不同体位对直接喉镜气管插管效果影响的meta分析

Effects of different body position for tracheal intubation during direct layngoscopy:a meta-analysis

目的系统评价不同体位对直接喉镜气管插管效果的影响。方法采用计算机检索PubMed、Web of Science、Cochrane、Ovid、中国生物医学文献数据库、中国知网、维普及万方数据库中关于不同体位下直接喉镜气管插管的对照试验文献。经筛选文献、资料提取及评价文献质量后,采用SPSS20.0及RevMan5.3统计软件进行meta分析。结果共纳入17篇文献,13篇为随机对照试验(RCT),4篇为临床对照试验。meta分析结果显示:与简单后仰位比较,嗅物位可以提高气管插管患者的声门视野[比值比(OR)=1.35,95%置信区间(95%CI):1.11~1.63,P=0.002],提高首次插管成功率(OR=0.50,95%CI:0.37~0.66,P<0.00001),更易于插管(OR=1.58,95%CI:1.37~1.83,P<0.00001);与嗅物位比较,斜坡位的声门视野差异不明显(OR=0.87,95%CI:0.59~1.30,P=0.50),首次插管成功率无明显差异(OR=1.44,95%CI:0.76~2.75,P=0.26)。结论嗅物位能够提高声门视野,提高插管成功率,建议作为临床气管插管患者的首选体位;斜坡位在声门视野和首次插管成功率上不劣于嗅物位,未来还需要更多高质量RCT进行研究。

Objective To validate the efficacy of different body position in the tracheal intubation during direct laryngoscopy.Methods A computer search was used to search the controlled trial articles of tracheal intubation during direct laryngoscope in different body positions from PubMed,Web of Science,Cochrane,Ovid,Chinese Biomedical Literature Database,CNKI,VIP and Wanfang database.After screening the literature,extracting data and evaluating the quality of the literature,SPSS20.0 and RevMan5.3 software were used for meta-analysis.Results A total of 17 articles were included,13 were randomized controlled trials(RCT)and 4 were clinical controlled trials.The results of the meta-analysis showed that compared with the simple head extension position,the olfactory position could improve the glottis visual field of patients with tracheal intubation[odds ratio(OR)=1.35,95%confidence interval(95%CI):1.11-1.63,P=0.002],improve the success rate of first intubation(OR=0.50,95%CI:0.37-0.66,P<0.00001),easier to intubate(OR=1.58,95%CI:1.37-1.83,P<0.00001);Compared with the sniffing position,the glottal visual field at the ramped position was not significantly different(OR=0.87,95%CI:0.59-1.30,P=0.50),there was no significant difference in the first intubation success rate(OR=1.44,95%CI:0.76-2.75,P=0.26).Conclusion The sniffing position can improve the glottis visual field and increase the success rate of intubation.It is recommended as the preferred position for clinical tracheal intubation patients;the ramped position is not inferior to the sniffing position in terms of the glottal visual field and the success rate of the first intubation.There will be more high-quality RCT for research in future.