Dhane Malek, Gervais Anne-Sophie, Joharifard Shahrzad, Trudeau Maeve O'Neill, Barrington Keith J, Villeneuve Andréanne
Department of Anesthesia, McGill University, 1001 Boulevard Decarie, Montréal, QC, H4A 3J1, Canada.
Department of Pediatrics, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
Pediatr Surg Int. 2022 Jun;38(6):801-815. doi: 10.1007/s00383-022-05117-y. Epub 2022 Apr 8.
Over the last few decades, several articles have examined the feasibility of attempting primary reduction and closure of gastroschisis without general anesthesia (GA). We aimed to systematically evaluate the impact of forgoing routine intubation and GA during primary bedside reduction and closure of gastroschisis.
The primary outcome was closure success. Secondary outcomes were mortality, time to enteral feeding, and length of hospital stay.
12 studies were included: 5 comparative studies totalling 192 patients and 7 descriptive case studies totalling 56 patients. Primary closure success was statistically equivalent between the two groups, but trended toward improved success with GA/intubation (RR = 0.86, CI 0.70-1.03, p = 0.08). Mortality was equivalent between groups (RR = 1.26, CI 0.26-6.08, p = 0.65). With respect to time to enteral feeds and length of hospital stay, outcomes were either equivalent between the two groups or favored the group that underwent primary closure without intubation and GA.
There are few comparative studies examining the impact of performing primary bedside closure of gastroschisis without GA. A meta-analysis of the available data found no statistically significant difference when forgoing intubation and GA. Foregoing GA also did not negatively impact time to enteral feeds, length of hospital stay, or mortality.
在过去几十年中，有几篇文章探讨了在无全身麻醉（GA）的情况下尝试对腹裂进行一期复位和缝合的可行性。我们旨在系统评估在腹裂一期床边复位和缝合过程中放弃常规插管和全身麻醉的影响。
主要结局是缝合成功。次要结局包括死亡率、开始肠内喂养的时间和住院时间。
纳入12项研究：5项比较研究共192例患者，7项描述性病例研究共56例患者。两组之间一期缝合成功率在统计学上相当，但全身麻醉/插管组的成功率有提高的趋势（相对危险度RR = 0.86，可信区间CI 0.70 - 1.03，p = 0.08）。两组死亡率相当（RR = 1.26，CI 0.26 - 6.08，p = 0.65）。关于开始肠内喂养的时间和住院时间，两组结局相当，或有利于未进行插管和全身麻醉而进行一期缝合的组。
很少有比较研究探讨在无全身麻醉的情况下对腹裂进行一期床边缝合的影响。对现有数据进行的荟萃分析发现，放弃插管和全身麻醉时无统计学显著差异。放弃全身麻醉也未对开始肠内喂养的时间、住院时间或死亡率产生负面影响。
