Effects Of Recruitment Maneuvers On Pulmonary Atelectasis After Partial Pulmonary Resection By Single-port Thoracoscope

Objective To evaluate the effect of pulmonary ultrasound on pulmonary atelectasis after partial pulmonary resection by single-port thoracoscope.Methods A randomized,double-blind,prospective,controlled clinical study was conducted on 90 patients who were diagnosed with pulmonary sarcoidosis and underwent selective single-port thoracoscopic partial pulmonary resection under general anesthesia in the second affiliated hospital of suzhou university from January to June 2019.All patients were double lumen endotracheal intubation of general anesthesia,according to the patients with lung after operation time,selected cases can be divided into RMO group(no recuitment),RM1 group(recruitment every 60 minutes)and RM2 group(recuitment every 30 minutes)three groups,30 cases in each group.Blood pressure(BP),heart rate(HR),the amount of fluid replenishment,blood loss,ephedrine dosage,operation time and mechanical ventilation time were recorded under anesthesia.Set the following observation time points:observation(T1),between the three groups of anesthesia for patients with trachea intubation(T2),lateral position after one-lung ventilation(T3),single lung ventilation after 15 minutes(T4)single lung ventilation after 30 minutes(T5),60 minutes after one-lung ventilation(T6),single lung ventilation end to dual lung ventilation(T7 has),after extubation af ter 30 minutes(T8),24 h after surgery(T9),including T2 to record T7 has time points of two groups of patients with airway peak pressure(Ppeak),platform(Pplat),breathing at the end of the carbon dioxide(PetCO2)and dynamic lung compliance(Cdyn),The time points of lung ultrasound examination and scoring were T1,T8 and T9.Ultrasound examination area adopted the 12-zone method.Result There was no statistically significant difference in gender,age,operation time,fluid rehydration and other general information between the groups.After lung reconstruction,when T6 time point,the index level of RM30 group and RM60 group improved,but the improvement of RM30 group was better(P<0.05).Ultrasound examination of the lungs was performed:(1)①T1 time point:the LUS scores of the whole lung and each region of the patients were basically the same between the groups.②T8 time point:the LUS score of RMO and RM60 groups was significantly higher than that of RM30 group.At the time point of T8,the LUS score of the non-surgical side posterior upper lung and posterior lower lung of the RM60 group was significantly higher than that of the RM30 group.The LUS score of RMO in non-surgical side posterior upper lung,posterior lower lung,surgical posterior upper lung and posterior lower lung was significantly higher than that in RM30 group.③T9 time point:LUS score of RM30group was significantly lower than that of RMO and RM60 groups.(2)The LUS score at time points T8 increased in all the three groups,while the LUS score at time points T9 decreased.Moreover,the four regions of non-surgical side anterior upper lung,posterior lower lung,posterior upper lung,and posterior lower lung all showed an overall trend of ascending and descending first.Conclusion(1)Lung ultrasound technology can be used to observe changes in lung tissue imaging during the perioperative period.Combined with previous data,it can dynamically observe changes in lung air content(including atelectasis,lung consolidation,etc.).(2)On the ultrasound image,it was found that all the patients underwent partial pulmonary resection with single-hole thoracoscopy had atelectasis in varying degrees,especially in the back and lateral areas of the non-surgical side of the lung,which lasted until one day after the operation.(3)Lung atelectasis in RM60 and RM30 groups was improved to a certain extent through lung recruitment,and the effect of RM30 group was better than that of RM60 group.