Analysis Of Related Factors Of Hypoxemia In One-lung Ventilation During Thoracoscopy Surgery In Infants

BackgroundThoracoscopic surgery is becoming more and more mature,with less trauma,fewer complications,and beautiful postoperative incisions.It has been widely used in adults.In recent years,the application of thoracoscope to infants has also been effectively verified.Because infants are different from adults in anatomy and physiology,their unique physiological structure,especially infants under three months of age,may not tolerate one-lung ventilation.Therefore,pediatric thoracoscopic surgery has stricter requirements for anesthesia management.Hypoxemia is the most common and most serious complication in thoracoscopic surgery^[1].Most of the related studies focusing on hypoxemia are based on single factors,such as catheter selection and intubation position,anesthesia Changes in medications and patient position,etc.Multi-factor analysis is more reliable than single-factor independent analysis.However,at present,there are few multi-factor analyses on the related factors of single-lung ventilation hypoxemia at home and abroad,especially the related factors of single-lung ventilation hypoxemia in infants.This study focuses on the study of the related factors of hypoxemia during thoracoscopic surgery in infants with single-lumen catheters,and aims to explore the influencing factors of hypoxemia during thoracoscopic surgery and reduce the incidence of intraoperative hypoxemia,with a view to The anesthesia management of pediatric thoracoscopic surgery provides theoretical and practical basis.Objectiveinfants from 0-72 months of pediatric surgery in the Third Affiliated Hospital of Guangzhou Medical University were used as observation objects to observe the possible influencing factors of intraoperative hypoxemia during single-lumen endotracheal tube used in pediatric thoracoscopic surgery for one-lung ventilation.Multivariate logistics stepwise regression analysis method was used to explore the independent influencing factors of hypoxemia in pediatric thoracoscopic surgery with single lumen endotracheal tube,so as to provide a reliable reference for predicting and preventing hypoxemia in pediatric thoracoscopic surgery,thereby improving The safety of pediatric thoracoscopic surgery and anesthesia.MethodsTo collect and analyze the clinical medical records of 169 cases of congenital pulmonary cystadenoma,pulmonary sequestration,diaphragm repair,and pectus excavatum under thoracoscopic surgery from May 2019 to December 2020 in the Third Affiliated Hospital of Guangzhou Medical University.There were 21 standard cases.Finally,148 cases were collected by gender,month age,preoperative HGB,operation type,operation time,one-lung ventilation side,echocardiogram/chest CT,and MAP,HR,Sp O₂ at different time points.First conduct a single factor analysis of the collected data to screen out the variables with P<0.1,and then conduct a multivariate logistics stepwise regression analysis to explore the related factors of hypoxemia during the use of single-lumen endotracheal catheters in pediatric thoracoscopic surgery.Provide reference for predicting and preventing the occurrence of hypoxemia in infants with thoracoscopic surgery.ResultsThe incidence of intraoperative hypoxemia（Sp O₂<90%）in 148 cases was 25%（37 cases in total）.There was no statistically significant difference in the general information of the children（P（29）0.05）,there was no statistically significant difference in the occurrence of hypoxemia between different age groups（P（29）0.05）,and there was no statistical difference in the occurrence of hypoxemia between the surgical grades Learning significance（P（29）0.05）.In the univariate analysis,there are 4 factors related to intraoperative hypoxemia,namely MAP（r=-0.136 P=0.099）and Sp O₂（r=0.221P=0.007）before tracheal tube insertion,and after tracheal tube insertion Sp O₂（r=0.319 P=0.000）and MAP during intraoperative hypoxemia（r=-0.151 P=0.067）.In the logistics multivariate stepwise regression analysis,there are two statistically significant（P<0.05）factors,both of which are independent risk factors.They are Sp O2 before tracheal tube insertion（OR=2.404 P=0.045）and Sp O₂ after tracheal tube insertion.（OR=6.137 P=0.000）ConclusionSpO₂ <97% in infants before and after intubation is an independent risk factor for intraoperative hypoxemia.As the blood oxygen saturation of children before and after intubation decreases,the incidence of intraoperative hypoxemia will increase.