机器人心脏手术体外循环前后单肺通气时的低氧血症

Hypoxemia with one lung ventilation before and after cardiopulmonary bypass during robotic cardiac surgery

目的分析机器人微创心脏手术中,在单肺通气(OLV)、二氧化碳气胸以及体外循环(CPB)的影响下发生低氧血症的机制,探讨合适的措施来预防和改善低氧血症。方法 130例行机器人心脏手术的患者,记录患者术前及术中的肺功能及血气指标,当SpO2小于90%时即认为有低氧血症,抽取动脉血做血气分析,并记录低氧血症的发生时刻和持续时间。结果术中有21.5%发生低氧血症,多发生于CPB停机后OLV 5 min、15 min、25 min,最低PaO2为53.4 mm Hg;通过放松(并不完全松开)钳夹非通气侧支气管导管的钳子,恢复部分非通气侧肺通气,经过(3.7±1.4)min,可使PaO2由(65.4±8.8)mmHg上升到(104.4±10.5)mm Hg。结论在机器人心脏手术麻醉中,低氧血症的发生率高于其他传统开胸手术,低氧血症发生的原因更复杂,但通过严格的术前评估和及时的处理,尚不致发生相关并发症。

Objective To investigate the occurrence and treatment of hypoxemia during robotic cardiac surgery with one lung ventilation （OLV）, carbon dioxide pneumothorax and cardiopulmonary bypass （CPB）. Methods 130 consecutive patients undergo- ing robotic cardiac surgery using the da Vinci system were studied. With general anesthesia, a left - sided double - lumen tube was in- tubated for OLV, and the dependent lung was ventilated with a tidal volume of 6 -8 ml/kg （ideal body weight） and a fraction of inspir- atory oxygen （ FiO2 ） of 1.0 during OLV. SpO2 and arterial blood gases were monitored. When hypoxemia was identified as SpO2 less than 90%, appropriate measures were taken to correct it. Results Hypexemia has occurred during OLV after CPB, its incidence was 21.5%. Of which the minimum value of PaO2 was 53 mm Hg. Partial opened （ not loosen） the pliers clamping on the non - ventilated side of bronchial catheter to restore partial ventilation for the non - dependent lung was effective for correcting hypexemia. The PaO2 raised from （65.4±8.8） mmHg to （104.4±10.5） mmHg within （3.7 ±1.4） min. Conclusion The incidence of hypoxemia is higher, and mechanism of hypoxemia is more complex during robotic cardiac surgery than non - cardiac surgery which needed OLV. Taking careful preoperative assessment and immediate treatment are important to avoid associated complications.