国际麻醉学与复苏杂志   2024, Issue (5): 7-7
    
短暂停通气结合术侧肺阻塞技术术中胸膜切开前单肺通气低氧血症危险因素的临床观察
张凌, 万磊, 李文静, 李佳仪, 宋比佳, 邵刘佳子, 薛富善1()
1.中国医学科学院整形外科医院
Clinical observation of the risk factors of hypoxemia during one lung ventilation before intraoperative pleurotomy using short apnea combined with intraoperative pulmonary obstruction technique
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摘要:

目的 观察采用短暂停通气结合术侧肺阻塞技术进行单肺通气(OLV)管理时胸膜切开前低氧血症的发生情况及其独立危险因素。 方法 107例行肺部分切除术的患者,根据从肺隔离OLV开始时至胸膜切开前是否发生低氧血症分为低氧血症组(YH组,24例)和无低氧血症组(NH组,83例),记录患者低氧血症发生率,观察发生低氧血症的患者解除术侧肺阻塞前及解除术侧肺阻塞1 min后的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)变化。采用多因素logistic回归分析确定胸膜切开前低氧血症发生的独立危险因素。 结果 107例患者中,胸膜切开前低氧血症的发生率为22.4%。14例发生低氧血症的患者,解除术侧肺阻塞前的PaO2低于解除术侧肺阻塞1 min后(P<0.05),但PaCO2差异无统计意义(P>0.05)。多因素logistic回归分析发现,OLV‑胸膜切开时间(OLV‑TE)延长[比值比(OR)=1.141, 95%置信区间(CI)1.043~1.249]和OLV时高气道峰压(Ppeak)(OR=1.235,95%CI 1.035~1.473)是胸膜切开前低氧血症发生的独立危险因素。 结论 采用短暂停通气结合术侧肺阻塞技术进行OLV管理时,胸膜切开前低氧血症的发生率为22.4%,且OLV‑TE延长和OLV时高Ppeak是胸膜切开前低氧血症的独立危险因素。解除非通气侧肺阻塞是纠正胸膜切开前低氧血症的有效方法。

关键词: 电视胸腔镜手术; 肺隔离技术; 单肺通气; 低氧血症
Abstract:

Objective To determine the occurrence and independent risk factors of hypoxemia during one lung ventilation (OLV) before pleurotomy using short apnea combined with intraoperative pulmonary obstruction technique. Methods A total of 107 patients who underwent partial pulmonary resection were enrolled. According to the presence of hypoxemia from lung isolation and OLV to pleurotomy, they were divided into two groups: a hypoxemia group (group YH, n=24) and a non‑hypoxemia group (group NH, n=83). The incidence of hypoxemia was recorded, while the changes of arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) in patients with hypoxemia were observed before and 1 min after removal of intraoperative pulmonary obstruction. Multivariate logistic regression analysis was performed to determine the independent risk factors for hypoxemia before pleurotomy. Results Among the 107 patients, the incidence of hypoxemia before pleurotomy was 22.4%. For 14 patients with hypoxemia, the PaO2 before removal of intraoperative pulmonary obstruction was lower than that 1 min after the removal (P<0.05), without statistical difference (P>0.05). Multivariate logistic regression analysis showed that both the prolonged OLV‑pleurotomy time (OLV‑TE) [odds ratio (OR)=1.141, 95% confidence interval (CI) 1.043−1.249] and an increased peak airway pressure (Ppeak) during OLV (OR=1.235, 95%CI 1.035−1.473) were the independent risk factors for hypoxemia before pleurotomy. Conclusions The incidence of hypoxemia is 22.4% during OLV before pleurotomy through short apnea combined with intraoperative pulmonary obstruction technique, and both the prolonged OLV⁃TE and the increased Ppeak during OLV are the independent risk factors for hypoxemia before pleurotomy. Removal of intraoperative pulmonary obstruction is an effective method to correct hypoxemia before pleurotomy.

Key words: Video‑assisted thoracic surgery; Lung isolation; One lung ventilation; Hypoxemia