纤维支气管镜使用后单肺手术期间低氧血症的多因素分析

目的探讨纤维支气管镜（纤支镜）使用后胸外科单肺手术低氧血症的影响因素。方法选择2017年9月~2018年9月在武汉大学人民医院行胸外科单肺手术患者665例，记录患者性别、年龄、体质量指数、肺部病史、合并症、身高/甲颏距离、吸烟和饮酒情况、肺功能、术前氧分压、屏气试验时间、术前是否打鼾、手术时间、单肺通气时间、双腔管（左、右）、尿量，双腔管插管后和体位改变后均用纤支镜定位双腔管位置。根据患者术中是否发生低氧血症，分为低氧血症组和非低氧血症组。利用多因素logistic回归分析，筛选胸外科单肺手术低氧血症的危险因素。结果665例患者均完成了本研究，其中58例患者术中发生低氧血症，发生率为8.72%。低氧血症与非低氧血症组的年龄、吸烟、饮酒、鼾症、术前合并心脑肺部疾病、肺功能双腔管（左/右）、术前氧分压、屏气实验、体质量指数及身高/甲颏距离差异有统计学意义（P < 0.05）。Logistic回归分析结果显示，吸烟、肺功能异常、术前氧分压低、屏气实验短，身高/甲颏距离大是胸外科单肺手术低氧血症的危险因素。结论纤支镜使用后胸外科单肺手术低氧血症的独立危险因素为吸烟、肺功能异常、术前氧分压低、屏气实验短，身高/甲颏距离≥21.43。 

Risk factors of hypoxia during one-lung ventilation after using flexible fiberoptic bronchoscopy

ObjectiveTo explore the risk factors of hypoxia during one-lung ventilation undergoing thoracic surgery after using flexible fiberoptic bronchoscopy.MethodsA total of 665 patients underwent thoracic surgery from September 2017 to September 2018 in Renmin Hospital of Wuhan University, with flexible fiberopticbronchoscopy to achieve optimal position of lung isolation devices, were retrospectively analyzed. We analyzed gender, age, BMI, lung history, preoperative comorbidities, height to thyromental and sternomental distance(TMD) ratio, smoking and preoperative alcohol abuse, pulmonary function test, preoperative PaO₂, breath experiment, preoperative snoring, operation time, time of one-lung ventilation, left or right double-lumen endotracheal tubes(DLT), urine volume. The patients were divided into hypoxemia group and non-hypoxemia group, according to whether hypoxemia developed during one-lung ventilation. The multi-variate logistic regression was used to stratify the risk factors forhypoxia during one-lung ventilation undergoing thoracic surgery after using flexible fiberoptic bronchoscopy.ResultsFifty-eight patients developed hypoxemia with the total number of 665, and the incidence was 8.72%. Age, smoking, preoperative comorbidities, preoperative PaO₂, breath experiment, BMI, TMD ratio were related to hypoxemia. The results of logistic regression analysis showed that smoking, pulmonary function test abnormal, low preoperative PaO₂, short time of breath experiment and high height to TMD ratio were independent risk factors for hypoxemia(P < 0.05).ConclusionSmoking, pulmonary function test abnormal, low preoperative PaO₂, short time of breath experiment, high height to TMD ratio are independent risk factors for hypoxia during one-lung ventilation undergoing thoracic surgery after using flexible fiberoptic bronchoscopy.