The Effect Of Diaphragm Rehabilitation Training On Diaphragm Function After Laparoscopic Cholecystectomy

Objectives:To explore the effect of diaphragm rehabilitation training on the diaphragm function of patients undergoing laparoscopic cholecystectomy,and to provide a reference for promoting the recovery of diaphragm function in patients undergoing general anesthesia and laparoscopic surgery.Methods:From January 2020 to May 2020,60 patients undergoing elective LC surgery in our hospital,30 men and women,aged 18-55 years,and Body Mass Index(BMI)18-24 kg/m2,ASA grade Ⅰ-Ⅱ grade.The patient had no previous history of respiratory diseases;no history of thoracic and abdominal organ surgery;no thoracic deformities;no chronic metabolic diseases,no thoracic and abdominal effusions,or huge tumors;and had not used drugs that affect muscle structure and neurological diseases.According to the random number table method,15 men and 15 women were included in the rehabilitation group(group E,n=30),while the control group(group C,n=30)was randomly included in 15 men and 15 women.During the operation,select Volume Controlled Ventilation(VCV)ventilation mode,tidal volume is set to 6ml/kg corrected body weight,PEEP 5cmH2O,oxygen concentration(FiO2)is set to 0.6,inhalation ratio(I:E)is adjusted to 1:2,respiratory rate 10-16 times/min,maintain end-tidal carbon dioxide(PETCO2)between 35-45mmHg.Patients in group E were guided by anesthetist A to complete a diaphragm rehabilitation training using deep breathing trainer 10min after extubation,and then performed diaphragm rehabilitation training at 9:00 and 15:00 every day on 1,2,and 3 days after surgery,and patients in group C No intervention.Two groups of patients underwent diaphragmatic ultrasound examination before entering the room(T0),immediately after removing the tracheal tube(T1),the first day after the operation(T2),and the third day after the operation(T3),and the anesthesiologist A recorded the calm breath The thickness of the end-diaphragm muscle(TdiFRC),the maximum thickness of the end-inspiratory diaphragm(TdiFVC),the degree of diaphragmatic movement under calm breathing(DMERC)and the degree of diaphragmatic movement under deep brething(DMFVC)were used to calculate the thickening fraction(TF).Two groups of patients collected 1ml radial artery blood samples at T0,T2 and T3 for blood gas analysis,and measured arterial oxygen partial pressure(PaO2)and arterial carbon dioxide partial pressure(PaCO2).Clinical Pulmonary Infection Score(CPIS)was performed during postoperative follow-up to record the pulmonary complications of the two groups of patients within 3 days after operation.After that,the two groups of patients were re-divided into two groups according to gender,and whether there was a gender difference in the diaphragm indicators between the two groups was compared.Results:Due to changes in the surgical plan of 3 patients,1 patient had incomplete diaphragmatic ultrasound data collection.After excluding these 4 patients,56 patients were included in the study,28 patients in group E and 28 patients in group C.Compared with the T0 time point,the TdiFRC,TdiFVC,DMFRC,DMFVC and TF of the two groups of patients were significantly decreased at the T1-3 time point(P<0.05).Compared with the T1 time point,the T2 and T3 time points of the two groups of patients were TdiFRC,TdiFvc,DMFRC,DMFVC and TF gradually increased with time(P<0.05).Compared with group C,there were no significant differences in TdiFRC,TdiFVC,DMFRC,DMFVC and TF at time points T0 and T1 in group E(P>0.05).TdiFRC,TdiFVC,DMFRC,DMFVC,TF and PaO2 at time points T2 and T3 were significant Increased(P<0.05).There was no significant difference in CPIS score between the two groups(P>0.05).After regrouping the two groups of patients by gender,27 cases in the male group and 29 cases in the female group,it was found that each of the diaphragm indicators showed significant gender differences.The male patients had TdiFRC,TdiFvc,DMFRC,DMFVC and T0-3 time points.TF was greater than female patients(P<0.05).Conclusions:1.All patients undergoing general anesthesia laparoscopic cholecystectomy have diaphragmatic function impairment after operation,which lasts for at least three days after operation;2.Diaphragm rehabilitation training can effectively improve the postoperative oxygenation of patients,and can accelerate the recovery of diaphragm function after laparoscopic cholecystectomy to a certain extent.3.Diaphragm indicators showed significant gender differences,as follows:compared with female patients,the diaphragm thickness,movement of the diaphragm,and diaphragm thickness score of male patients were significantly increased.