单肺通气期间低氧血症的病理生理机制与管理策略

Pathophysiological Mechanism and Management Strategy of Hypoxemia during One-Lung Ventilation

摘要: 单肺通气(one-lung ventilation, OLV)是胸外科手术中常用的通气技术，但其导致低氧血症是临床常见的并发症。本文综述了单肺通气期间低氧血症的病理生理机制、风险因素及防治策略，为临床预防单肺通气期间低氧血症提供理论依据。单肺通气(one-lung ventilation, OLV)涉及选择性地仅对患者的一侧肺进行通气。单肺通气可以充分暴露患侧肺的视野，为外科操作提供空间，同时还可以避免健侧肺被污染。单肺通气的出现极大地促进了胸科手术的发展。但单肺通气会造成强制性肺内分流，这可能导致低氧血症。实际上，低氧血症是麻醉医师在OLV期间遇到的最常见问题之一，影响约5%的病例。尽管低氧血症没有一致的定义，但一般认为，吸入氧浓度(FIO₂)为100%时，动脉血氧饱和度SPO₂ < 90%是普遍接受的标准。本文系统综述了OLV期间低氧血症的病理生理机制、风险因素及防治策略，为临床实践提供循证依据。本文中大多数讨论涉及接受开胸手术、胸腔镜手术的患者。

Abstract: One-lung ventilation (OLV) is a commonly used ventilation technique in thoracic surgery, but its hypoxemia is a common clinical complication. This paper reviews the pathophysiological mechanism, risk factors and prevention strategies of hypoxemia during one-lung ventilation, and provides theoretical basis for clinical prevention of hypoxemia during one-lung ventilation. One-lung ventilation (OLV) involves selectively ventilating only one lung of a patient. One-lung ventilation can fully expose the vision of the affected lung, provide space for surgical operation, and at the same time avoid the pollution of the healthy lung. The emergence of one-lung ventilation has greatly promoted the development of thoracic surgery. However, one-lung ventilation will cause forced intrapulmonary shunt, which may lead to hypoxemia. In fact, hypoxemia is one of the most common problems encountered by anesthesiologists during OLV, affecting about 5% of cases. Although there is no consistent definition of hypoxemia, it is generally believed that when the inhaled oxygen concentration (FIO₂) is 100%, the arterial oxygen saturation SPO₂ < 90% is a generally accepted standard. This paper systematically reviews the pathophysiological mechanism, risk factors and prevention strategies of hypoxemia during OLV, so as to provide evidence-based evidence for clinical practice. Most of the discussions in this paper involve patients undergoing thoracotomy and thoracoscopic surgery.