| Objective:To compare the effects of fraction of inspired oxygen(FIO2)on preoperative atelectasis during general anesthesia in thyroid-associated surgery.Method:111 patients from The Second Affiliated Hospital of Su Zhou University,scheduled to undergo thyroidectomy from June.2018 to September.2018,classified ASA-? total or partial thyroidectomy,aged 19-65 years,BMI19-30Kg/m2 thyroidectomy were randomly divided into 3 groups,37 patients in each group.Group I FIO2=40%Group IIFIO2=60%;Group ? FIO2=80%.Group I was excluded from 1 postoperative bleeding case required a second surgery,and group ? was excluded for personal rejection.Therefore,29 patients in group ?,30 patients in group ?,and 28 patients in group ? were included in the study.Each group was fastinducted anesthesia by 100%FIO2,and FIO2 was changed to the target oxygen concentration after machine-controlled ventilation.After the patient were extubated,they were transferred toPICU with nasal oxygen consciously,and the oxygen flow rate was 3 L/min.Observation indicators:1 pulse oximetry(Sp02):Sp02 change was observed all over the operation.Once Sp02<90%the experimental study was terminated immediately,meanwhile airway management measures were taken.2 Pulmonary ultrasound score:Ultrasound observation time point:1 day before surgery(T1),30 minutes after extubation(T2),and 24 hours after operation(T3).Ultrasound observation site:left upper front chest,lower left front chest,upper left chest,lower left chest,left posterior chest,left posterior chest,right upper chest,right lower chest,right upper chest,lower right chest,right rear There are 12 areas in the upper chest and right lower chest.Pulmonary ultrasound imaging scoring criteria:0 points:normal lung tissue images,clear A line and lung slip sign,0-2 B lines;1 point:bigger than or equal to 3 B lines or subpleural separated by smooth pleural line;2 points:multiple merged B-lines or thickened subpleural small consolidation,irregular pleural line separation;3 points:greater than 1*2cm subpleural consolidation.The images of different lung regions at different time points were scored,and the scoreswere added to calculate the average LUS value to evaluate the severity of atelectasis in 12 regions.Results:1.? At T2,the mean value of LUS in group I was significantly lower than that in group ? and ?;The mean value of LUS in group ? and group ? was not statistically significant.the LUS value of left posterior,right posterior superior and right posterior lung of group ? was significantly higher than that of I.The LUS values of the corresponding regions were statistically significant(P<0.05);the LUS values of the left posterior superior,the left posterior,the right posterior superior,and the right posterior lower lung of the ? group were significantly higher than the LUS values of the corresponding regions of the I group,and The difference was statistically significant(P<0.05).?At T3,The mean value of LUS in group ? was significantly lower than that in group ?,and The difference was statistically significant(P<0.05).There was no statistically significant difference in LUS scores between the three groups.2.?The total scores of LUS at the T1 and T2 showed an upward trend in the 3 groups.The difference was statistically significant(P<0.05).The total scores of LUS in the three groups at T2 and T3 showed a downward trend,and the difference is statistically significant(P<0.05);?3 groups of patients in the left posterior superior,the left posterior,the right posterior superior,and the right posterior lung regions showed this trend,and the difference was statistically significant(P<0.05).3.?At T2,the LUS values of the left and right upper lungs and the left and right lower lungs of the patients in group ??? and ? was significantly higher than those in the anterior and lateral lungs.At T3,compare groups I?? and ? the difference between the LUS value of the left and right lower lungs and the right posterior superior of the patient was significantly higher than compared with that of the anterior and lateral lungs.The difference in lung and side lung ratio was statistically significant(P<0.05).4.?At T2 and T3,the Sp02 of group ? was significantly higher than that of group ? and group ?.The Sp02 of group ? was significantly higher than that of group ?,and the difference was statistically significant((P<0.05));?The group of group ? and group ? had Sp02 lower than T1.the Sp02 at the T3 is higher than that atT2 point,and the difference is statistically significant(P<0.05).5.The postoperative hospital stay and wound healing in the three groups Comparison,the difference is not statistically significant.Conclusions:1.This study showed that different degrees of atelectasis occurred after thyroid-associated surgery and general anesthesia,and can continue until more than one day after surgery,especially in the bilateral posterior dorsal lung region;2.Ultrasound observation within 24 hours after operation,Comparing the results of different inhaled oxygen concentrations(40%,60%,80%),the degree of atelectasis at FiO240%were the lightest,while the effect of FiO2 60%and FiO2 80%were similar. |
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