单肺通气期间肺牵张指数对肺叶切除术后低氧血症的影响  

Effect of pulmonary stretch index during one-lung ventilation on postoperative hypoxemia after pulmonary lobectomy

作　　者：张玉梅 张滢莹 向晋贤 孔霞 刘力 王晓斌 Zhang Yumei;Zhang Yingying;Xiang Jinxian;Kong Xia;Liu Li;Wang Xiaobin(Department of Anesthesiology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Anesthesiology and Critical Care Medicine Key Laboratory,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院麻醉科,泸州646000 [2]西南医科大学附属医院麻醉研究室,泸州646000

出　　处：《国际麻醉学与复苏杂志》2025年第3期247-254,共8页International Journal of Anesthesiology and Resuscitation

基　　金：四川省科技厅专项基金(2022YFS0632)。

摘　　要：目的探讨单肺通气期间肺牵张指数(SI)对肺癌患者行肺叶切除术后发生低氧血症的影响。方法采用前瞻性队列研究收集2022年7月1日至2022年12月31日在西南医科大学附属医院行电视胸腔镜辅助(VATS)肺叶切除术患者。所有患者接受双腔气管导管插管、小潮气量肺保护性通气策略、呼气末正压(PEEP)递增法肺复张、同步间歇指令性通气培养自主呼吸,手术全程采用全凭静脉麻醉。采集单肺通气开始5 min内SI,根据SI平均值将患者分为低SI组、适宜SI组、高SI组。记录患者一般情况、麻醉相关资料和手术相关资料、呼吸力学指标(气道峰压、气道平台压、气道平均压、驱动压、吸气阻力、静态肺顺应性和机械功率);主要结局为术后第1~5天或出院时发生低氧血症的情况,次要结局为术前和术后第2天非手术侧不同含气量肺组织的占比。采用单因素和多因素logistic回归进行术后低氧血症发生风险相关性分析。结果共72例患者被纳入分析,其中低SI组36例,适宜SI组21例,高SI组15例。3组患者一般情况、麻醉相关资料和手术相关资料差异无统计学意义(均P>0.05)。与低SI组比较:高SI组患者气道峰压、气道平台压、气道平均压、驱动压、吸气阻力、机械功率较低(均P<0.05),静态肺顺应性较高(P<0.05);适宜SI组患者气道峰压、驱动压、吸气阻力较低(均P<0.05)。与高SI组比较,适宜SI组患者气道峰压、吸气阻力、机械功率较高(均P<0.05)。术后低氧血症发生率低SI组为66.7%、适宜SI组为38.1%、高SI组为26.7%,低SI组发生率更高(P<0.05)。多因素logistic回归分析显示,术后低氧血症发生风险与年龄、基础动脉血氧饱和度、单肺通气时长、静态肺顺应性、吸气阻力、气道平均压、气道峰压、气道平台压、驱动压、机械功率以及SI相关,其中SI每增加0.1,术后低氧血症发生风险降低30%。亚组分析发现,SI与术后低Objective To investigate the effect of pulmonary stretch index(SI)during one-lung ventilation(OLV)on postoperative hypoxemia in lung cancer patients undergoing pulmonary lobectomy.Methods A prospective cohort study was conducted on patients who underwent video-assisted thoracoscopic surgery(VATS)lobectomy at the Affiliated Hospital of Southwest Medical University from July 1,2022,to December 31,2022.All patients received double-lumen endotracheal intubation,a low tidal volume lung protective ventilation strategy,positive end-expiratory pressure(PEEP)with incremental recruitment maneuvers and synchronized intermittent mandatory ventilation to encourage spontaneous breathing.Total intravenous anesthesia was maintained throughout the surgery.The pulmonary SI was recorded within the first 5 min of OLV.Based on the average SI,the patients were divided into three groups:a low-SI group,an optimal-SI group,and a high-SI group.Their general information,anesthesia-related and surgical data,respiratory mechanics parameters(peak airway pressure,plateau airway pressure,mean airway pressure,driving pressure,inspiratory resistance,static lung compliance,and mechanical power)were recorded.Primary outcomes were the incidence of hypoxemia on postoperative days 1‒5 or at discharge.Secondary outcomes were the percentage of non-operated lung tissue with different aeration levels before surgery and on postoperative day 2.Univariate and multivariate logistic regression analyses were conducted to analyze the risk factors for postoperative hypoxemia.Results A total of 72 patients were included in the study,including 36 patients in the low-SI group,21 patients in the optimal-SI group,and 15 patients in the high-SI group.There were no statistical differences in general information,anesthesia-related and surgical data among the three groups(all P>0.05).Compared with the low-SI group,the high-SI group showed decreases in peak airway pressure,plateau airway pressure,mean airway pressure,driving pressure,inspiratory resistance,and mechanical

关 键 词：单肺通气 肺牵张指数 肺叶切除术 术后低氧血症 

分 类 号：R614[医药卫生—麻醉学]