Application Of Intermittent Apnea Combined With Low-level PEEP Ventilation Strategy In Patients Undergoing Flexible Ureteroscopy

Objective:To explore the effect of intermittent apnea combined with low-level positive end expiratory pressure?PEEP?ventilation strategy on patients undergoing flexible ureteroscopic lithotripsyMethods:Seventy-three American Society of Anesthesiologists physical status?or?patients,aged 25⁶0 yr,with body mass index of 18²8kg/m²,scheduled for ureteroscopic holmium laser lithotripsy under tracheal intubation anesthesia,were divided into 3 groups according different ventilation methods:Conventional mechanical ventilation group?group C,n=20?,Apnea group?group A,n=28?and Apnea combined PEEP group?group P,n=25?.In group C,conventional ventilation mode was used,in group A,traditional apnea ventilation mode was used,and in group P,apnea combined with low-level PEEP?5cmH₂O?ventilation mode was used.Before anesthesia induction?T₁?,before surgery?T₂?,before the first of controlled breath?T₃?,after the last controlled breath immediately?T₄?,and 30 minutes after extubation?T₅?,the basic vital signs were recorded and the radial artery and internal jugular vein blood were extracted for blood gas analysis,at 24 h after surgery?T₆?the internal jugular venous blood were extracted..PaCO₂,pH,Oxygenation index?OI?were recorded at T₁^T₅.And serum lung Clara cell secreted protein?CC16?were recorded at T_1,T₅ and T₆.Cerebral indicators including cerebral regional oxygen saturation?rSO₂?,cerebral extraction rate of oxygen?CERO₂?,arterial and internal jugular venous oxygen pressure difference?Pa-jvO₂?and arterial and internal jugular venous oxygen saturation?Sa-jvO₂?were recorded in T₁^T₅.Venous S100?protein were recorded at T_1,T₅ and T_6..Cardiac correlation indicators including Troponin?cTnT and cTnI?,Myoglobin?Mb?and Creatine kinase isoenzyme?CK-MB?were recorded at T₁,T₅ and T₆.Recording surgery-related indicators including the laser lithotripsy time,the mobility of the surgical field of the surgeon and the evaluation score of the lithotripsy condition of the three groups of patients.Results:Compared with group C,laser lithotripsy time was significantly reduced in group P and group A?P<0.001?,operator satisfaction score increased significantly?P<0.001?.Compared with group C,PaCO₂ in group A was significantly increased,pH was significantly reduced,and OI was significantly reduced at T₄?P<0.0167?.PaCO₂increased and pH decreased in group P,but the difference was not statistically significant.Compared with group A,PaCO₂ in group P was significantly reduced,pH was significantly increased,and OI was significantly increased at T₄?P<0.0167?.There was no statistical difference in the remaining of three groups at all time points.Conclusion:Intermittent apnea combined with low-level PEEP?5cmH₂O?ventilation strategy can be safely used in ureteroscopic surgery.It not only retains the advantages of traditional apnea ventilation strategy,but also makes up for its disadvantages,It is a better ventilation strategy.