Article record

视频喉镜与直接喉镜用于儿科急诊气管插管的比较：系统综述与荟萃分析

Video laryngoscopy versus direct laryngoscopy for pediatric emergency tracheal intubation: a systematic review and meta-analysis.

综述 Meta咽喉科IF 2.9Q2

文献信息

PMID	42960018
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Thomaz Bittencourt Couto 查看其他 6 位作者 Jason Acworth；Leandra Rech；Stephan Katzenschlager；Michelle Myburgh；Barnaby R Scholefield；Allan de Caen
作者单位	Emergency Department, Instituto da Criança e do Adolescente do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. 查看其他 8 条单位信息 Centro de Simulação Realística, Einstein Hospital Israelita, Brazil.；Emergency Department, Queensland Children's Hospital, Australia.；Faculty of Medicine, University of Queensland, Australia.；Hospital de Clínicas de Porto Alegre, Unidade de Terapia Intensiva Pediátrica, Brazil.；Heidelberg University, Medical Faculty Heidelberg, Department of Anaesthesiology, Heidelberg, Germany.；University of the Free State, Bloemfontein, South Africa.；Department of Paediatrics, Western University, Canada Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.；Division of Pediatric Critical Care Medicine, Stollery Children's Hospital/University of Alberta, Edmonton, Canada.
期刊	Resuscitation plus
SCI 分区	Q2
IF	2.9
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

目的： 比较视频喉镜与直接喉镜在心脏骤停及围骤停情境下用于儿科插管的效果。
方法： 本系统综述（PROSPERO CRD420251081694）检索了MEDLINE、Embase和Cochrane数据库，检索时间自建库至2026年5月1日。两名作者独立筛选研究；数据由一名作者提取，并由第二名审阅者独立核实。纳入的研究比较视频喉镜与直接喉镜在儿科急性照护中的应用；场所包括急诊科、重症监护室和院前环境。使用ROBINS-I和RoB2评估偏倚风险。关键结局为出院存活率、首次插管成功率、总体插管成功率以及严重气管插管相关事件。其他数据包括研究设计、场所、年龄、操作者类型和设备。荟萃分析采用随机效应Mantel-Haenszel模型，报告风险比（RR）及95%置信区间。使用GRADE评估证据确定性。
结果： 共纳入18项研究（17项观察性研究，1项随机对照试验）。视频喉镜的首次成功率更高（72.2% vs 69.0%；RR 1.11，95% CI 1.06-1.16；极低确定性）。视频喉镜的严重不良事件较少（7.7% vs 11.8%；RR 0.76，95% CI 0.62-0.93；极低确定性）。总体成功率（RR 1.00，95% CI 0.99-1.01）和血氧饱和度下降（RR 0.88，95% CI 0.77-1.01）相似。没有研究报告生存结局或针对心脏骤停的数据。
结论： 在接受急诊气管插管的儿童中，视频喉镜可能与首次成功率提高和不良事件减少相关，尽管证据确定性极低且因果推断受限。尚无关于生存结局和心脏骤停的数据。

英文摘要

AIM: To compare video laryngoscopy with direct laryngoscopy for pediatric intubation during cardiac arrest and peri-arrest scenarios.
METHODS: This systematic review (PROSPERO CRD420251081694) searched MEDLINE, Embase, and Cochrane from inception to May 1, 2026. Two authors independently screened studies; data were extracted by one and independently verified by a second reviewer. Eligible studies compared video versus direct laryngoscopy in pediatric acute care; emergency department, intensive care, and prehospital settings. Risk of bias was assessed using ROBINS-I and RoB2. Critical outcomes were survival to hospital discharge, first-pass intubation success, overall intubation success, and severe tracheal intubation-associated events. Additional data included study design, setting, age, operator type, and device. Meta-analyses used random-effects Mantel-Haenszel models reporting risk ratios (RR) with 95% confidence intervals. Certainty of evidence was assessed using GRADE.
RESULTS: Eighteen studies (17 observational, 1 RCT). First-pass success was higher with video laryngoscopy (72.2% vs 69.0%; RR 1.11, 95% CI 1.06-1.16; very low certainty). Severe adverse events were less frequent with video laryngoscopy (7.7% vs 11.8%; RR 0.76, 95% CI 0.62-0.93; very low certainty). Overall success (RR 1.00, 95% CI 0.99-1.01) and desaturation (RR 0.88, 95% CI 0.77-1.01) were similar. No studies reported survival outcomes or data specific to cardiac arrest.
CONCLUSION: Among children undergoing emergency tracheal intubation, video laryngoscopy may be associated with improved first-pass success and fewer adverse events, although the certainty of evidence is very low and causal inferences are limited. No data were available for survival outcomes and cardiac arrest.