Schloss Brian, Martin David, Beebe Allan, Klamar Jan, Tobias Joseph D
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.
Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States.
Thorac Cardiovasc Surg Rep. 2013 Dec;2(1):16-8. doi: 10.1055/s-0033-1343734. Epub 2013 Apr 15.
To improve surgical visualization and facilitate the procedure, one-lung ventilation (OLV) is frequently used during thoracic surgery. Although generally well tolerated, the ventilation-perfusion inequality induced by OLV may lead to a decrease in oxygenation and, at times, hypoxemia. Effective treatment algorithms and strategies are necessary for the treatment of hypoxemia during OLV to ensure that the technique can be continued without interruption and allow for completion of the surgical procedure. Treatment strategies may include applying positive end expiratory pressure to the nonoperative lung, continuous positive airway pressure or low flow oxygen insufflation to the operative lung, decreasing anesthetic agents that interfere with hypoxic pulmonary vasoconstriction (HPV), or switching to total intravenous anesthesia. Although less commonly employed, α-adrenergic agonists may also improve oxygenation during OLV by augmenting HPV. We present a 12-year-old girl who developed hypoxemia during OLV, which was not corrected by the usual maneuvers. Hypoxemia was successfully treated with a phenylephrine infusion. The potential applications of α-adrenergic agonists such as phenylephrine in the treatment of hypoxemia during OLV are discussed and its physiologic basis reviewed.
为了改善手术视野并便于手术操作，胸外科手术期间经常采用单肺通气（OLV）。尽管一般耐受性良好，但OLV引起的通气-灌注不均可能导致氧合降低，有时还会导致低氧血症。治疗OLV期间的低氧血症需要有效的治疗算法和策略，以确保该技术能够不间断地继续进行，并允许完成手术过程。治疗策略可能包括对非手术侧肺施加呼气末正压，对手术侧肺持续气道正压通气或低流量氧气吹入，减少干扰低氧性肺血管收缩（HPV）的麻醉剂，或改用全静脉麻醉。虽然较少使用，但α-肾上腺素能激动剂也可能通过增强HPV来改善OLV期间的氧合。我们报告一名12岁女孩，她在OLV期间出现低氧血症，常规措施未能纠正。通过去氧肾上腺素输注成功治疗了低氧血症。讨论了去氧肾上腺素等α-肾上腺素能激动剂在治疗OLV期间低氧血症中的潜在应用，并回顾了其生理基础。
