喉罩通气与面罩通气对院外心脏骤停患者复苏效果的Meta分析

Laryngeal mask and bag valve mask in out-of-hospital cardiac arrest:a meta-analysis

目的综合评价喉罩通气与面罩通气对院外心脏骤停(out of hospital cardialc arrest,OHCA)患者急救复苏的效果。方法采用Meta分析方法制定原始文献的纳入标准、排除标准及检索策略,检索多个中英文文摘型数据库及全文数据库,获得喉罩通气与面罩通气前瞻性和回顾性研究,进行文献质量评价后,应用Rev Man 5.3分析软件进行敏感性和异质性分析,并采用固定效应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,Meta分析结果显示,排除异质性,喉罩通气较面罩通气具有较高的院外心脏骤停(OHCA)患者复苏成功率(OR=2.28,95%CI1.74-2.99Z=5.97,P<0.01),但对复苏成功后1个月生存率、复苏成功率及神经系统功能恢复方面的影响效果无统计学意义(P>0.05)。结论喉罩通气具有更高的院外心脏骤停患者复苏成功率,但对远期效果生存几率及神经系统的改善情况还需要大样本、多中心RCT研究有待进一步验证。

Objective To compare the effects of laryngeal mask airway(LWV)and bag valve mask ventilation(BVM)with cardiac arrest outside the hospital by meta-analysis.Methods Many kinds of databases were researched and all the randomized controlled trials and case-control studies were included,which compared laryngeal mask airway and bag valve mask airway in adults(≥18 years)out of hospital with cardiac arrest.After evaluation of the quality of included studies and extraction of the data,the software of Review Manager 5.3 was used to analyze those outcomes.Results Nine case-control studies were included.Laryngeal mask airway was significantly more beneficial than bag valve mask ventilation in improving the rate of return of spontaneous circulation after excluding heterogeneity(OR=2.28,95%Cl 1.74-2.99 Z=5.97,P<0.01),and there were no significant differences in affecting one-month survival and one-month neural function.Conclusion There is no enough evidence to draw a conclusion.Adequately,powered,high quality randomized controlled trials are still needed to assess the effects of laryngeal mask airway and bag valve mask ventilation in adults with cardiac arrest outside the hospital.