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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (03) : 437 -443. doi: 10.3877/cma.j.issn.1674-6902.2026.03.013

论著

非通气侧肺无呼吸性气流通气模式对胸腔镜肺肿瘤肺叶切除术单肺通气期低氧血症的影响研究
王晓强1, 孙玉满2,†(), 郑玄1, 赵鑫鑫1, 郑晶晶1   
  1. 1063000　唐山，唐山职业技术学院附属医院胸外科
    2063000　唐山，唐山职业技术学院附属医院病理科
  • 收稿日期:2025-11-17 出版日期:2026-06-25
  • 通信作者: 孙玉满
  • 基金资助:
    河北省卫生健康委课题项目(20181313)

Effect of apneic oxygen insufflation of the non-ventilated lung on the risk of hypoxemia during one-lung ventilation in lung tumor patients undergoing thoracoscopic lobectomy

Xiaoqiang Wang1, Yuman Sun2,†(), Xuan Zheng1, Xinxin Zhao1, Jingjing Zheng1   

  1. 1Department of Thoracic Surgery, Affiliated Hospital of Tangshan Vocational and Technical College, Tangshan 063000, China
    2Department of Pathology, Affiliated Hospital of Tangshan Vocational and Technical College, Tangshan 063000, China
  • Received:2025-11-17 Published:2026-06-25
  • Corresponding author: Yuman Sun
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引用本文：

王晓强, 孙玉满, 郑玄, 赵鑫鑫, 郑晶晶. 非通气侧肺无呼吸性气流通气模式对胸腔镜肺肿瘤肺叶切除术单肺通气期低氧血症的影响研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(03): 437-443.

Xiaoqiang Wang, Yuman Sun, Xuan Zheng, Xinxin Zhao, Jingjing Zheng. Effect of apneic oxygen insufflation of the non-ventilated lung on the risk of hypoxemia during one-lung ventilation in lung tumor patients undergoing thoracoscopic lobectomy[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 437-443.

目的

探讨非通气侧肺应用无呼吸性气流通气(apneic oxygen insufflation, AOI)对胸腔镜肺叶切除术患者单肺通气(one lung ventilation, OLV)期间低氧血症风险的影响。

方法

选取2019年9月至2024年3月我院收治的行胸腔镜肺叶切除术79例患者为对象，随机分为观察组40例，对照组39例，观察组单肺通气期间非通气侧肺接受无呼吸性气流通气，氧流量5 L/min，持续30 min，对照组不接受无呼吸性气流通气。比较两组脉博血氧饱和度(SpO2<90%)发生率、术中SpO2及PaO2/FiO2变化，记录住院期间不良事件。

结果

两组患者年龄、性别、ASA分级、肺功能及手术方式、麻醉药物用量、单肺通气时长等差异无统计学意义(P>0.05)。观察组低氧血症发生3例(7.50%)低于对照组低氧血症10例(25.64%)(P＝0.037)。随手术时间延长，两组SpO2呈下降趋势(F时间＝13.524，P<0.001)，观察组下降幅度小于对照组(F治疗×时间＝3.042，P＝0.004；F治疗＝8.038，P＝0.008)。OLV 20 min(OLV 20)、OLV 25 min (OLV 25)、OLV 40 min (OLV 40)及OLV 45 min( OLV 45)时对照组SpO2低于观察组(P<0.05)。两组PaO2/FiO2在OLV 30时降至最低，OLV 45时回升(F时间＝101.016，P<0.001)。OLV 30及OLV 45时对照组PaO2/FiO2低于观察组[OLV 30：(28.05±8.42)kPa比(35.38±10.84)kPa，t＝3.351，P＝0.001；OLV 45：(37.07±10.99)kPa比(43.14±10.99)kPa，t＝2.454，P＝0.016]。住院期间观察组发生不良事件7例(17.50%)，对照组发生不良事件9例(23.08%)，差异无统计学意义(P＝0.538)。

结论

对于胸腔镜肺叶切除术患者，单肺通气期间对非通气侧肺实施无呼吸性气流通气可降低低氧血症发生率，改善术中氧合功能，不增加不良事件风险。

关键词: 无呼吸性气流通气, 肺肿瘤, 肺叶切除术, 单肺通气, 低氧血症
Objective

To investigate the effect of apneic oxygen insufflation(AOI) applied to the non-ventilated lung on the risk of hypoxemia during one-lung ventilation(OLV) in patients undergoing thoracoscopic lobectomy.

Methods

A total of 79 patients who underwent thoracoscopic lobectomy in our hospital from September 2019 to March 2024 were enrolled and randomly divided into an observation group 40 cases and a control group 39 cases. During one-lung ventilation, the observation group received apneic oxygen insufflation to the non-ventilated lung at an oxygen flow rate of 5 L/min for 30 minutes, while the control group did not receive apneic oxygen insufflation. The incidence of hypoxemia (SpO2<90%), intraoperative changes in SpO2 and PaO2/FiO2, and in-hospital adverse events were compared between the two groups.

Results

There were no statistically significant differences between the two groups in age, sex, ASA classification, pulmonary function, surgical procedure, anesthetic drug dosage, or one-lung ventilation duration (P>0.05). The incidence of hypoxemia in the observation group was 3 cases (7.50%), which was significantly lower than the 10 cases (25.64%) in the control group (P=0.037). As the operation time progressed, SpO2 showed a downward trend in both groups (Ftime=13.524, P<0.001), but the decrease in the observation group was smaller than that in the control group (Ftreatment×time=3.042, P=0.004; Ftreatment=8.038, P=0.008). At OLV 20 min(OLV 20), OLV 25 min (OLV 25), OLV 40 min (OLV 40) and OLV 45 min(OLV 45), SpO2 in the control group was significantly lower than that in the observation group (P<0.05). PaO2/FiO2 in both groups reached the lowest value at OLV 30 and rebounded at OLV 45 (Ftime=101.016, P<0.001). At OLV 30 and OLV 45, PaO2/FiO2 in the control group was significantly lower than that in the observation group [OLV 30: (28.05±8.42)kPa vs (35.38±10.84)kPa, t=3.351, P=0.001; OLV 45: (37.07±10.99)kPa vs (43.14±10.99)kPa, t=2.454, P=0.016]. During hospitalization, adverse events occurred in 7 cases (17.50%) in the observation group and 9 cases (23.08%) in the control group, with no statistically significant difference (P=0.481).

Conclusion

In patients undergoing thoracoscopic lobectomy, applying apneic oxygen insufflation to the non-ventilated lung during one-lung ventilation can reduce the incidence of hypoxemia, improve intraoperative oxygenation, and does not increase the risk of adverse events.

Key words: Apneic oxygen insufflation, Lung tumor, Lobectomy, One-lung ventilation, Hypoxemia
表1 两组肺肿瘤患者临床资料结果
临床资料 观察组(n＝40) 对照组(n＝39) Z/t/χ2值 P值
ASA分级[n(%)]     0.579 0.749
Ⅰ级 21(52.50) 18(46.15)    
Ⅱ级 18(45.00) 19(48.72)    
Ⅲ级 1(2.50) 2(5.13)    
疾病诊断[n(%)]     0.535 0.765
肺癌 36(90.00) 35(89.74)    
肺部良性肿瘤 3(7.50) 2(5.13)    
肺部癌前病变 1(2.50) 2(5.13)    
肿瘤标志物[ng/ml，M50(P25，P75)]        
CEA 5.52(2.60，31.24) 5.47(2.51，30.66) －0.109 0.911
NSE 17.64(12.75，29.62) 14.08(13.11，30.89) －0.273 0.752
CYFRA21-1 4.29(2.57，11.36) 4.17(2.33，10.82) －0.346 0.705
SCC-Ag 1.46(0.88，2.16) 1.41(0.79，2.07) －0.137 0.886
吸烟史[n(%)] 5(12.50) 7(17.95) － 0.546a
术前肺功能检查(±s)        
FEV1(L) 2.54±0.57 2.55±0.71 0.069 0.945
FVC(L) 3.36±0.73 3.36±0.89 0.000 0.999
FEV1/FVC(%) 75.75±6.68 76.28±8.15 0.317 0.753
一氧化碳弥散量[ml/(kPa·min)] 18.33±4.56 18.36±4.77 0.029 0.977
术前动脉血气分析(±s)        
PaO2(kPa) 13.59±1.75 13.50±2.30 0.196 0.845
PaCO2(kPa) 5.44±0.43 5.46±0.50 0.191 0.849
图1 肺肿瘤患者组织病理学结果(×100)。图A为左肺上叶腺癌；图B为右肺上叶腺癌；图C为右肺上叶肉芽肿性炎伴非典型增生结节；图D为左肺下叶炎性假瘤
图2 肺肿瘤患者胸部CT影像学表现。图A为肺腺瘤患者术前CT示左肺上叶舌段可见边界欠清的不规则软组织密度影30 mm×21 mm，伴周围肺纹理牵拉、聚集，毛刺、分叶、胸膜牵拉倾向；图B为肺腺瘤患者术后CT，示左肺上叶舌段已完全切除；图C为肉芽肿性炎伴非典型增生结节患者术前CT示右肺上叶见多发小结节影，结节密度偏高、部分边界欠清，局部肺纹理紊乱；图D为肉芽肿性炎伴非典型增生结节患者术后CT示右肺上叶原增生结节手术切除，靶病灶基本消失，术区残留少许纤维条索瘢痕；图E为炎性假瘤患者术前CT示左肺中下叶近心缘旁见类圆形软组织密度肿块(炎性假瘤)，病灶边界相对清晰、密度均匀，邻近肺纹理受压推移；图F为炎性假瘤患者术后CT示左肺原炎性假瘤病灶完整切除，原肿块区域实性病灶消失
表2 两组肺肿瘤患者术中临床指标结果
临床指标 观察组(n＝40) 对照组(n＝39) Z/χ2值 P值
手术方式[n(%)]     3.088 0.214
肺楔形切除 4(10.00) 1(2.56)    
肺段切除 2(5.00) 5(12.82)    
肺叶切除 34(85.00) 33(84.62)    
手术侧[n(%)]     2.234 0.135
左侧 11(27.50) 17(43.59)    
右侧 29(72.50) 22(56.41)    
麻醉药物与输液量[M50(P25，P75)]        
丙泊酚(mg) 1 169.00(910.50，1 316.50) 1 100.00(977.75，1 360.50) －0.048 0.962
瑞芬太尼(mg) 1 228.00(1 099.00，1 601.25) 1 278.50(1 045.75，1 527.25) －0.269 0.788
罗库溴铵(mg) 100.00(90.00，110.00) 95.00(80.00，110.00) －0.426 0.670
勃脉力A(ml) 500.00(400.00，700.00) 555.00(400.00，662.50) －0.135 0.893
术中参数[M50(P25，P75)]        
术中失血量(ml) 50.00(47.50，100.00) 50.00(50.00，100.00) －0.424 0.672
手术时长(min) 117.50(100.00，146.25) 120.00(95.00，141.25) －0.217 0.828
麻醉时长(min) 165.00(150.00，200.00) 172.50(145.00，196.25) －0.024 0.981
OLV时相(min) 95.00(80.00，122.50) 105.00(80.00，126.25) －0.525 0.599
表3 两组肺肿瘤患者术中SpO2变化[%，(±s)]
组　别 例数 OLV 0 OLV 15 OLV 20 OLV 25 OLV 30 OLV 35 OLV 40 OLV 45
观察组 40 99.93±0.27 98.30±1.60 99.09±0.66 98.83±1.08 98.20±2.53 97.85±2.84 98.09±2.71 98.00±1.97
对照组 39 99.98±0.16 98.68±1.00 97.88±2.20 97.43±2.87 97.18±3.15 97.30±1.90 96.73±3.27 97.00±2.28
t值 － 0.998 1.262 3.329 2.883 1.589 1.009 2.015 2.088
P值 － 0.321 0.211 0.001 0.005 0.116 0.316 0.047 0.040
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