Liu Yuqi, Chen Lianhua, Li Shitong
Anesthesiology Department of Obstetrics and Gynecology, Hospital of FuDan University, Shanghai, China.
Paediatr Anaesth. 2014 Oct;24(10):1023-30. doi: 10.1111/pan.12469. Epub 2014 Jun 28.
Either controlled ventilation or spontaneous respiration is commonly used in general anesthesia for inhaled foreign body removal via rigid bronchoscopy. Controversy in the literature exists concerning which form of ventilation is optimally suited for bronchoscopy. We performed a meta-analysis to compare controlled ventilation and spontaneous respiration with respect to complications, operation time, and anesthesia recovery time.
We searched MEDLINE (1946-2013) and the Cochrane Central Register of Controlled Trials, EMBASE. The articles were evaluated for validity, and the data on complications, including desaturation, laryngospasm, laryngeal edema, bucking and coughing, body movement, breath holding, operation time, and anesthesia recovery time, were extracted by the authors and summarized using odds ratios, mean differences, and 95% confidence intervals (CIs).
From the included studies, 423 subjects received controlled ventilation, whereas 441 subjects received spontaneous respiration. There was no significant difference in the incidence of desaturation between controlled ventilation and spontaneous respiration (odds ratio, 0.70; 95% CI, 0.30-1.63). However, the incidence of laryngospasm was lower when controlled ventilation was performed (OR, 0.27; 95% CI, 0.10-0.76). The operation time (mean difference, -9.07 min; 95% CI, -14.03 to -4.12) was shorter in the controlled ventilation group.
Current evidence does not show a preference for either controlled ventilation or spontaneous respiration, although laryngospasm has a lower incidence when controlled ventilation is performed. Additional clinical studies are required to substantiate this issue.
在全身麻醉下通过硬质支气管镜取出吸入性异物时，通常采用控制通气或自主呼吸。文献中对于哪种通气方式最适合支气管镜检查存在争议。我们进行了一项荟萃分析，以比较控制通气和自主呼吸在并发症、手术时间和麻醉恢复时间方面的差异。
我们检索了MEDLINE（1946 - 2013年）、Cochrane对照试验中央注册库和EMBASE。对文章进行有效性评估，作者提取包括血氧饱和度降低、喉痉挛、喉水肿、呛咳和咳嗽、身体移动、屏气、手术时间和麻醉恢复时间等并发症的数据，并使用比值比、平均差和95%置信区间（CI）进行汇总。
在所纳入的研究中，423名受试者接受了控制通气，而441名受试者接受了自主呼吸。控制通气和自主呼吸在血氧饱和度降低的发生率上没有显著差异（比值比，0.70；95% CI，0.30 - 1.63）。然而，进行控制通气时喉痉挛的发生率较低（OR，0.27；95% CI，0.10 - 0.76）。控制通气组的手术时间较短（平均差，-9.07分钟；95% CI，-14. 的-4.12）。
目前的证据并未显示出对控制通气或自主呼吸的偏好，尽管进行控制通气时喉痉挛的发生率较低。需要更多的临床研究来证实这一问题。
