可视喉镜与直接喉镜在小儿气管插管中的有效性和安全性的比较

2020
07/28

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翻译:吴学艳  编辑:冯玉蓉  审校:曹莹

目的:小儿与成人气道的解剖和生理存在差异,使小儿气管插管成为一项挑战。本研究旨在对可视喉镜(VL)和直接喉镜(DL)在小儿气管插管结果中的有效性和安全性进行比较。

设计:系统回顾和meta分析。

机构:手术室。

患者:需要气管插管的儿科患者。

干预:可视喉镜或直接喉镜。

方法:在PubMed、Embase和Cochrane图书馆进行电子检索,筛选截至2020年1月发表的相关随机对照试验。观察结果包括插管时间、首次插管失败率、Cormack-Lehane喉部视野分级、困难气管插管比例(IDS)、声门开放评分百分比(POGO)、喉外按压操作(OLEM)以及并发症。采用相对危险度和加权平均差值(WMD)、95%CI以及随机效应模型来计算汇总结果。

主要结果:我们总共分析了27项试验,涉及2461名患儿。用VL插管的儿童插管所需时间长于DL插管时间(WMD 3.41,95%CI 1.2 9~5.5 3,P=0.0.002),然而,婴儿用VL和DL插管所需时长相似(WMD1.72,95%CI -1.0 9~4.5 4,P=0.0.230)。在儿童和婴儿中,VL与DL首次插管失败率无显著差异。VL可改善POGO和插管损伤,但不能改善Cormack-Lehane分级、IDS、喉外按压、声音嘶哑及氧饱和度下降。

结论:与DL插管相比,VL插管对儿科患者及时插管和首次插管失败率均无显著改善,但可改善POGO并减少插管损伤。

原始文献来源:Hu X,  Jin Y,  Li J, et al. Efficacy and safety of video laryngoscopy versus direct laryngoscopy in paediatric intubation: A meta-analysis of 27 randomized controlled trials.[J].J Clin Anesth 2020 Jul 06;66

Efficacy and safety of video laryngoscopy versus direct laryngoscopy in paediatric intubation: A meta-analysis of 27 randomized controlled trials

Abstract

Objective: Anatomical and physiological differences in paediatric and adult airways make intubation of pae-diatric patients a challenge. This study aimed to compare the efficacy and safety of video laryngoscopy (VL) todirect laryngoscopy (DL) on intubation outcomes in paediatric patients.

Design: Systematic review and meta-analysis.

Setting: Operating room.

Patients: Paediatric patients who needed tracheal intubation.

Intervention: Video laryngoscopy or direct laryngoscopy.

Measurements: Electronic searches in PubMed, Embase, and the Cochrane Library were performed to identify relevant randomized controlled trials published through January 2020. Outcomes included time to intubate,intubation failure at first attempt, Cormack-Lehane laryngeal view grade, intubation difficulty scale (IDS),percentage of glottic opening score (POGO), optimal external laryngeal manipulation (OLEM), and complications. Relative risks and weighted mean difference (WMD), with 95% CI, were employed to calculate summary results using a random-effects model.

Main results: Overall, 27 trials including 2461 paediatric patients were analysed. Children with video laryngo-scopy intubation required longer time to intubate than direct laryngoscopy intubation (WMD 3.41, 95% CI:1.29–5.53, P = 0.002), whereas infants receiving video laryngoscopy and direct laryngoscopy intubation ex-perienced similar time to intubate (WMD 1.72, 95% CI: −1.09-4.54, P = 0.230). No significant differences wereobserved on intubation failure at first attempt between video laryngoscopy and direct laryngoscopy intubations in children and infants, respectively. Video laryngoscopy improved the POGO and intubation trauma but not Cormack-Lehane laryngeal view grade, IDS, external laryngeal manipulation, hoarseness, or oxygen desaturation.

Conclusions: Compared with direct laryngoscopy intubation, there were no benefits for paediatric patients withvideo laryngoscopy on time to intubate and failure at first attempt, but there were benefits with regard to POGO and intubation trauma.

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本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:guikequan@hmkx.cn
关键词:
插管,喉咙

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