Department of Anesthesia, Vancouver Acute, Vancouver General Hospital, Vancouver, Canada.
Curr Opin Anaesthesiol. 2011 Feb;24(1):24-31. doi: 10.1097/ACO.0b013e3283415659.
Hypoxemia during one-lung ventilation (OLV) has become less common; however, it may still occur in about 10% of cases. We review recent developments which may affect the incidence and treatment of hypoxemia during OLV.
Changes in surgical techniques are affecting oxygenation during OLV. The increased use of the supine position may adversely affect the prevalence of hypoxemia, whereas the increased application of thoracoscopic techniques is limiting the treatment options. Treatment options such as global or selective recruitment maneuvers and drug effects of dexmedetomidine and epoprostenol on arterial oxygenation during OLV are discussed. Capnometry prior to, or early during OLV, may in fact be able to predict the degree of hypoxemia during OLV. Persistent controversies surrounding the effect of epidural anesthesia, ventilatory modalities and gravity are reviewed.
Interesting concepts have emerged from case reports and small studies on the treatment and prediction of hypoxemia during OLV. Definitive studies on the most effective ventilatory mode remain elusive. End-organ effects of OLV are an exciting new concept that may shape clinical practice and research going forward.
单肺通气（OLV）期间的低氧血症已不那么常见，但仍可能发生在约 10%的病例中。我们回顾了可能影响 OLV 期间低氧血症发生率和治疗的最新进展。
手术技术的变化正在影响 OLV 期间的氧合。仰卧位的使用增加可能会对低氧血症的发生率产生不利影响，而胸腔镜技术的广泛应用则限制了治疗选择。讨论了 OLV 期间全身性或选择性复张手法以及右美托咪定和前列环素对动脉氧合的药物作用等治疗选择。在 OLV 之前或早期进行呼气末二氧化碳监测实际上可能能够预测 OLV 期间的低氧血症程度。围绕硬膜外麻醉、通气方式和重力对低氧血症影响的持续争议进行了综述。
关于 OLV 期间低氧血症的治疗和预测，来自病例报告和小型研究的有趣概念不断涌现。关于最有效的通气模式的明确研究仍难以捉摸。OLV 的终末器官效应是一个令人兴奋的新概念，可能会塑造未来的临床实践和研究。
