ProSeal喉罩与气管插管在腹腔镜胆道手术麻醉中的应用评价  

Proseal Laryngeal Mask Airway versus Endotracheal Tubes for Intraoperative Airway Management during Laparoscopic Biliary Tract Surgery:A Systematic Review

作　　者：张艳菊[1] 刘馨烛[1] 刘斌[1] 

机构地区：[1]四川大学华西医院麻醉科,成都610041

出　　处：《中国循证医学杂志》2009年第5期552-557,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的对比ProSeal喉罩(PLMA)与气管插管(TT)在腹腔镜胆道手术中气道管理的效果和安全性。方法采用Cochrane系统评价方法,计算机检索Cochrane对照试验资料库、MEDLINE、VIP和CNKI(截至2008年5月),手检相关杂志和会议摘要。由两名研究者独立进行资料提取、质量评价和交叉核对,如遇分歧讨论解决,必要时咨询第三者。采用RevMan4.2软件对同质研究进行Meta分析。结果共纳入7个随机对照试验,包括493例患者。Meta分析结果显示:①术中不良反应:所有研究对象在术中均未发生反流误吸,通气不足等意外。②术后咽痛:PLMA组术后咽痛发生人数明显少于对照组[OR=0.27,95%CI(0.13,0.53),P=0.0002];拔管反应:PLMA组术后并发症发生人数明显少于对照组[OR=0.01,95%CI(0.00,0.03),P<0.00001]。③两组在气腹形成后气道峰压[WMD=0.01,95%CI(-0.66,0.68),P=0.98]及气腹形成后呼气末CO2分压[WMD=0.01,95%CI(-0.58,0.59),P=0.99]以及两者的置入情况[OR=0.58,95%CI(0.23,1.47),P=0.25]等方面差异均无统计学意义。④血流动力学变化(包括激素水平),TT组较PLMA组明显,其差异有统计学意义。结论在腹腔镜胆道手术中,PLMA是一种安全、有效的气道管理方式,但由于纳入研究数量少,同时存在选择性偏倚和测量性偏倚的中度可能性,因此期待将来有更多高质量的RCT为临床工作提供高强度的证据。Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask （PLMA） compared to endotracheal tube （TT） for airway management in the patients undergoing laparoscopic biliary tract surgery. Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers （CCTR） of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneity studies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that： （1） Side effects： none of the patients experienced regurgitation or hypoventilation. （2） PLMA was superior to TT in terms of less postoperative sore throat （OR=0.27, 95%CI 0.13 to 0.53, P=0.0002） and response during extubation （OR=0.01, 95%CI 0.00 to 0.03, P〈0.00001）. （3） PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation （Ppeak： WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; Pe,CO2： WMD=0.01, 95%CI -0.58 to 0.59, P=0.99） and ease of insertion （OR--0.58, 95%C1 0.23 to 1.47, P=0.25）. （4） Hemodymatics changed during the procedure： PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.

关 键 词：PROSEAL喉罩 气管插管 腹腔镜胆道手术 随机对照试验 系统评价 

分 类 号：R614[医药卫生—麻醉学]