人工间歇性气道正压通气（IPAP）治疗单肺通气期间分泌相关低氧血症：病例报告
Manual Intermittent Positive Airway Pressure (IPAP) for the Management of Secretion-Related Hypoxemia During One-Lung Ventilation: A Case Report.
摘要(中文译文)
单肺通气（OLV）期间的低氧血症是胸科手术中公认的并发症，通常由非通气侧肺持续灌注导致肺内分流增加所引起。然而，部分发作不能仅归因于分流相关机制，因为通气侧肺内过多分泌物导致的气道阻塞也可能引起通气受损、严重高碳酸血症和肺顺应性降低。我们报告一例64岁男性患者，在接受左侧电视辅助胸腔镜手术时，单肺通气开始后不久即出现严重低氧血症和高碳酸血症。纤维支气管镜检查发现通气侧肺内有大量脓性分泌物，且标准抢救策略未能恢复足够的氧合。因此，在对非通气侧肺实施手动间歇气道正压（IPAP）的同时，进行支气管镜下吸引和灌洗。在应用手动IPAP后，氧饱和度改善，PaCO₂显著下降，肺顺应性增加，使手术得以完成且未出现进一步并发症。本病例提示，单肺通气期间的低氧血症可能由肺内分流增加以外的机制引起，而对于因分泌物积聚导致通气受损的病例，对非通气侧肺应用手动IPAP可能是一种有效的抢救策略。
Abstract
Hypoxemia during one-lung ventilation (OLV) is a well-established complication in thoracic surgery, typically resulting from an increased intrapulmonary shunt due to continued perfusion of the non-ventilated lung. However, some episodes cannot be attributed solely to shunt-related mechanisms, as airway obstruction from excessive secretions in the ventilated lung may also cause impaired ventilation, severe hypercapnia, and reduced lung compliance. We report the case of a 64-year-old male patient undergoing left-sided video-assisted thoracoscopic surgery in whom severe hypoxemia and hypercapnia developed shortly after the initiation of OLV. Fiberoptic bronchoscopy revealed dense purulent secretions in the ventilated lung, and standard rescue strategies failed to restore adequate oxygenation. Manual intermittent positive airway pressure (IPAP) was therefore applied to the non-ventilated lung while bronchoscopic aspiration and lavage were performed. Following the application of manual IPAP, oxygen saturation improved, PaCO₂ decreased markedly, and lung compliance increased, allowing the surgery to be completed without further complications. This case suggests that hypoxemia during OLV may result from mechanisms other than an increased intrapulmonary shunt and that manual IPAP applied to the non-ventilated lung may represent an effective rescue strategy in cases associated with ventilation impairment due to secretion accumulation.
如何引用
AMA
Ökkeş Hakan Miniksar, Seher Altınel, Hakan Nomenoğlu, Nurcan Özaslan, Mustafa Kalkan, Göktürk Fındık. Manual Intermittent Positive Airway Pressure (IPAP) for the Management of Secretion-Related Hypoxemia During One-Lung Ventilation: A Case Report.. Cureus. 2026; doi:10.7759/cureus.106647.
APA
Ökkeş Hakan Miniksar, Seher Altınel, Hakan Nomenoğlu, Nurcan Özaslan, Mustafa Kalkan, Göktürk Fındık (2026). Manual Intermittent Positive Airway Pressure (IPAP) for the Management of Secretion-Related Hypoxemia During One-Lung Ventilation: A Case Report.. Cureus. https://doi.org/10.7759/cureus.106647
GB/T 7714
Ökkeş Hakan Miniksar, Seher Altınel, Hakan Nomenoğlu, Nurcan Özaslan, Mustafa Kalkan, Göktürk Fındık. Manual Intermittent Positive Airway Pressure (IPAP) for the Management of Secretion-Related Hypoxemia During One-Lung Ventilation: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.106647.
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