Department of Anesthesiology and Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan.
Ann Thorac Surg. 2013 Jul;96(1):127-32. doi: 10.1016/j.athoracsur.2013.04.017. Epub 2013 May 31.
Robot-assisted coronary artery bypass grafting requires continuous one-lung ventilation (OLV) to evacuate the thoracic cavity. Whether this ventilatory mode subjects patients to serious hypoxemia remains underinvestigated.
From 2005 to 2010, all patients receiving robot-assisted coronary artery bypass graft surgery using OLV with active capnothorax for internal mammary artery harvesting and then passive pneumothorax for minithoracotomy direct-vision coronary bypass graft surgery were included. Patients' variables of oxygenation were monitored and compared throughout the whole surgical period. Persistent oxygen desaturation (arterial oxygen pressure <70 mm Hg) refractory to primary managements was defined as a hypoxemic event, and predictors of such events were identified by multivariate regression analysis.
A total of 255 consecutive patients were enrolled. Average oxygen saturation decreased modestly during the first stage of OLV with active capnothorax, causing hypoxemic events in 9 patients (4.3%) leading to death in 2 (0.8%), whereas it dropped drastically in the second stage of OLV with passive pneumothorax, resulting in hypoxemic events in 32 patients (12.6%) and death in 1 (0.4%). Multivariate regression analysis identified high pulmonary vascular resistance and low left ventricular ejection fraction as predictors of hypoxemia during internal mammary artery takedown, whereas prolonged procedure and chronic obstructive pulmonary disease were identified as predictors during minithoracotomy bypass grafting.
Robot-assisted two-stage coronary artery bypass surgery employing OLV could be complicated by serious hypoxemia especially at the minithoracotomy grafting stage and in patients with specific risk factors. Thus, when managing such patients, invasive monitoring and aggressive treatment of arterial desaturation are mandatory to ensure the patient's safety and procedural smoothness.
机器人辅助冠状动脉旁路移植术需要持续的单肺通气（OLV）以排空胸腔。这种通气模式是否会导致患者严重低氧血症仍未得到充分研究。
2005 年至 2010 年，所有接受机器人辅助冠状动脉旁路移植手术的患者均采用 OLV 进行通气，OLV 期间主动使用二氧化碳气腹以获取内乳动脉，然后被动使用气胸以进行小开胸直视冠状动脉旁路移植手术。监测并比较了患者整个手术期间的氧合变量。将对初始处理措施无反应的持续性氧饱和度降低（动脉血氧压＜70mmHg）定义为低氧血症事件，并通过多变量回归分析确定此类事件的预测因素。
共纳入 255 例连续患者。OLV 期间主动使用二氧化碳气腹的第一阶段，平均血氧饱和度略有下降，导致 9 例患者（4.3%）出现低氧血症事件，其中 2 例（0.8%）死亡，而在 OLV 期间被动使用气胸的第二阶段，平均血氧饱和度急剧下降，导致 32 例患者（12.6%）出现低氧血症事件，其中 1 例（0.4%）死亡。多变量回归分析发现，高肺血管阻力和低左心室射血分数是内乳动脉取出期间低氧血症的预测因素，而手术时间延长和慢性阻塞性肺疾病是小开胸旁路移植期间低氧血症的预测因素。
机器人辅助两阶段冠状动脉旁路移植术采用 OLV 可能会导致严重低氧血症，尤其是在小开胸旁路移植阶段和具有特定危险因素的患者中。因此，在管理此类患者时，必须进行有创监测并积极治疗动脉血氧饱和度降低，以确保患者的安全和手术的顺利进行。
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