加温预处理改善SLIPA喉罩置入条件的Meta与试验序贯分析

Metaand Trial Sequential Analysis of Prewarming SLIPA Laryngeal Mask for Improvement on the Intubation Conditions

目的通过Meta分析和试验序贯分析(Trial Sequential Analysis,TSA)系统评价加温预处理SLIPA喉罩改善其置入条件的有效性。方法计算机检索Pub Med、Web of Science、The Cochrane Library、EM base、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普和万方数据库中预加温SLIPA喉罩用于术中机械通气的随机对照试验(Randomized Clinical Trial,RCT),检索时限为建库至2021年6月30日。由2名研究者独立筛选文献、提取相关数据并且评价纳入研究的偏倚风险,然后采用Rev Man 5.4软件进行Meta分析,应用TSA v0.9软件进行TSA。结果共纳入4个研究,309例患者。Meta分析和TSA结果显示,预加温SLIPA喉罩能缩短其置入时间(MD=-1.33 s,95%CI:-2.15~-0.51,P=0.001),降低术后口腔粘膜损伤发生率和术后咽痛的发生率(RR=0.33,95%CI:0.19~0.54,P<0.0001;RR=0.56,95%CI:0.45~0.70,P<0.00001)。尚不能明确预加温对置入后即刻的气道密闭压(MD=1.20 cmH_(2)O,95%CI:0.08~2.32,P=0.04)和首次置入的成功率(RR=1.04,95%CI:0.99~1.09,P=0.10)的影响。结论当前证据显示,预加温SLIPA喉罩改善置入条件主要表现为可缩短置入时间、降低术后口腔粘膜损伤发生率和术后咽痛发生率。预加温能否提高置入后即刻的气道密闭压和首次置入成功率尚待进一步研究证实。

Objective To systematically evaluate the efficacy of prewarming SLIPA laryngeal mask on improvement of the intubation conditions by using meta-analysis and trial sequential analysis(TSA).Methods The datebases including Pub Med,Web of Science,The Cochrane Library,EM base,Chinese Biomedical Literature Database(CBM),Chinese Journal Full-text Database(CNKI),Vipu and Wanfang were searched by computer randomized clinical trial(RCT)of prewarmed SLIPA laryngeal mask for intraoperative mechanical ventilation.The search retrieval time from the establishment of the database to June 30,2021.Two researchers independently screened the literature,extracted relevant data and evaluated the risk of bias of the included studies.Then Rev Man 5.4 software was used for meta-analysis,and TSA v0.9 software was used for TSA.Results A total of 4 studies with 309patients were included.Meta-analysis and TSA results showed that prewarming SLIPA laryngeal mask could shorten the insertion time(MD=-1.33 s,95%CI:-2.15 to-0.51,P=0.001),reduce the incidence of postoperative oral mucosal injury and postoperative pharyngeal pain(RR=0.33,95%CI:0.19 to 0.54,P<0.0001;RR=0.56,95%CI:0.45 to 0.70,P<0.00001).The effect of prewarming on airway sealing pressure immediately after implantation(MD=1.20 cmH_(2)O,95%CI:0.08 to 2.32,P=0.04)and the success rate of the first implantation(RR=1.04,95%CI:0.99 to 1.09,P=0.10)was not clear.Conclusion Current evidence shows that prewarming SLIPA laryngeal mask can improve the implantation conditions mainly by shortening the implantation time,reducing the incidence of postoperative oral mucosal injury and postoperative pharyngeal pain.Further studies need to confirm whether prewarming can improve airway sealing pressure immediately after implantation and the success rate of the first implantation.