The Clinical Research To Assess The Perioperative Atelectasis And Guide The Lung Protective Ventilation By The Ultrasound

Objective1.Evaluate the impact of atelectasis to patients during the longtime laparoscopic gynecological surgery by lung ultrasound;2.Eveluate the effect of lung protective ventilation strategy combined with recruitment maneuver to atelectasis during the longtime laparoscopic gynecological surgery by lung ultrasound.MethodsEighty subjects going through general anesthesia during the laparoscopic gynecological surgery were randomly divided into the control group of Trendelenburg position（C0=20）,the control group of head-down lithotomy（C1=20）,the recruitment group of Trendelenburg position（R0=20）and the recruitment group of head-down lithotomy position（R1=20）.All groups taken lung-protective ventilation measures which were low tidal volume and 5cmH₂O PEEP,but the group R0 and group R1 added recruitment maneuver.When the four predetermined time points which 5 minutes after intubation（T1）,5 minutes after pneumoperitoneum established（T2）,40 minutes after pneumoperitoneum established（T3）,5 minutes before extubation（T4）,the Lung ultrasonography was implemeneted and the picture and score of lung ultrasound was recorded.Meanwhile,the hemodynamics、respiratory mechanics and oxygenation were also recorded.ResultsThe lung ultrasound score of each group were increasing over time（P<0.05）.Compared C0 with C1、R0 with R1,the score of lung ultrasound was not statistically significant at the T1 and T2（P>0.05）.At the T3,there is a statistical difference between C1 and R1、C1 and R0（P>0.05）.The lung ultrasound score of C1 was significantly higher than R1,and also higher than C0 at the T4（P<0.05）.Compared with the lung ultrasound score of each area of chest,the posterior chest’s score was obviously higher at the T1.There were statistically differences not only the posterior chest compared with the front and side,but also the side chest compared with the front at the T3 and T4.In the meantime,the score of posterior chest was found great changes during the period（P<0.05）.There was no statistically difference between groups in MAP and HR（P>0.05）.Compared with the T1,the index of respiratory mechanics and oxygenation at the T2、T3、T4 was statistically differen（P<0.05）,except of SpO₂.The outcome of post-operation follow-up had no statistically difference（P>0.05）.ConclusionsThe head-down lithotomy position with pneumoperitoneum would obviously increase the severity of the atelectasisduring the longtime laparoscopic gynecological surgery.It was not clearly influent to the prognosis that the recruitment maneuve was added on the traditional lung-protective ventilation.However,it remarkably reduced the duration and severity of the atelectasis in local area.