喉罩全麻对胸腔镜手术有效性与安全性的Meta分析
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摘要
目的:系统评价喉罩全麻对胸腔镜手术的有效性与安全性。方法:计算机检索EBSCO、Web of science、Pubmed、Cochrane Library、Embase、ClinicalTrials.gov等英文数据库和SinoMed、中国知网、维普、万方数据库等中文数据库,检索时限均从建库至2018年9月,由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入10篇随机对照研究,696个患者。Meta分析结果显示:喉罩组住院时间[MD=-2.71,95%CI(-3.31,-2.12),P <0.001]、复苏时间[MD=-16.62,95%CI(-21.99,-11.26),P <0.001]、术后胃肠道不适发生率[RR=0.35,95%CI(0.20,0.61),P=0.0002]、术后咽喉不适发生率[RR=0.18,95%CI(0.12,0.28),P <0.0001]低于对照组,手术时间[MD=2.09,95%CI(0.20,3.98),P=0.03]、术中最高呼气末二氧化碳分压(PetCO2)[MD=1.92,95%CI(0.05,3.79),P=0.04]高于对照组,但两者术中出血量、术野满意度、术中最低脉氧饱和度(SPO2)的差异无统计学意义。结论:喉罩全麻用于胸腔镜手术能缩短住院及复苏时间,减轻术后不良反应,不影响手术术野及出血量,但延长手术时间、增加术中最高PetCO2,临床医生要根据患者情况,慎重选择。
Objective: To systematically review the clinical effect and safety of laryngeal mask anesthesia in thoracoscopic surgery. Methods: English databases including EBSCO, Web of Science, PubMed, Cochrane Library,Embase, and ClinicalTrials.gov and Chinese databases including SinoMed, CNKI, VIP, and Wanfang Data were searched for randomized controlled trials(RCTs) published up to September 2018. Two reviewers independently screened these RCTs and extracted related data. After risk of bias was assessed for these RCTs, RevMan 5.3 was used to perform the meta-analysis. Results: A total of 10 RCTs with 696 patients were included. The meta-analysis showed that compared with the control group, the laryngeal mask group had significantly shorter length of hospital stay(MD =-2.71, 95% CI:-3.31 to-2.12, P < 0.0001) and recovery time(MD =-16.62, 95% CI:-21.99 to-11.26, P < 0.0001), significantly lower incidence rates of postoperative gastrointestinal discomfort(RR = 0.35,95% CI: 0.20 ～ 0.61, P = 0.0002) and postoperative throat discomfort(RR = 0.18, 95% CI: 0.12 ～ 0.28, P <0.001), a significantly longer time of operation(MD = 2.09, 95% CI: 0.20 ～ 3.98, P = 0.03), and a significantly higher maximum end-tidal partial pressure of carbon dioxide(PetCO2) during surgery(MD = 1.92, 95% CI: 0.05-3.79,P = 0.04), but there were no significant differences between the two groups in intraoperative blood loss, degree of satisfaction with surgical field, and minimum pulse oxygen saturation during surgery. Conclusion: Laryngeal mask anesthesia for thoracoscopic surgery can shorten the length of hospital stay and recovery time and reduce postoperative adverse reactions. It does not affect surgical field or intraoperative blood loss, but it may prolong the time of operation and increase maximum PetCO2 during surgery. Clinicians should select the method for anesthesia based on patient's conditions.
Objective: To systematically review the clinical effect and safety of laryngeal mask anesthesia in thoracoscopic surgery. Methods: English databases including EBSCO, Web of Science, PubMed, Cochrane Library,Embase, and ClinicalTrials.gov and Chinese databases including SinoMed, CNKI, VIP, and Wanfang Data were searched for randomized controlled trials(RCTs) published up to September 2018. Two reviewers independently screened these RCTs and extracted related data. After risk of bias was assessed for these RCTs, RevMan 5.3 was used to perform the meta-analysis. Results: A total of 10 RCTs with 696 patients were included. The meta-analysis showed that compared with the control group, the laryngeal mask group had significantly shorter length of hospital stay(MD =-2.71, 95% CI:-3.31 to-2.12, P < 0.0001) and recovery time(MD =-16.62, 95% CI:-21.99 to-11.26, P < 0.0001), significantly lower incidence rates of postoperative gastrointestinal discomfort(RR = 0.35,95% CI: 0.20 ～ 0.61, P = 0.0002) and postoperative throat discomfort(RR = 0.18, 95% CI: 0.12 ～ 0.28, P <0.001), a significantly longer time of operation(MD = 2.09, 95% CI: 0.20 ～ 3.98, P = 0.03), and a significantly higher maximum end-tidal partial pressure of carbon dioxide(PetCO2) during surgery(MD = 1.92, 95% CI: 0.05-3.79,P = 0.04), but there were no significant differences between the two groups in intraoperative blood loss, degree of satisfaction with surgical field, and minimum pulse oxygen saturation during surgery. Conclusion: Laryngeal mask anesthesia for thoracoscopic surgery can shorten the length of hospital stay and recovery time and reduce postoperative adverse reactions. It does not affect surgical field or intraoperative blood loss, but it may prolong the time of operation and increase maximum PetCO2 during surgery. Clinicians should select the method for anesthesia based on patient's conditions.
引文
1.Yan TD,Cao C,D’Amico TA,et al.Video-assisted thoracoscopic surgery lobectomy at 20 years:a consensus statement[J].Eur J Cardiothorac Surg,2014,45(4):633-639.
2.Mi?ambres E,Burón J,Ballesteros MA,et al.Tracheal rupture after endotracheal intubation:a literature systematic review[J].Eur J Cardiothorac Surg,2009,35(6):1 056-1 062.
3.Tokics L,Hedenstierna G,Svensson L,et al.V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans[J].J Appl Physiol(1985),1996,81(4):1 822-1 833.
4.Keles S,Kocaturk O.Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia:comparison of nasal tracheal intubation and laryngeal mask airway[J].J Pain Res,2018,11:103-110.
5.毛松松,马珏,唐继鸣,等.喉罩和气管内插管在成人NUSS手术麻醉中的对照研究[J].广东药学院学报,2014,30(3):366-369,372.
6.王继云,李婷,李万刚,等.喉罩通气麻醉在胸腔镜下肺部手术中的应用[J].河北医科大学学报,2017,38(12):1401-1 405.
7.郭涛,韩哲,苏莉,等.喉罩通气在胸腔镜胸交感神经链切断术中的临床研究[J].心肺血管病杂志,2012,31(3):315-317.
8.杨汉宇,董庆龙,梁丽霞,等.保留自主呼吸的喉罩全身麻醉对胸腔镜肺大疱切除手术的应用[J].广州医科大学学报,2015,43(3):45-48.
9.张洪江,潘维敏,张林,等.喉罩全麻和气管插管全麻在单孔胸腔镜肺叶切除术中的临床对照研究[J].实用医学杂志,2017,33(3):455-458.
10.蔡开灿,王向东,叶靖,等.喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究[J].南方医科大学学报,2013,33(05):756-760.
11.付凯文.胸椎旁神经阻滞复合喉罩全麻在肺大泡切除术中的应用[D].南昌:南昌大学,2018.
12.刘雨睿.放置喉罩保留自主呼吸静脉麻醉在胸腔镜肺大泡切除术的应用:一项随机平行对照临床试验[D].四川:西南医科大学,2018.
13.Mao SS,Du XJ,Ma JE,et al.A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure[J].J Thorac Dis,2018,10(6):3 216-3 224.
14.Chen JF,Du Q,Lin M,et al.Transareolar Single-Port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation:a randomized controlled trial[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2016,26(12):958-964.
15.Wang SL,Zhang J,Cheng H,et al.A clinical evaluation of the ProSeal laryngeal mask airway with a coopdech bronchial blocker for One-Lung ventilation in adults[J].JCardiothorac Vasc Anesth,2014,28(4):900-903.
16.Campos JH.Current techniques for perioperative lung isolation in adults[J].Anesthesiology,2002,97(5):1 295-1 301.
17.Whitehead T,Slutsky AS.The pulmonary physician in critical care7:ventilator induced lung injury[J].Thorax,2002,57(7):635-642.
18.Malhotra A.Low-tidal-volume ventilation in the acute respiratory distress syndrome[J].N Engl J Med,2007,357(11):1 113-1 120.
19.Pinhu L,Whitehead T,Evans T,et al.Ventilator-associated lung injury[J].Lancet,2003,361(9354):332-340.
20.Gothard J.Lung injury after thoracic surgery and one-lung ventilation[J].Curr Opin Anaesthesiol,2006,19(1):5-10.
21.Ambrogi MC,Fanucchi O,Gemignani R,et al.Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia:Preliminary experience[J].Journal of Thoracic and Cardiovascular Surgery,2012,144(2):514-515.
22.Gonzalez-Rivas D,Fernandez R,De La Torre M,et al.Single-port thoracoscopic lobectomy in a nonintubated patient:the least invasive procedure for major lung resection?[J].Interact Cardiovasc Thorac Surg,2014,19(4):552-555.
23.Zhang RX,Li Y,Liu XB,et al.Is laryngeal mask airway general anesthesia feasible for minimally invasive esophagectomy?[J].J Thorac Dis,2018,10(3):E210-E213.
24.何明枫,陈宇.允许性高碳酸血症对单肺通气后肺功能及萎陷侧肺炎症反应的影响[J].临床麻醉学杂志,2015,31(12):1172-1175.
25.徐志礼.允许性高碳酸血症的器官保护及应用策略[J].临床肺科杂志,2011,16(3):432-434.
26.夏舒萌,薛晓东,陈延英,等.双管喉罩复合静脉全麻在胸腔镜下交感神经链切断术中的应用[J].临床麻醉学杂志,2013,29(3):259-260.
27.Belena JM,Nunez M,Anta D,et al.Comparison of laryngeal mask airway supreme and laryngeal mask airway proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy:a randomised controlled trial[J].Eur J Anaesthesiol,2013,30(3):119-123.
28.Peirovifar E,Eydi M,Mirinejhad MM,et al.Comparison of postoperative complication between Laryngeal Mask Airway and endotracheal tube during low-flow anesthesia with controlled ventilation[J].Pak J Med Sci,2013,29(2):601-605.
29.Du XJ,Mao SS,Cui JX,et al.Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure[J].J Thorac Dis,2016,8(8):2 061-2 067.
30.Jarineshin H,Kashani S,Vatankhah M,et al.Better hemodynamic profile of laryngeal mask airway insertion compared to laryngoscopy and tracheal intubation[J].Iran Red Crescent Med J,2015,17(8):e28 615.
31.Ambrogi MC,Fanucchi O,Korasidis S,et al.Nonintubated thoracoscopic pulmonary nodule resection under spontaneous breathing anesthesia with laryngeal mask[J].Innovations(Phila),2014,9(4):276-280.
2.Mi?ambres E,Burón J,Ballesteros MA,et al.Tracheal rupture after endotracheal intubation:a literature systematic review[J].Eur J Cardiothorac Surg,2009,35(6):1 056-1 062.
3.Tokics L,Hedenstierna G,Svensson L,et al.V/Q distribution and correlation to atelectasis in anesthetized paralyzed humans[J].J Appl Physiol(1985),1996,81(4):1 822-1 833.
4.Keles S,Kocaturk O.Postoperative discomfort and emergence delirium in children undergoing dental rehabilitation under general anesthesia:comparison of nasal tracheal intubation and laryngeal mask airway[J].J Pain Res,2018,11:103-110.
5.毛松松,马珏,唐继鸣,等.喉罩和气管内插管在成人NUSS手术麻醉中的对照研究[J].广东药学院学报,2014,30(3):366-369,372.
6.王继云,李婷,李万刚,等.喉罩通气麻醉在胸腔镜下肺部手术中的应用[J].河北医科大学学报,2017,38(12):1401-1 405.
7.郭涛,韩哲,苏莉,等.喉罩通气在胸腔镜胸交感神经链切断术中的临床研究[J].心肺血管病杂志,2012,31(3):315-317.
8.杨汉宇,董庆龙,梁丽霞,等.保留自主呼吸的喉罩全身麻醉对胸腔镜肺大疱切除手术的应用[J].广州医科大学学报,2015,43(3):45-48.
9.张洪江,潘维敏,张林,等.喉罩全麻和气管插管全麻在单孔胸腔镜肺叶切除术中的临床对照研究[J].实用医学杂志,2017,33(3):455-458.
10.蔡开灿,王向东,叶靖,等.喉罩全麻与气管插管全麻胸腔镜手术治疗肺大疱的临床对照研究[J].南方医科大学学报,2013,33(05):756-760.
11.付凯文.胸椎旁神经阻滞复合喉罩全麻在肺大泡切除术中的应用[D].南昌:南昌大学,2018.
12.刘雨睿.放置喉罩保留自主呼吸静脉麻醉在胸腔镜肺大泡切除术的应用:一项随机平行对照临床试验[D].四川:西南医科大学,2018.
13.Mao SS,Du XJ,Ma JE,et al.A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure[J].J Thorac Dis,2018,10(6):3 216-3 224.
14.Chen JF,Du Q,Lin M,et al.Transareolar Single-Port needlescopic thoracic sympathectomy under intravenous anesthesia without intubation:a randomized controlled trial[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2016,26(12):958-964.
15.Wang SL,Zhang J,Cheng H,et al.A clinical evaluation of the ProSeal laryngeal mask airway with a coopdech bronchial blocker for One-Lung ventilation in adults[J].JCardiothorac Vasc Anesth,2014,28(4):900-903.
16.Campos JH.Current techniques for perioperative lung isolation in adults[J].Anesthesiology,2002,97(5):1 295-1 301.
17.Whitehead T,Slutsky AS.The pulmonary physician in critical care7:ventilator induced lung injury[J].Thorax,2002,57(7):635-642.
18.Malhotra A.Low-tidal-volume ventilation in the acute respiratory distress syndrome[J].N Engl J Med,2007,357(11):1 113-1 120.
19.Pinhu L,Whitehead T,Evans T,et al.Ventilator-associated lung injury[J].Lancet,2003,361(9354):332-340.
20.Gothard J.Lung injury after thoracic surgery and one-lung ventilation[J].Curr Opin Anaesthesiol,2006,19(1):5-10.
21.Ambrogi MC,Fanucchi O,Gemignani R,et al.Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia:Preliminary experience[J].Journal of Thoracic and Cardiovascular Surgery,2012,144(2):514-515.
22.Gonzalez-Rivas D,Fernandez R,De La Torre M,et al.Single-port thoracoscopic lobectomy in a nonintubated patient:the least invasive procedure for major lung resection?[J].Interact Cardiovasc Thorac Surg,2014,19(4):552-555.
23.Zhang RX,Li Y,Liu XB,et al.Is laryngeal mask airway general anesthesia feasible for minimally invasive esophagectomy?[J].J Thorac Dis,2018,10(3):E210-E213.
24.何明枫,陈宇.允许性高碳酸血症对单肺通气后肺功能及萎陷侧肺炎症反应的影响[J].临床麻醉学杂志,2015,31(12):1172-1175.
25.徐志礼.允许性高碳酸血症的器官保护及应用策略[J].临床肺科杂志,2011,16(3):432-434.
26.夏舒萌,薛晓东,陈延英,等.双管喉罩复合静脉全麻在胸腔镜下交感神经链切断术中的应用[J].临床麻醉学杂志,2013,29(3):259-260.
27.Belena JM,Nunez M,Anta D,et al.Comparison of laryngeal mask airway supreme and laryngeal mask airway proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy:a randomised controlled trial[J].Eur J Anaesthesiol,2013,30(3):119-123.
28.Peirovifar E,Eydi M,Mirinejhad MM,et al.Comparison of postoperative complication between Laryngeal Mask Airway and endotracheal tube during low-flow anesthesia with controlled ventilation[J].Pak J Med Sci,2013,29(2):601-605.
29.Du XJ,Mao SS,Cui JX,et al.Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure[J].J Thorac Dis,2016,8(8):2 061-2 067.
30.Jarineshin H,Kashani S,Vatankhah M,et al.Better hemodynamic profile of laryngeal mask airway insertion compared to laryngoscopy and tracheal intubation[J].Iran Red Crescent Med J,2015,17(8):e28 615.
31.Ambrogi MC,Fanucchi O,Korasidis S,et al.Nonintubated thoracoscopic pulmonary nodule resection under spontaneous breathing anesthesia with laryngeal mask[J].Innovations(Phila),2014,9(4):276-280.