背景:气管内插管通常与术后并发症有关,例如喉咙痛不适和声音嘶哑,降低患者满意度,延长住院时间。喉罩(LMA)在减少气管插管相关的气道并发症中起着至关重要的作用。这项荟萃分析是为了确定LMA在电视胸腔镜手术(VATS)中的有效性和安全性。
方法:PubMed,Embase,科克伦图书馆,从开始到2023年10月5日,搜索Medline和WebofScience数据库以寻找合格的研究。使用Cochrane工具(RoB2)评估RCT的可能性偏差。我们进行了敏感性分析和亚组分析以评估结果的稳健性。
结果:本荟萃分析纳入了7篇文献。与气管插管相比,术后住院时间差异无统计学意义(SMD=-0.47,95%CI=-0.98-0.03,P=0.06),术中最低SpO2(SMD=0.00,95%CI=-0.49-0.49,P=1.00),低氧血症(RR=1.00,95%CI=0.26-3.89,P=1.00),术中最高PetCO2(SMD=0.51,95%CI=-0.12-1.15,P=0.11),手术野满意度(RR=1.01,95%CI=0.98-1.03,P=0.61),麻醉时间(SMD=-0.10,95%CI=-0.30-0.10,P=0.31),LMA组手术时间(SMD=0.06,95%CI=-0.13~0.24,P=0.55)和失血量(SMD=-0.13,95%CI=-0.33~0.07,P=0.21)。然而,LMA与较低的喉部不适发生率(RR=0.28,95%CI=0.17-0.48,P<0.00001)和术后声音嘶哑发生率(RR=0.36,95%CI=0.16-0.81,P=0.01)相关,气管插管与术后清醒时间延长有关(SMD=-2.19,95%CI=-3.49--0.89,P=0.001)。
结论:与气管插管相比,LMA可有效降低VATS后咽喉不适和声音嘶哑的发生率,并能加速麻醉的恢复.对于某些特定的胸外科手术,LMA似乎是气管插管的替代方法。LMA在VATS中的疗效和安全性有待进一步探讨。
BACKGROUND: Endotracheal intubation is often associated with postoperative complications such as sore throat discomfort and hoarseness, reducing patient satisfaction and prolonging hospital stays. Laryngeal mask airway (LMA) plays a critical role in reducing airway complications related to endotracheal intubation. This meta-analysis was performed to determine the efficacy and safety of LMA in video-assisted thoracic surgery (VATS).
METHODS: The PubMed, Embase, Cochrane Library, Medline and Web of Science databases were searched for eligible studies from inception until October 5, 2023. Cochrane\'s tool (RoB 2) was used to evaluate the possibility biases of RCTs. We performed sensitivity analysis and subgroup analysis to assess the robustness of the results.
RESULTS: Seven articles were included in this meta-analysis. Compared with endotracheal intubation, there was no significant difference in the postoperative hospital stay (SMD = -0.47, 95% CI = -0.98-0.03, P = 0.06), intraoperative minimum SpO2 (SMD = 0.00, 95% CI = -0.49-0.49, P = 1.00), hypoxemia (RR = 1.00, 95% CI = 0.26-3.89, P = 1.00), intraoperative highest PetCO2 (SMD = 0.51, 95% CI = -0.12-1.15, P = 0.11), surgical field satisfaction (RR = 1.01, 95% CI = 0.98-1.03, P = 0.61), anesthesia time (SMD = -0.10, 95% CI = -0.30-0.10, P = 0.31), operation time (SMD = 0.06, 95% CI = -0.13-0.24, P = 0.55) and blood loss (SMD =- 0.13, 95% CI = -0.33-0.07, P = 0.21) in LMA group. However, LMA was associated with a lower incidence of throat discomfort (RR = 0.28, 95% CI = 0.17-0.48, P < 0.00001) and postoperative hoarseness (RR = 0.36, 95% CI = 0.16-0.81, P = 0.01), endotracheal intubation was found in connection with a longer postoperative awake time (SMD = -2.19, 95% CI = -3.49 - -0.89, P = 0.001).
CONCLUSIONS: Compared with endotracheal intubation, LMA can effectively reduce the incidence of throat discomfort and hoarseness post-VATS, and can accelerate the recovery from anesthesia. LMA appears to be an alternative to endotracheal intubation for some specific thoracic surgical procedures, and the efficacy and safety of LMA in VATS need to be further explored in the future.