喉罩与气管插管用于全麻俯卧位手术的安全性Meta分析

The safety of laryngeal mask and tracheal intubation for surgery in prone position under general anesthesia:a Meta-analysis

目的系统评价全麻俯卧位手术应用喉罩进行气道管理的安全性。方法采用计算机检索PubMed、Web of Science、The Cochrane Library、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全麻俯卧位手术使用喉罩进行气道管理的临床对照试验文献。检索时限为建库至2021年3月。由2名评价员独立筛选文献、资料提取及评价文献质量后,采用RevMan 5.4统计软件进行Meta分析。结果纳入7篇RCT,共500例患者。Meta分析结果显示:喉罩组气道压峰值低于气管插管组(WMD=1.80,95%CI:2.60~0.99,P<0.05);喉罩组置管后心率明显低于气管插管组(WMD=-14.05,95%CI:17.49~10.60,P<0.05);喉罩组术后咽痛发生率明显低于气管插管组(OR=0.36,95%CI:0.18~0.73,P<0.05)。而首次插管成功率差异无统计学意义(P>0.05)。结论全麻俯卧位手术应用喉罩进行气道管理是安全有效的,简单易行,对位准确,行机械通气时气道密闭性好,且比气管插管血流动力学波动小,术后并发症发生率低。

Objective To systematically evaluate the safety of laryngeal mask for airway management during surgery in the prone position under general anesthesia.Methods This study searched literature with clinical randomized controlled trials(RCTs)on airway management by laryngeal mask for surgery in the prone position under general anesthesia from databases including PubMed,Web of Science,The Cochrane Library,Chinese Biomedical Literature Database,China National Knowledge Infrastructure,VIP and Wanfang Database.The published time of the literature was from the establishment of the database to March 2021.After two reviewers screened the literature,extracted the data and evaluated the literature quality,and the Meta-analysis was conducted using statistical software RevMan 5.4.Results Seven RCTs were included,with a total of 500 patients.The results of Meta-analysis showed that the peak airway pressure of the laryngeal mask group was lower than that of the tracheal intubation group(WMD=1.80,95%CI:2.60~0.99,P<0.05);the heart rate of the patients after intubation in the laryngeal mask group was significantly lower than that in the tracheal intubation group(WMD=-14.05,95%CI:17.49~10.60,P<0.05);the incidence of postoperative pharyngeal pain in the laryngeal mask group was significantly lower than that of the tracheal intubation group(OR=0.36,95%CI:0.18~0.73,P<0.05).There was no statistical difference in the success rate of the first intubation(P>0.05).Conclusion The laryngeal mask for airway management during surgery in the prone position under general anesthesia is safe,effective,simple and accurate,with good airway tightness during mechanical ventilation.And it has less hemodynamic fluctuation than tracheal intubation as well as lower incidence of postoperative complications.