摘要目的 探讨间停呼吸联合呼气末正压通气（PEEP）在输尿管软镜手术中的临床应用价值。方法 选择大连市友谊医院2019年11月～2020年5月收治的输尿管、肾结石实施全身麻醉气管插管下软镜碎石术患者80 例，按照随机数字表法分为两组，各40 例。对照组实施间停呼吸，观察组则实施间停呼吸联合低水平PEEP 干预，比较两组呼吸恢复10 min 后血气分析结果及呼吸力学指标变化，比较两组麻醉苏醒质量指标和发生的呼吸相关并发症发生情况。结果 呼吸恢复10 min 后，观察组动脉血二氧化碳分压水平低于对照组，动脉血氧分压水平高于对照组，差异有统计学意义（P＜0.05）；呼吸恢复10 min 后，观察组气道峰压、平均气道压均低于对照组，差异有统计学意义（P＜0.05）；观察组麻醉苏醒时间及麻醉拔除气管导管时间均短于对照组，差异有统计学意义（P＜0.05）；围麻醉期观察组并发症总发生率低于对照组，差异有统计学意义（P＜0.05）。结论 针对输尿管软镜碎石术中应用间停通气联合PEEP 干预，可更好地维持呼吸功能，促进麻醉恢复，减少呼吸相关并发症。
Abstract：Objective To explore the clinical application value of intermittent breathing combined with positive end-expiratory (PEEP) pressure ventilation in ureteral soft mirror surgery.Methods A total of 80 cases with ureter and kidney stones from November 2019 to May 2020 treated with soft-mirror lithotripsy under tracheal intubation under general anesthesia in Dalian Friendship Hospital were randomly divided into two groups,40 cases in each group.The patients in control group were given intermittent breathing,the patients in observation group were given intermittent breathing combined with low-level PEEP.Then the blood gas analysis was compared and the respiratory mechanics indexes were compared at 10 min minutes of respiratory recovery.The quality indexes of anesthesia flexible ureteroscopy surgery were compared and the respiratory complications were compared.Results After 10 minutes of breathing recovery,Pa-CO2 level in the observation group was lower than that in the control group,PaO2 level was higher than that in the control group,the differences were statistically significant (P＜0.05).The Ppeak and Pmean were lower in the observation group than those in the control group,the differences were statistically significant (P＜0.05);the time to wake up from anesthesia and the time to remove the tracheal tube in the observation group were shorter than those in the control group (P＜0.05);the total incidence of complications in the observation group during the peri-anaesthesia period was lower than that in the control group,and the difference was statistically significant (P＜0.05).Conclusion The application of intermittent ventilation combined with PEEP intervention in ureteral soft-mirror lithotripsy can better maintain respiratory function and promote anesthesia recovery,so it can reduce respiratory-related complications.
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