| Objective: Thoracoscopic surgery is currently the best option for the treatment of early-stage non-small cell lung cancer,and hypoxemia during one-lung ventilation is an issue that must be attached importance.In this study,we used thoracoscopic lung resection patients as study subjects,we investigated the effect of different hypoxic pretreatment measures on arterial oxygen partial pressure before pleura was cut during one-lung ventilation,and also explored these ventilation strategies’ effect on postoperative pulmonary complications.The aim was to provide a simple and safe means to improve oxygenation during one-lung ventilation and prevent hypoxemia due to one-lung ventilation in clinical anesthesia.Methods: Ninety-one patients undergoing video-assisted thoracic surgery with general anesthesia were selected,randomly divided into intermittent hypoxia group(group R),continuous hypoxia group(group L)and control group(group C)according to the random number.Patients were routinely received cardiac monitoring,pulse oximetry monitoring,and radial artery penetration tube was performed to monitor patients’ arterial blood pressure.Patients in all groups were anesthetized with midazolam 0.05 mg/kg,sufentanil 0.5μg/kg,etomidate 0.3 mg/kg,rocuronium 0.6 mg/kg,and the dose of these drugs could be increased or decreased as appropriate.After patients were intubated and positioned,the fibrinoscope was used to confirm the catheter position,and the interventions were implemented for different groups of patients after fixation.In the group R,the nondependent lung was not ventilated for 2 min and then ventilated for 2 min while the dependent lung was continuously ventilated.This was repeated four times.In the group L,the nondependent lung was not ventilated for 14 min and then ventilated for 2 min while the dependent lung was continuously ventilated.In the group C,both lungs were ventilated for 16 min.All patients started formal one-lung ventilation after pleura was cut.We measured Pa O2 at different time points,which were admission without oxygen(T0),before formal one-lung ventilation(T1),5min after one-lung ventilation(T2),15 min after one-lung ventilation(T3),and 30 min after one-lung ventilation(T4).And we recorded the cases of Sp O2 <95% or Sp O2 <90%,the number of cases with restored bilateral lung ventilation.We also recorded the number of postoperative pulmonary complications.Respiratory and hemodynamic parameters,including plateau pressure,peak airway pressure,tidal volume,heart rate,and mean arterial pressure were recorded at each time point,and intraoperative vasoactive drugs were also recorded.Results:In the comparison of Pa O2 in each group,Pa O2 was higher in both experimental groups than in the control group at T3 and T4(p<0.05),but there was no statistically significant difference in Pa O2 at T3 and T4 between the two experimental groups(p>0.05).Intra-group comparison indicated that compared with T1,Pa O2 decreased significantly in all three groups at T2,T3 and T4,and the difference was statistically significant(p<0.05).And compared with T3,Pa O2 increased slightly in all three groups at T4,but the difference was not statistically significant(p>0.05).In the comparison of Sp O2 <95% or Sp O2 <90%,three cases in group C,one case in group L and one case in group R appeared Sp O2 <95%,and the difference was not statistically significant(p>0.05).No patients in the three groups appeared Sp O2 <90%.No patients in the three groups had to suspend surgery and restore ventilation in both lungs.There was no statistically significant difference in postoperative pulmonary complications among the three groups(p>0.05).Conclusions: 1.During thoracoscopic surgery,before formal one-lung ventilation(before pleura was cut),hypoxic preconditioning of the affected lung improves arterial oxygenation during one-lung ventilation.2.Hypoxic preconditioning of the affected lung did not reduce postoperative pulmonary complications when pure oxygen inhaled. |
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