Observation Of Lung Air Content With Ultrasound Between General Anesthesia And Combined Spinal-epidural Anesthesia

Objective: The study was designed to investigate the effect of different anesthesia methods on the changes of lung air content in lower orthopedic surgery patients by lung ultrasonography,so as to guide the clinical selection of the suitable anesthetic method to reduce the incidence of lung air content reduction after operation.Methods: The study was divided into healthy volunteers and Patients who underwent lower orthopaedic surgery.10 healthy volunteers,which included 5 males and 5 females,The datas were collected before lie supine and lie supine after 2 hours.90 patient,which included 47 males and 43 females,were randomly divided into general anesthesia group(GA group,N=45)and combined spinal-epidural anesthesia group(CSEA group,N=45).During the research,9 cases were excluded,and finally 81 cases were included study,there were 41 cases in the GA group and 40 cases in the CSEA group.Then accoring to whether the age of these patients were over 65 years,patients in the GA group were divided into two subgroups,the elderly group(20 cases)and the adult group(21 cases);patients in the CSEA group were divided into two subgroups,the elderly group(17 cases)and the adult group(23 cases)patients in the hard waist group were divided into two subgroups,that is,the hard waist group(17 cases).And the hard waist adult group(23 cases).The datas were collected before operation(T1),postoperative 0.5h(T2),and postoperative 20-30h(T3).The mechanical ventilator model of general anesthesia is volume control mode without Positive end-expiratory pressure.The tidal volume was 8*ideal body weight(ml),and the oxygen concentration was 60%.The respiratory could be adjusted so that the end-tidal carbon dioxide was between 35-40 mmhg.The puncture site in the CSEA was taken at the L3-4 gap,3 ml 0.5% bupivacaine was slowly pushed into subarachnoid space.The level of Anesthesia was controled below T8.Oxygen is usually given by mask,and the Oxygen Flowrate was 3L/min.The images of the lung ultrasound in 12 areas of the lung were collected by an experienced team member of the study team.The other two members assessed the collected images,and the final scores were averaged.Results: Compared with the lung ultrasound sores before lying supine and the lung ultrasound scores after lying supine for 2 hours in 10 heathy volunteers,Except for a certain amount of data,there was no significant difference in statistical difference.Compared with T1,the LUS scores in T2 and T3 of patients with combined spinal-epidural anesthesia were significantly lower than those with general anesthsia,which means that the degrees of the loss of lung air contentof the CSEA group were significantly lower than those of the GA group,and there was a statistically significant difference between the two groups.The lung ultrasound scores of the GA elderly group in the T2 and T3 time were significantly higher than those of the GA adult group.The lung ultrasound scores of the CSES elderly group in the T2 and T3 time were significantly higher than those of the CSEA adult group.That means,lung gas content reduction in the elderly group after operation(T2,T3)is significantly higher than the adult group,no matter whether they were underwent general anesthesia or combined spinal-epidural anesthesia,which was statistically significant.Conclusions: From the results of this study,the following conclusions can be drawn: 1.Lung ultrasound can show the changes of the lung air content well.2.Lying supine for 2 hours without experience of surgery and anesthesia has no significant effect on lung air content.3.In patients undergoing lower orthopedic surgery with general anesthesia and combined spinal-epidural anesthesia,the lung air content decreased from 0.5h after operation and continued to 24 h after operation;The effects of general anesthesia on lung air content were greater than those of combined spinal-epidural anesthesia;and the changes of lung air content in elderly patients who underwent general anesthesia or combined spinal-epidural anesthesia were greater than those in adult patients.