【摘要】 目的 回顾我院胸外肿瘤手术麻醉清醒期发生顽固性低氧血症的病例，就其发生的原因进行分析，并提出值得注意的问题和处理方法。 方法 回顾870例开胸术患者资料，共21例出现清醒期顽固性低氧血症，其中男14例，女7例，平均年龄为57±10.3岁，分别接受食管癌根治术，肺叶或全肺切除术，纵隔肿瘤切除术。麻醉均采用气管内或支气管内插管静吸复合全麻。 结果 全组病例清醒期SpO 2 均低于91%，单一的吸氧治疗难以奏效，均需要辅助通气。其中急性心肌缺血1例，拔管后SpO 2 =80%，面罩吸氧后SpO 2 =91%。呼吸道急性阻塞6例包括喉水肿、喉痉挛4例;误吸与反流2例。其特点是拔管前无法预料，拔管后即出现严重的呼吸困难。肺复张不良9例包括胸腔引流管位置不恰当、左主支气管萎陷、全肺切除术后健侧气道分泌物多、支气管残端出血，陈旧血积聚小支气管、气胸等情况。支气管痉挛3例，急性呼衰2例。 结论 清醒期难纠正的低氧血症，往往提示存在麻醉或外科即时并发症的可能，应积极寻找原因，以免病情发展而增加治疗的难度。

    【关键词】 开胸术 麻醉 并发症 清醒期 低氧血症

    Constant hypoxaemia during anesthesia recovery period forthoracic surgery-its causes and prevention

    Xu Meixi，He Weixiong，Li Yi

    Department of Anesthesiology，Cancer Center，Sun Yansen University，Guangzhou510060.

    【Abstract】 Objective To study the incidence and cause of hypoxemia in patients submitted for thoracic surgery during anesthesia recovery period.Provide suggestions as to management of hypoxaemia in the immediate post-operative period.Methods 21patients between the ages of46years and68years who received the thoracic operation had sustained hypoxemia in the immediate postoperative period.Eleven patients underwent cancer of the esophagus radical resection.The other ten had pneumonectomy and thoracotomy.General anesthesia with usual endotracheal or endobronchial intubation was used with isoflurane ......