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

doi:10.3877/cma.j.issn.1674-6902.2026.03.013

Abstract

Abstract:

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 (F_time=13.524, P<0.001), but the decrease in the observation group was smaller than that in the control group (F_{treatment×time}=3.042, P=0.004; F_treatment=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 (F_time=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

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]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 437-443.

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References 30

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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)	－	0.546^a
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

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)	－	0.546^a
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

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

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

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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