The Different Effects Between Total Intravenous Anesthesia And Combined Intravenous And Inhalation Anesthesia On Atelectasis After Cholecystectomy

Objectives:The study was designed to investigate the effects of total intravenous anesthesia?TIVA?and combined intravenous and inhalation anesthesia?CIIA?on the occurrence of perioperative atelectasis after cholecystectomy by using lung ultrasound?LUS?,followed by analysis on the association of atelectasis and perioperative pulse oxygen saturation?SpO₂?,risk factors.Methods:A total of 85 patients were collected,who underwent laparoscopic cholecystectomy in the second affiliated hospital of soochow university from February,2017 to June,2017.Patients were randomly assigned into TIVA group?N=42?or CIIA group?N=43?using random number table.The surface projection of the total lung was divided into 12 regions,and LUS was performed to extract videos before operation?T1?,half an hour after extubation?T2?and 20-30 hours after operation?T3?.After scoring each region?LUS score?according to the recognized LUS scoring standard,scores from 12regions were added to acquire the total score of the patient?LUS scores?,which could reflect the severity of atelectasis.SPSS 24.0 software was used for statistical analysis.Measurement data were presented as mean±standard deviation?x±s?.Two independent sample t-test or chi-square test was used to compare the general information of the patients in both groups,multivariate analysis of variance was utilized in comparisons among groups of different LUS scores,analysis of variance of repeated measures was employed in LUS total scores as well as the variation tendency of LUS score in each region from T1,T2,T3,analysis of variance of non-repeated measures was used to compare the LUS scores of the 12 lung regions,and Pearson correlation analysis was utilized to compare LUS score and relevant indicators,risk factors.A p<0.05 was considered as statistical significance.Results:Analysis of variance of repeated measures indicated that there was no interaction effect between anesthesia methods or time in either total LUS scores or LUS score of each region.Comparisons among groups of total LUS scores were not statistically significant?p>0.05?.The total LUS scores rose from T1 to T2,but descended from T2 to T3,which was statistically significant?p<0.05?.Further analysis of each region revealed that the LUS scores of left posterosuperior region at T3,right anteroinferior region at T2and right inferior region at T3 in TIVA group?x±s=0.16±0.37,0.00±0.00 and 0.16±0.37,respectively?were significantly lower than those in CIIA group?x±s=0.57±0.85,0.15±0.45 and 0.43±0.74,respectively??p<0.05?.The LUS scores of left posterosuperior,right anteroinferior region,right superior region and right inferior region in the TIVA group exhibited a significantly descending tendency along with time,compared to the CIIA group?p<0.05?.The LUS scores in 12 regions were unevenly distributed in both groups,with those in left posterosuperior region,left posteroinferior region,right posterosuperior region,right posteroinferior region being significantly higher than the other regions?p<0.05?.The correlation between total LUS scores and SpO₂ at T2 and T3 were statistically significant?r=-0.334,r=-0.299,respectively?.The correlation between total LUS scores at T2 and operating time was statistically significant.In addition,the correlation between total LUS scores at T3 and operating time,in-bed time were statistically significant?p<0.05?.Conclusions:Postoperative atelectasis in varying degrees was unavoidable,which lasted for more than a day by ultrasound after laparoscope cholecystectomy.Atelectasis was unevenly distributed,with the bilateral back regions being the most significant.Atelectasis was probably the contributor to the decline in SpO₂ in patients,whose severity was likely to be associated with operating time and in-bed time.However,there was no significant difference between TIVA and CIIA except for individual points and regions.