胸腔镜单肺通气患者术中低氧血症的影响因素分析OA

Objective:To explore the independent influencing factors of intraoperative hypoxemia in patients undergoing thora-coscopic surgery with one-lung ventilation,and to provide reference for early clinical warning and intervention.Methods:Clinical data of 180 patients who underwent thoracoscopic surgery with one-lung ventilation from Jan.2022 to Dec.2024 were retrospectively ana-lyzed.Propensity score matching was used to match the hypoxemia group and non-hypoxemia group at a ratio of 1:1,with 90 patients in each group.Baseline confounding variables including age,gender,body mass index,underlying comorbidities,preoperative cardiac function and preoperative hemoglobin were corrected during matching,with the caliper value set to 0.02.Baseline data of the two groups were balanced and comparable after matching.Univariate analysis and multivariate logistic regression analysis were used to screen the independent influencing factors of hypoxemia,and targeted intervention countermeasures were formulated.Results:Univari-ate analysis revealed statistically significant differences between the two groups in terms of preoperative forced expiratory volume in the first second as a percentage of predicted value,preoperative forced vital capacity as a percentage of predicted value,intraoperative one-lung ventilation duration,total volume of fluid infusion,tidal volume setting,alveolar ventilation volume,inspired oxygen concentration,intraoperative lung compliance and intraoperative intrapulmonary shunt rate(P<0.05).Multivariate logistic regression analysis dem-onstrated that reduced forced expiratory volume in the first second as a percentage of predicted value,prolonged one-lung ventilation duration,excessive intraoperative fluid infusion volume,higher tidal volume setting,insufficient alveolar ventilation volume,inad-equate inspired oxygen concentration,decreased intraoperative lung compliance and elevated intrapulmonary shunt rate were indepen-dent influencing factors for the occurrence of intraoperative hypoxemia(P<0.05).Conclusions:Intraoperative hypoxemia in patients undergoing thoracoscopic one-lung ventilation is affected by multiple factors.In clinical practice,comprehensive measures such as opti-mizing surgical procedures,individualized ventilation parameter setting,strengthening monitoring of key indicators and implementing precise fluid management should be adopted to reduce the risk of intraoperative hypoxemia.