The Impact Of Pneumoperitoneum During Gynecologic Surgery On Atelectasis

ObjectiveTo Apply lung ultrasound(LUS)to assess the atelectasis status after Endoscopic surgery and laparotomy,and analyse related factorsMethodsThe project applied prospective cohort study,and selected gynecological total hysterectomy,subtotal hysterectomy and myomectomy in the Second Affiliated Hospital of Suzhou University from January,2017 to June,2017,which was divided into endoscopy(3 7 cases)and laparotomy group(39 cases)according to pneumoperitoneum status.All the selected patients were conducted with pulmonary ultrasonography at the three time points of pre-operation(TO),post-operation PACU(T1),20-30 hours after operation,and were given scores.Ultrasonic observation area included left upper forebreast,left lower forebreast,left upper pleurobranch,left lower pleurobranch,left posterior superior area,left posterior inferior area,right upper forebreast,right lower forebreast,right upper pleurobranch,right lower pleurobranch,right posterior superior area,right posterior inferior area.The project used independent sample t test to make a comparison on mean value difference of LUS total score in the same time point between the two groups,and on mean value difference of the LUS score in the same time point and on the same position between the two groups.The project used paired sample t test to make pairwise comparison on mean value difference of LUS total score for all the cases at different time point(T0、T1、T2).And the project took repeated measures to compare scores at different time point and different position and scores at different time point and same position.The correlation between T1-T0 LUS score difference(T1-T0)and age,height,mechanical ventilation,body mass index(BMI),PACU pain score were analyzed by applying bivariate correlation analysis.P<0.05 means difference has statistical significance.The grouping of patients was not entirely randomized,but the relevant factors were balanced through covariance analysis to reduce the deviation to the greatest extent brought about by nonrandom grouping.ResultsThe comparison of LUS score mean value between the two groups of patients at the same time in the same area had no statistical difference,P>0.05.The comparison of LUS score mean value between the two groups of patients at the same time in the same area after covariance analysis still had no obvious statistical difference,P>0.05.Comparison of LUS score mean value among all patients at the same time in different area were conducted,the results showed that LUS score mean value in all the area of TO were relatively low,and there were no obvious difference for all positions,P>0.05,there was no statistical significance;in the comparison of LUS score mean values of all areas at post-operation T1,T2,the scores of bilateral posterior superior areas and posterior inferior areas were obviously higher than other areas,and the scores of bilateral posterior inferior areas were higher than the posterior superior areas.The difference had statistical significance,P<0.05.Comparison of LUS score mean value among all patients at different time in same area were conducted,and the comparison of LUS score mean values of bilateral inferior lung and bilateral posterior back among all the patients were conducted.The results showed that T1 was evidently higher than T0,P<0.01,the difference had statistical significance;while T2 was evidently lower than T1,P<0.01,the difference had statistical significance,and T2 was evidently higher than T0,P<0.01,the difference had statistical significance.Comparison of LUS total score mean value among all patients at different time were conducted,and the comparison of LUS total score mean value between all the patients at the three time points(T0,T1,T2)were conducted.The results showed that,P<0.01,the difference had statistical significance.Comparison of LUS total score mean value between the two groups of patients at the same time were conducted,the comparison of LUS total score mean value between the two groups at the same time showed that P>0.05,the difference had no statistical difference.The comparison of LUS total score mean value between the two groups of patients at the same time after covariance analysis had no obvious difference,P>0.05.Correlation analysis showed that the post-operation pulmonary ventilation changes had no correlations with age,mechanical ventilation,PACU pain score,height,weight and etc.,P>0.05;they had positive correlations with BMI,P<0.05,the difference had statistical significanceConclusionsThis study showed that there were pulmonary ultrasonographic image changes at different extent after total hysterectomy,subtotal hysterectomy and myomectomy,especially with significant change for the bilateral posterior back.This change occurred immediately right after the ending of the surgery and lasted for about 24h with mitigatory trend.This pulmonary imaging change had no obvious difference from the application of endoscopy or laparotomy;further discovering that this change had a bit of correlation with the weight index of patients,but had no obvious relationship with age,mechanical ventilation,PACU pain score.