Clinical Study Of Lung Recruitment Strategy In Patients Undergoing Laparoscopic Radical Gastrectomy

Objective:To investigate the effects of lung recruitment strategy on respiratory mechanics and circulation in patients undergoing laparoscopic radical gastrectomy.Methods:A total of 90 patients with gastric cancer who underwent laparoscopic radical gastrectomy were selected from patients with gastric cancer who were treated in our hospital.Randomized digital table method was divided into 3 groups（n=30）,control group（C group）,lung re-expansion group（P group）every half hour after pneumoperitoneum,and pulmonary re-expansion group every hour after pneumoperitoneum（R group）.Time points were selected respectively:5 minutes before pneumoperitoneum（T₀）,30 minutes after pneumoperitoneum（T₁）,60minutes after pneumoperitoneum（T₂）,90 minutes after pneumoperitoneum（T₃）,120 minutes after pneumoperitoneum（T₄）,5 minutes after pneumoperitoneum（T₅）,and 5 minutes before tube extubation（T₆）.P_peak,P_mean,Cdyn,PetCO₂,BP,HR were measured respectively.At the same time,arterial blood gas was extracted for analysis,arterial oxygen partial pressure oxygen concentration was monitored,and oxygenation index was calculated.Postoperative pulmonary complications and length of hospital stay were recorded.Results:Compared with group C,group P significantly increased arterial oxygen concentration and lung compliance 60,90,120 minutes after pneumoperitoneum and 60 minutes after pneumoperitoneum.Ppeak was significantly decreased 5min after the end of pneumoperitoneum and 5min before extubation.PaO2/FiO2 was significantly increased 60min,90min,120min after pneumoperitoneum and 5min before extubation,and the time to reach extubation,PACU delivery（P<0.05）.Compared with group C,group R significantly increased PaO2 120min after pneumoperitoneum,5min after pneumoperitoneum,increased Cdyn 60min after pneumoperitoneum,significantly increased PaO2/FiO2 60min,90min,and120min after pneumoperitoneum,significantly shortened extubation time,PACU delivery time（P<0.05）.Compared with the R group,Ppeak was significantly decreased in the P group at 60min,90min,120min after pneumoperitoneum and 5min before extubation,while Cdyn was significantly increased at 60min,90min and 120min after pneumoperitoneum（P<0.05）.There was no significant difference in postoperative pulmonary complications among the three groups（p>0.05）.Conclusions:pulmonary revascularization under laparoscopic radical gastrectomy can improve the pulmonary function of patients,and the effect of pulmonary revascularization after half an hour of pneumoperitoneum is better than that of the group of pulmonary revascularization every hour.