声门上气道与气管插管在鼻窦手术中的比较：系统评价与荟萃分析

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中文摘要

目的： 本系统评价评估气管插管（ET）与声门上气道装置（SGA）在内镜鼻窦手术（ESS）气道管理中的相对安全性和副作用特征。
方法： 于2025年4月检索MEDLINE、Embase和Cochrane Library。对三项或以上研究以可比方法报告的结果进行随机效应荟萃分析；其余结果进行叙述性综合。主要结局为误吸事件、气道污染和术后不良症状（咳嗽、咽痛、声音嘶哑、恶心和呕吐）；次要结局为手术时间和估计失血量。共纳入九项研究（714例患者，1995-2024年）。
结果： 误吸罕见（一例无症状的ET病例）。汇总分析显示，使用SGA可显著减少气道污染（RR 0.27，95% CI 0.15-0.47，I²=0%）。装置污染在两组中均常见（SGA 0-86%，ET 53-77%），但临床后果有限。汇总分析还显示，使用SGA可显著减少术后第0天咳嗽（RR 0.39，95% CI 0.23-0.68，I²=0%），而第0天咽痛无显著差异（RR 0.65，95% CI 0.24-1.74，I²=68.7%）。声音嘶哑、失血量和手术时间有减少趋势，倾向于SGA，但无统计学意义。
结论： 历史上认为SGA在ESS期间气道保护较差的担忧未得到当前比较证据的支持。在适当选择的低误吸风险患者中，SGA是ET的安全替代方案。鉴于证据基础存在异质性，研究结果应辅助而非替代临床判断，装置选择应依据个体患者和手术因素。

英文摘要

PURPOSE: This systematic review evaluates the relative safety and side-effect profiles of endotracheal tubes (ETs) and supraglottic airway devices (SGAs) for airway management in endoscopic sinus surgery (ESS).
METHODS: A search of MEDLINE, Embase and the Cochrane Library was conducted in April 2025. Random-effects meta-analysis was performed for outcomes reported by three or more studies with comparable methodology; remaining outcomes were synthesised narratively. Primary outcomes were aspiration events, airway contamination and adverse post-operative symptoms (cough, sore throat, hoarseness, nausea and vomiting); secondary outcomes were operative time and estimated blood loss. Nine studies (714 patients, 1995-2024) were eligible.
RESULTS: Aspiration was rare (one asymptomatic ET case). Pooled analysis demonstrated a significant reduction in airway contamination with SGA use (RR 0.27, 95% CI 0.15-0.47, I²=0%). Device contamination was common in both (SGAs 0-86%, ETs 53-77%) but of limited clinical consequence. Pooled analysis also demonstrated a significant reduction in post-operative day 0 cough with SGA use (RR 0.39, 95% CI 0.23-0.68, I²=0%), whereas day 0 sore throat showed no significant difference (RR 0.65, 95% CI 0.24-1.74, I²=68.7%). Trends toward reduced hoarse voice, blood loss and operative time favoured SGAs but were not significant.
CONCLUSION: The historical concern that SGAs offer inferior airway protection during ESS is not supported by current comparative evidence. In appropriately selected, low-aspiration-risk patients, SGAs represent a safe alternative to ETs. Given the heterogeneous evidence base, findings should assist rather than replace clinical judgment, with device selection guided by individual patient and procedural factors.