| Objective:Lung ultrasound was used to demonstrate the positive significance of lung recruitment maneuver in preventing intraoperative atelectasis,and to evaluate and compare the effects of manual lung recruitment maneuver and pressure-controlled ventilayion(PCV)lung recruitment maneuver on the incidence of atelectasis during the perioperative period of laparoscopic surgery,so as to explore more appropriate methods for intraoperative recruitment maneuver.Methods:A prospective cohort study was conducted to select 90 patients who underwent Laparoscopic total hysterectomy,laparoscopic double salpingectomy and laparoscopic total hysterectomy double adnexectomy in the Department of Gynecology of Affiliated Hospital of Chifeng University from January 2022 to December 2022.The subjects were categorized into three cohorts(consisting of 30 individuals in each cohort)based on a random number generator.Group A:no pulmonary reexpansion operation was performed during the operation.Group B:manual lung recruitment maneuver was given during the operation;Group C:Lung recruitment maneuver was given PCV during the operation.Age,weight and height of each patient were recorded before surgery,and body mass index was calculated.After the establishment of pneumoperitoneum during the operation,pulmonary regrowth was performed once every hour,and pulmonary regrowth was performed once during the operation.Six time points in perioperative period were selected:Mean arterial pressure(MAP),heart rate(HR)and oxygen saturation(SpO2)were monitored and recorded at each time point(T0-T5)at 5min before anesthesia induction,5min after intubation(T1),before lung recruitment maneuver(T2),10min after lung recruitment maneuver(T3),after surgery(T4),and 15min after extubation(T5).Lung compliance(Cdyn),airway peak pressure(Ppeak)and partial end-expiratory carbon dioxide pressure(PetCO2)at each time point(T1-T4)during mechanical ventilation after endotracheal intubation;Lung ultrasonography was performed before anesthesia induction(T0)and 15 minutes after extubation(T5),and modified LUS score was used to evaluate the lung regrowth effect.Record clinical pulmonary infection score(CPIS)at 1 day after surgery;Record the occurrence of postoperative pulmonary complications(PPCs)in the three groups within 7 days after surgery;Finally,operation,anesthesia,extubation time were recorded.Results:(1)Patients in 3 groups were selected as normal patients undergoing preoperative pulmonary ultrasound examination,and there was no statistical significance in modified LUS score at T0 time point(p>0.05).Comparison of modified LUS score at T5 time point among 3 groups showed that group A was higher than group B,and group B was higher than group C,with statistical significance(p<0.05).(2)There was no significant difference in MAP among T0,T1,T2 and T5 time points(p>0.05);The MAP comparison between the three groups at T3 and T4 showed that group A was significantly higher than group C,and group C was higher than group B,with statistical significance(p<0.05).(3)There was no significant difference in HR among T0,T1,T2 and T5 time points(p>0.05);The comparison of HR of three groups at T3 and T4 showed that group A was significantly higher than group C,and group C was higher than group B,with statistical significance(p<0.05).(4)There was no significant difference in SpO2 among T0,T1,T2 and T5 time points(p>0.05);The comparison of SpO2 of three groups at T3 and T4 showed that group A was lower than group B and group C,there was a significant statistical difference.(p<0.05),but there was no significant difference found between group B and group C(p>0.05).(5)There was no statistical significance in Ppeak difference among the three groups at T1 and T2(p>0.05).Comparison of Ppeak among the three groups at T3 and T4 showed that group A was higher than group B and group C,and group B was higher than group C,with statistical significance(p<0.05).(6)There was no statistically significant variation in PetCO2 among the three groups at T1 and T2.(p>0.05).The comparison of PetCO2 between the three groups at T3 and T4 showed that group A was higher than group B and group C,with statistical significance(p<0.05).Group B and group C did not show any significant statistical difference.(p>0.05).(7)There was no statistically significant difference in Cdyn among the three groups at T1 and T2(p>0.05).Comparison of Cdyn among the three groups at T3 and T4 showed that group B and C were higher than group A,and group C was higher than group B,with statistical significance(p<0.05).(8)The clinical pulmonary infection score(CPIS)on the day after surgery and the incidence of PPCs within 7 days after surgery in group A was higher than that in group B and group C(p<0.05).but the group B and group C showed no statistical significance(p>0.05).Conclusion:Based on the findings of this research,different degrees of atelectasis occurred after Laparoscopic total hysterectomy,laparoscopic double salpingectomy and laparoscopic total hysterectomy double adnexectomy.Both of the two methods of lung recruitment maneuver can improve the degree of postoperative atelectasis in patients,and both of the two methods of lung recruitment maneuver can reduce the incidence of postoperative lung inflammation to a certain extent.In this study,although there was no significant difference between the two methods of lung recruitment maneuver in reducing the incidence of postoperative pulmonary inflammation in patients,the PCV method of lung recruitment maneuver was more suitable for gynecological laparoscopic surgery.This method could effectively improve patients’postoperative atelectasis,and had a better effect on patients’ intraoperative airway improvement,while had less impact on patients’ intraoperative hemodynamics. |
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