Randomized Controlled Trial of Three Anesthetic Ventilation Strategies for Perioperative Safety in Patients Undergoing Flexible Ureteroscopic Lithotripsy
HUANG Mengdie
PENG Jiao
XIONG Gaocai
LIU Cong
CHEN Bing
Abstract：Objective To explore the effects of one-lung ventilation(OLV),intermittent apnea ventilation(IAV),and conventional mechanical ventilation(CMV)on respiratory stability,oxygenation efficiency,and perioperative safety during flexible ureteroscopic lithotripsy(FURL),and to provide evidence for optimizing anesthetic management.Methods A randomized controlled study was conducted on patients with unilateral simple renal calculi(diameter≤2.5 cm)and upper ureteral calculi who underwent FURL at Leshan Shizhong District People's Hospital from April 2023 to December 2024.The patients were randomly divided into three groups at a ratio of 1:1:1:OLV group,IAV group,and CMV group.Intraoperative oxygenation indicators[arterial partial pressure of oxygen(PaO₂),arterial partial pressure of carbon dioxide(PaCO₂),pulse oxygen saturation(SpO₂)],hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)],metabolic indica-tors[lactate(Lac),pH value],lithotripsy time,number of mucosal injuries,degree of injury,postoperative fever,surgeon satisfaction score,and anesthetic recovery indicators[awakening time,post-anesthesia care unit(PACU)stay time,Steward score]were recorded and statistically analyzed.Results The OLV group was significantly superior to the other two groups in oxygenation capacity,operation time,surgeon satisfaction score,and postoperative recovery(awakening time,PACU stay time,Steward score);it also had the lowest number of mucosal injuries,degree of mucosal injury,and postoperative fe-ver rate.In the IAV group,the switching between apnea and ventilation led to prolonged operation time(P<0.001),and Pa-CO₂ increased significantly at 5 minutes before the end of lithotripsy(P<0.001),but no significant change in pH was ob-served.In the CMV group,due to interference from respiratory movement,the number of mucosal injuries and the degree of injury were the most severe(P<0.001),and the postoperative fever rate was the highest(50%).A positive correlation was found between the degree of mucosal injury and postoperative fever(OR=2.479,P=0.004).Conclusion OLV can signifi-cantly improve the stability of FURL,shorten the operation time,and reduce the risk of tissue injury and infection,making it the preferred anesthetic strategy for complex upper urinary tract calculi.For IAV,the balance between CO₂ accumulation and operational continuity should be considered,and it is suitable for experienced teams.The positive correlation between the de-gree of mucosal injury and fever in the CMV group suggests that preoperative infection control and intraoperative irrigation pressure monitoring should be strengthened.
Keywords：fflexible ureteroscopic lithotripsyrespiratory control strategyone-lung ventilationintermittent apnea ventilationconventional mechanical ventilationanesthetic management
Publication Date：2025-10-28
Online Publishing Date：2026-01-15(First online date of this platform, not the publication date of the document)
Pages：8( 327-334 )