ProSeal喉罩与气管插管用于腹腔镜手术中安全性的Meta分析
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摘要
目的采用Meta分析评价Pro Seal喉罩(PLMA)与气管插管(ETT)应用于腹腔镜手术的安全性。方法计算机检索Pub Med、EMbase、Cochrane Library、万方数据库,中国知网、中国生物医学文献数据库,收集自建库以来至2017年8月Pro Seal喉罩和气管插管的随机对照试验(RCT),由两位评价者独立对纳入研究进行资料提取及质量评估后,采用Rev Man 5. 3软件进行结果分析。结果共纳入6个RCT,459例患者。Meta分析结果显示:PLAM喉罩能降低置管(罩)时引起的心率(HR)变化[WMD=5. 91,95%CI(2. 85,8. 97)],拔管(罩)时心率也较平稳[WMD=5. 72,95%CI(2. 35,9. 09)],气腹期间呼气末二氧化碳(Et CO2)水平高于ETT组[WMD=-1. 03,95%CI(-1. 74,-0. 31)],而两者气腹期间心率变化,首次置管成功率、气腹期间脉氧饱和度(Sp O2),气腹期间气道压变化以及术后咽喉痛没有统计学差异(P> 0. 05)。结论 Pro Seal喉罩与气管插管用于腹腔镜手术比较,在安全性方面无显著差异,但Pro Seal喉罩使围术期血流动力学更加平稳。
Objective To evaluate the safety of Pro Seal laryngeal mask( PLMA) and tracheal intubation in laparoscopic surgery by meta-analysis. Methods The databases including PubMed,EMbases,Cochrane Library,CBM,CNKI and Wanfang databases were searched for RCT studies before August 2017 regarding Pro Seal laryngeal mask and endotracheal intubation. Two reviewers independently performed data extraction and quality assessment of the included studies and analyze by Rev Man 5. 3 software. Results A total of 6 RCTs and 459 patients were included. Meta-analysis showed that: The PLAM mask stabilized heart rate( HR) [WMD = 5. 91,95% CI( 2. 85,8. 97) ]on catheterization( mask)and extubation [WMD = 5. 72,95% CI( 2. 35,9. 09) ]. The level of end-tidal carbon dioxide( EtCO2) in pneumoperitoneum group was higher than in ETT group [WMD =-1. 03,95% CI(-1. 74,-0. 31) ]. The success rate of initial catheterization,SpO2 during pneumoperitoneum,airway pressure variation during pneumoperitoneum,and postoperative sore throat were not significantly different. Conclusion Compared with tracheal intubation,Pro Seal laryngeal mask showed similar safety but better hemodynamics stability.
Objective To evaluate the safety of Pro Seal laryngeal mask( PLMA) and tracheal intubation in laparoscopic surgery by meta-analysis. Methods The databases including PubMed,EMbases,Cochrane Library,CBM,CNKI and Wanfang databases were searched for RCT studies before August 2017 regarding Pro Seal laryngeal mask and endotracheal intubation. Two reviewers independently performed data extraction and quality assessment of the included studies and analyze by Rev Man 5. 3 software. Results A total of 6 RCTs and 459 patients were included. Meta-analysis showed that: The PLAM mask stabilized heart rate( HR) [WMD = 5. 91,95% CI( 2. 85,8. 97) ]on catheterization( mask)and extubation [WMD = 5. 72,95% CI( 2. 35,9. 09) ]. The level of end-tidal carbon dioxide( EtCO2) in pneumoperitoneum group was higher than in ETT group [WMD =-1. 03,95% CI(-1. 74,-0. 31) ]. The success rate of initial catheterization,SpO2 during pneumoperitoneum,airway pressure variation during pneumoperitoneum,and postoperative sore throat were not significantly different. Conclusion Compared with tracheal intubation,Pro Seal laryngeal mask showed similar safety but better hemodynamics stability.
引文
[1]Saraswat N,Kumar A,Mishra A,et al.The comparison of Proseal laryngeal mask airway and endotracheal tube in patients undergoing laparoscopic surgeries under general anaesthesia[J].Indian J Anaesth,2011,55(2):129-134.
[2]Chung CJ,Kim DY,Par K HS,et al.Efficacy and Safety of Positive Pressure Ventilation through Laryngeal Mask Airway during Laparoscopic Cholecystectomy[J].Korean J Anesthesiol,2002,42:43-49.
[3]Jeong JH,SO Song,Kim HD.Effects of Pro Seal Laryngeal Mask Airway on Intraoperative Ventilation and Blood Pressure,and Postoperative Sore Throat in Laparoscopic Cholecystectomy[J].Korean J Anesthesiol,2004,46:10-16.
[4]Handan Güle9 Cakan T,Yaman H,et al,Comparison of hemodynamic and metabolic stress responses caused byendotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy[J].J Res Med Sci,2012,17(2):148-153.
[5]赵国胜,马小玲.妇科腹腔镜手术采用食管引流型喉罩与气管插管全身麻醉对呼吸循环系统影响的比较[J].中国微创外科杂志,2007,7(10):976-978.
[6]Miller DM,Camporota L.Advantages of Pro SealTMand SLIPATMairways over tracheal tubes for gynecological laparoscopies[J].Can J Anaesth,2006,53(2):188-193.
[7]Nagahisa Y,Hashida K,Matsumoto R,et al.A randomized clinical study on postoperative pain comparing between the supraglottic airway device and endotracheal tubing in transabdominal preperitoneal repair(TAPP)[J].Hernia,2017,21(3):391-396.
[8]Hoda MQ,Samad K,Ullah H.Pro Seal versus Classic laryngeal mask airway(LMA)for positive pressure ventilation in adult patients undergoing elective surgery[J].Cochrane DB Syst Rev,2011,(3).
[9]Singh RP,Gulabani M,Kaur M,et al.Comparative assessment of Pro SealTMlaryngeal mask airway intervention versus standard technique of endotracheal extubation for attenuation of pressor response in controlled hypertensive patients[J].Indian J Anaesthesia,2016,60(7):458.
[10]Bele1a J M,Ochoa J,Nú1ez M,et al.Role of laryngeal mask airway in laparoscopic cholecystectomy[J].World J Gastrointest Surg,2015,7(11):319-325.
[11]Güle9 H,akan T,Yaman H,et al.Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy[J].J Res Med Sci,2012,17(2):148-153.
[12]吴昊.喉罩麻醉与气管插管麻醉对老年患者腹腔镜全麻诱导期血流动力学及应激激素的比较研究[J].中国实验诊断学,2016,20(8):1278-1281.
[13]Carron M,Veronese S,Gomiero W,et al.Hemodynamic and hormonal stress responses to endotracheal tube and Pro Seal laryngeal mask AirwayTMfor laparoscopic gastric banding[J].Anesthesiology,2012,117(2):309-320.
[14]唐爱平,陈金保.三代喉罩与气管插管在全麻诱导期对循环和BIS的影响[J].临床麻醉学杂志,2014,30(1):61-63.
[2]Chung CJ,Kim DY,Par K HS,et al.Efficacy and Safety of Positive Pressure Ventilation through Laryngeal Mask Airway during Laparoscopic Cholecystectomy[J].Korean J Anesthesiol,2002,42:43-49.
[3]Jeong JH,SO Song,Kim HD.Effects of Pro Seal Laryngeal Mask Airway on Intraoperative Ventilation and Blood Pressure,and Postoperative Sore Throat in Laparoscopic Cholecystectomy[J].Korean J Anesthesiol,2004,46:10-16.
[4]Handan Güle9 Cakan T,Yaman H,et al,Comparison of hemodynamic and metabolic stress responses caused byendotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy[J].J Res Med Sci,2012,17(2):148-153.
[5]赵国胜,马小玲.妇科腹腔镜手术采用食管引流型喉罩与气管插管全身麻醉对呼吸循环系统影响的比较[J].中国微创外科杂志,2007,7(10):976-978.
[6]Miller DM,Camporota L.Advantages of Pro SealTMand SLIPATMairways over tracheal tubes for gynecological laparoscopies[J].Can J Anaesth,2006,53(2):188-193.
[7]Nagahisa Y,Hashida K,Matsumoto R,et al.A randomized clinical study on postoperative pain comparing between the supraglottic airway device and endotracheal tubing in transabdominal preperitoneal repair(TAPP)[J].Hernia,2017,21(3):391-396.
[8]Hoda MQ,Samad K,Ullah H.Pro Seal versus Classic laryngeal mask airway(LMA)for positive pressure ventilation in adult patients undergoing elective surgery[J].Cochrane DB Syst Rev,2011,(3).
[9]Singh RP,Gulabani M,Kaur M,et al.Comparative assessment of Pro SealTMlaryngeal mask airway intervention versus standard technique of endotracheal extubation for attenuation of pressor response in controlled hypertensive patients[J].Indian J Anaesthesia,2016,60(7):458.
[10]Bele1a J M,Ochoa J,Nú1ez M,et al.Role of laryngeal mask airway in laparoscopic cholecystectomy[J].World J Gastrointest Surg,2015,7(11):319-325.
[11]Güle9 H,akan T,Yaman H,et al.Comparison of hemodynamic and metabolic stress responses caused by endotracheal tube and Proseal laryngeal mask airway in laparoscopic cholecystectomy[J].J Res Med Sci,2012,17(2):148-153.
[12]吴昊.喉罩麻醉与气管插管麻醉对老年患者腹腔镜全麻诱导期血流动力学及应激激素的比较研究[J].中国实验诊断学,2016,20(8):1278-1281.
[13]Carron M,Veronese S,Gomiero W,et al.Hemodynamic and hormonal stress responses to endotracheal tube and Pro Seal laryngeal mask AirwayTMfor laparoscopic gastric banding[J].Anesthesiology,2012,117(2):309-320.
[14]唐爱平,陈金保.三代喉罩与气管插管在全麻诱导期对循环和BIS的影响[J].临床麻醉学杂志,2014,30(1):61-63.