ObjectiveTo evaluate the effect of airway management drugs on the respiratory function and postoperative recovery of patients who had moderate or severe chronic obstructive pulmonary diseases(COPD) undergoing an open chest surgery. MethodThere were a total of 22 patients suffering from both lung cancer, esophageal cancer or gastroesophageal junction carcinoma and moderate to severe COPD(of which there were 16 males and 6 females; accepting traditional operation 5 cases and minimally-invasive operation 17 cases; lung cancer 16 cases, esophageal cancer 4 cases and gastroesophageal junction carcinoma 2 cases as the observation group). To statistic the respiratory function and arterial blood gas analysis before and after treating with airway management drugs. And compare the postoperative pulmonary complications(PPCs) and hospital-stay with 50 patients who have no COPD(of which there were 34 males and 16 females; accepting traditional operation 17 cases and minimally-invasive operation 33 cases; lung cancer 35 cases, esophageal cancer 11 cases and gastroesophageal junction carcinoma 4 cases as the control group). ResultThere was a statistical difference of forced expiratory volume in one second(FEV1), forced vital capacity(FVC) and maximal voluntary ventilation(MVV) after the above treatment by 7 to 10 days and comparing with prior treatment(P<0.05). Partial pressure of oxygen(PaO2) increased with no statistical difference(P>0.05) while PaCO2 decreased with a statistical difference(P<0.05）. Comparing with patients without COPD, the incidences of PPCs and postoperative hospital stay were of no statistical difference(P>0.05). ConclusionPatients with moderate or severe COPD with airway management drugs(antibiotics,glucocorticoids, bronchodilators and phlegm dissolving agent) in perioperative period could improve the respiratory function and operation tolerance effectively, reduce the incidence of PPCs and shorten postoperative hospital stay.
摘要:目的:评价II代引流型喉管(LTS II)和Proseal喉罩(PLMA)在择期手术中应用效果。方法:检索了Cochrane图书馆(2009年第3期)、Pubmed(1950～2009)、EMBase(1989～2009)、CNKI(1979～2009)、VIP(1989～2009)、CBM(1978～2009)中相关II代引流型喉管(LTS II)和Proseal喉罩在择期手术中应用的随机对照试验(RCT),同时筛检纳入文献的参考文献。由2名研究者对文献质量进行严格评价和资料提取,根据指标相应异质性进行描述性分析或Meta分析(RevMan 5.0)。结果:共纳入3个RCT,共244例研究对象,文献质量均为B级。3个RCT的结果显示与PLMA相比,LTS II具有相似的首次置入成功率(P=0.45)、术毕即刻上呼吸道损伤发生率(P=1.00)、术后24 h咽痛发生率(P=0.81)、术后24 h吞咽困难发生率(P=0.12)。2个RCT的结果显示两组引流管置入均较容易。1个RCT的结果显示两组的操作者主观评价相近(OR=1.86,95%CI 0.39～ 8.99)。气道封闭效果由于采用方法学差异性较大,指标也不尽相同,尚不能得出准确结果。结论:LTS II在择期手术中用于气道管理具有较好的前景。但是现时仍不宜用于需在择期术中进行控制通气的病人。关于气道封闭效果,尚需采用更合理规范的指标、更高质量的研究设计进一步研究。Abstract: Objective: To assess the efficacy of laryngeal tube suction II (LTS II) and LMAProseal (PLMA) for airway management in elective surgery. Methods:We searched Cochrane Library (2009),Pubmed (19502009)、EMBase (19892009),CNKI (19792009),VIP (19892009),CBM (19782009). The quality of the trials was assessed by two reviewers independently. RevMan 5.0 software provided by the Cochrane Collaboration was used for statistical analysis. Results:Three studies involving 244 participants were included. Same rates of fist successful attempt (P=0.45),upper airway trauma (P=1.00),sore throat (P=0.81) and dysphagia (P=0.12) were observed in LTS II and PLMA in all studies. Two studies indicated that the insertion of gastric tube was easy in both groups. The similarity of subjective maneuverability in two groups was reported in one study (OR=1.86, 95%CI 0.39 to 8.99). The correct result of effectiveness of airway seal could not be made because of various methods and measurements. Conclusion:LTS II have a good perspective in the airway management. Otherwise, it is not safe for patient required control ventilation because of lack of evidence on the effectiveness of airway seal. More RCTs of high quality need to be undertaken in the future.
ObjectiveTo compare the effects of different airway management strategies on outcomes of patients with out-of-hospital cardiac arrest (OHCA).MethodsWe searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and WanFang Data for relevant studies comparing the influence of different airway management strategies on outcomes of OHCA patients. The deadline was up to 31st May, 2019. Grading of Recommendations Assessment, Development and Evaluation system 3.6 was used for quality assessment, and RevMan 5.3 software was used for meta-analysis. Odds ratio (OR) and 95% confidence interval (CI) were used to conduct the comparison. Results A total of 20 studies were finally enrolled, including 880 567 OHCA patients. Compared with supraglottic airway (SGA), bag-valve mask (BVM) improved the rate of survival to discharge of OHCA patients [OR=1.45, 95%CI (1.01, 2.08), P=0.04], while the rate of return of spontaneous circulation (ROSC) was not improved (P>0.05); in the subgroup analysis, BVM and SGA had similar effect on the rate of ROSC and the rate of survival to discharge in Asian countries (P>0.05), while BVM performed better than SGA in the two rates in European and American countries. BVM and endotracheal intubation (ETI) had similar effect on the two rates (P>0.05). In Asian countries, ETI performed better than BVM in the rate of ROSC [OR=0.63, 95%CI (0.49, 0.81), P=0.000 3], and there was no statistically significant difference in the rate of survival to discharge between ETI and BVM (P>0.05); while in European andAmerican countries, BVM performed better than ETI in the rate of survival to discharge [OR=3.10, 95%CI (2.69, 3.56), P<0.000 01], and there was no statistically significant difference in the rate of ROSC between ETI and BVM (P>0.05). Compared with SGA, ETI improved the rate of ROSC [OR=0.68, 95%CI (0.62, 0.76), P<0.000 01] and the rate of survival to discharge [OR=0.89, 95%CI (0.81, 0.98), P=0.02]. In Asian countries, ETI performed better than SGA in the two rates (P<0.05); while in European and American countries and New Zealand, ETI performed better than SGA in the rate of ROSC (P<0.05), but there was no statistically significant difference in the rate of survival to discharge (P>0.05). Conclusions Different airway management strategies have differente effects on OHCA patients. The optimal airway management strategy when rescuing OHCA patients might be selected based on local emergency medical service system conditions.
ObjectiveThe clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals.MethodsA total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended.ResultsSmoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough.ConclusionFor perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.