Ultrasonographic Evaluation Of Diaphragm Function In Lobectomy Patients And Analysis On Its Correlation With Respiratory Muscle Strength

Objective : To investigate the changes of diaphragm thickness(TD),diaphragm thickening fraction(DTF),diaphragmatic excursion(DE)and respiratory muscle strength in patients with lobectomy,and to explore the correlation between diaphragmatic ultrasound and respiratory muscle strength.Methods : 60 patients with thoracoscopic lobectomy received in our hospital from October 2020 to February 2021 were selected.TD,DTF,DE,maximum inspiratory pressure(MIP)and maximum expiratory pressure(MEP)were measured before operation,1 d after operation and 7 d after operation.The perioperative changes were observed,and the correlation between diaphragm ultrasound index and respiratory muscle strength was analyzed by Pearson coefficient.Results:(1)The thickness of both sides of the diaphragm at the end of inspiration(Tdi(VL)),DTF,diaphragmatic excursion during quiet breathing at functional residual capacity(DE(FRC)),and diaphragmatic excursion during forced breathing at total lung capacity(DE(TLC))on postoperative day 1 were significantly lower than those before lobectomy(P<0.05).The thickness of both sides of the diaphragm at the end of expiration(Tdi(RV))increased compared with that before operation,and the difference was statistically significant(P<0.05).TDI(VL),DTF,DE(FRC),and DE(TLC)of bilateral diaphragms on postoperative day 7improved somewhat compared with 1 day after surgery,but were still lower than those before surgery(P<0.05).(2)The MIP,MEP,MIP%Pred and MEP%Pred of patients with lobectomy on postoperative day 1 were significantly lower than those before operation(P<0.05),and they were improved to some extent on postoperative day 7,but still lower than those before operation(P<0.05).(3)Preoperative MIP was positively correlated with Tdi(VL)on the operated side(r=0.297,P=0.025),and it was positively correlated with Tdi(RV)on the operated side(r=0.307,P=0.020).Preoperative MEP was negatively correlated with DTF on the operated side(r=-0.332,P=0.012)and the healthy side(r=-0.268,P=0.044).MIP on postoperative 7 day was positively correlated with Tdi(VL)on the operated side(r=0.261,P=0.050),and MEP%Pred was positively correlated with DTF on the operated side(r=0.289,P=0.029).Conclusion: TD,DTF,DE and respiratory muscle strength were significantly decreased in patients with lobectomy.There is a certain correlation between the diaphragm ultrasound index and respiratory muscle strength in patients with lobectomy,which can provide a reliable basis for clinical practice.