched for randomized controlled trials (RCTs) published up to September 2018. Two reviewers independently screened these RCTs and extracted related data. After risk of bias was assessed for these RCTs, RevMan 5.3 was used to perform the meta-analysis. Results: A total of 10 RCTs with 696 patients were included. The meta-analysis showed that compared with the control group, the laryngeal mask group had significantly shorter length of hospital stay (MD =-2.71, 95% CI:-3.31 to -2.12, P < 0.0001) and recovery time (MD =-16.62, 95% CI:-21.99 to -11.26, P < 0.0001), significantly lower incidence rates of postoperative gastrointestinal discomfort (RR = 0.35, 95% CI: 0.20 ~ 0.61, P = 0.0002) and postoperative throat discomfort (RR = 0.18, 95% CI: 0.12 ~ 0.28, P < 0.001), a significantly longer time of operation (MD = 2.09, 95% CI: 0.20 ~ 3.98, P = 0.03), and a significantly higher maximum end-tidal partial pressure of carbon dioxide (PetCO2) during surgery (MD = 1.92, 95% CI: 0.05 - 3.79, P = 0.04), but there were no significant differences between the two groups in intraoperative blood loss, degree of satisfaction with surgical field, and minimum pulse oxygen saturation during surgery. Conclusion: Laryngeal mask anesthesia for thoracoscopic surgery can shorten the length of hospital stay and recovery time and reduce postoperative adverse reactions. It does not affect surgical field or intraoperative blood loss, but it may prolong the time of opera? tion and increase maximum PetCO2 during surgery. Clinicians should select the method for anesthesia based on patient’s conditions.