可视喉镜在胃管置入患者中应用的Meta分析

Application of video laryngoscope in patients with gastric tube placement:a Meta-analysis

目的对比可视喉镜胃管置入方法(GVL)和传统胃管置入方法(GTI),评价胃管置入时应用可视喉镜的安全性和有效性。方法计算机检索PubMed、中国知识基础设施工程等国内外数据库,检索时间限定为从建库至2019年1月20日,选择随机对照试验(RCT)为研究对象,由2名研究者独立对文献严格筛选、资料提取并评价纳入研究的偏倚风险,采用软件RevMan 5.3.5对符合质量标准的文献进行Meta分析。结果共纳入24项RCT,1797例患者。Meta分析结果显示,与GTI组比较,给予可视喉镜干预后,GVL组的一次置管成功率显著性提高(OR=13.18,95%CI:[9.31,18.66],P<0.00001),缩短胃管置入时间(WMD=-5.91,95%CI:[-6.88,-4.94],P<0.00001),减少胃管置入过程中误入气管的发生率(OR=0.05,95%CI:[0.02,0.11],P<0.00001)、黏膜出血的发生率(OR=0.14,95%CI:[0.09,0.23],P<0.00001)和黏膜水肿的发生率(OR=0.08,95%CI:[0.03,0.23],P<0.00001)。结论对于需要胃管置入的患者,采用可视喉镜干预,能提高一次置管的成功率、缩短患者的胃管放置时间、显著降低术后并发症的发生率,减轻患者的痛苦,提高医疗效率。

Objective A comparison was made between the gastric tube insertion under video laryngoscope(GVL)and traditional gastric tube insertion(GTI),to evaluate the safety and effectiveness of former in gastric tube insertion patients.Methods A computer-based retrieval was performed in databases such as PubMed,China National Knowledge Infrastructure,etc.The retrieval time was limited from the inception of this method to January 20 th,2019.The study objects chosen from randomized controlled trials.The two researchers independently screened the literature strictly,extracted the data and evaluated the bias risks included in the study.The included studies were analysed by the software RevMan 5.3.5.Results Twenty-four randomized controlled trials(RCT)involving 1797 patients were included.The results of the Meta-analyses showed that,compared with group GTI,group GVL’s one-time tube placement success could be significantly improved(OR=13.18,95%CI:[9.31,18.66],P<0.00001),the time taken for insertion reduced(WMD=-5.91,95%CI:[-6.88,-4.94],P<0.00001),the incidence of malpositioning in trachea reduced(OR=0.05,95%CI:[0.02,0.11],P<0.00001),so were reduced the incidence of mucosal hemorrhage(OR=0.14,95%CI:[0.09,0.23],P<0.00001)and the incidence of mucosal edema(OR=0.08,95%CI:[0.03,0.23],P<0.00001).Conclusion The use of video laryngoscopy for patients with gastric tube insertion can increase one-time tube placement success,shorten time taken for insertion,and significantly reduce the incidence of postoperative complications,thereby reducing the suffering of patients and improving medical efficiency.