| Research purposesThe recruitment maneuver(RM)was conducted for patients undergoing laparoscopic cholecystectomy before the removal of tracheal catheter after surgery,Lung ultrasound was used to observe the incidence of postoperative lung air content reduction,and to explore the value of recruitment maneuvers in preventing postoperative lung air content reduction in such patients.Research method120 patients in laparoscopic cholecystectomy,aged 18-65 years,were classified as ASAI??,and were randomly divided into three groups,40 in each group.According to whether the recruitment maneuver was performed before the tracheal tube was removed,the three groups were named as RMO group:no recruitment maneuver;RM1 group:one recruitment maneuver before extubation;RM3 group:three recruitment maneuver before extubation.All patients were performed underwent total intravenous anesthesia,ventilator was set to volume control ventilation,tidal volume 8 ml/kg predicted body weight(PBW),recruitment maneuver mode using method of increasing tidal volume under capacity control,which is to limit the peak pressure of inhalation to 45 cm H2O,set PEEP at 12 cm H2O,adjust the respiratory rate to 6 times/min,and tidal volume is increased in a gradient of 4 ml/kg PBW until the Pplat reaches 30cm H2O,and then 3 times of breathing on the platform,then the tidal volume,respiratory rate,etc.are adjusted to the condition before recruitment,keeping the PEEP unchanged at 12 cm H2O until the tube is removed,and the RM3 group is repeating another RM one minute later.Repeat the above operation until the three groups are completed.Observed indicators included lung ultrasound(LUS)scores in each of the two lungs of the patient one day before surgery(T1),half an hour after surgery(T2),and one day after surgery(T3),SpO2 at each time point,Systolic blood pressure(SBP)before and after lung recruitment,diastolic blood pressure(DBP),heart rate(HR),etc.Parts of LUS observation:the thorax was divided into 12 quadrants:anterior,lateral,and posterior zones separated by the anterior and posterior axillary lines,which divided in upper and lower portions for the right and left lung.Ultrasound data were collected independently by experienced anesthesiologist doctors trained in pulmonary ultrasound.The data scores were taken by two other doctors in the study group,and the final score was taken as the average of two people.Research result(1)There was no significant difference in the total score of lung ultrasound(LUS)between the three groups at T1.The LUS total score of the three groups was significantly increased at T2 compared with T1,it is decreased at time T3 compared with T2,but still higher than T1 time;(2)Comparing the total scores of LUS in the three groups at T2 and T3,RMO group was higher than those in RM1 group and RM3 group,and RM1 group was higher than RM3 group.((3)At the time points of T2 and T3,the LUS scores of the left and right upper lung zones and the lower lung zone of the three groups were higher than those of the ipsilateral upper anterior chest;(4)There was no significant difference in SpO2 between the three groups at T1(p>0.05).The SpO2 of RM3 group was higher than that of RM1 group at T3,and the SpO2 of RM1 group at T3 was lower than that of T1 and T2(p<0.05);(5)There were no significant differences in systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)between the RM1 group and the RM3 group before or after RM.There was no significant difference in diastolic blood pressure and heart rate in one group.The systolic blood pressure of RM3 group decreased slightly after RM.ConclusionFrom the results of this study,the following conclusions can be drawn:1.Lung ultrasound can show the changes of the lung air content well.2.Patients undergoing laparoscopic cholecystectomy can experience some degree of lung air content reduction after general anesthesia and laparoscopic surgery.This status lasts for at least one day after surgery.3.Performing recruitment maneuver before removal of the tracheal tube can prevent postoperative lung air content reduction,and the effect of three lung recruitment maneuvers is better than single.In this study,the systolic blood pressure of the patients is slightly decreased in the three groups of recruitment maneuver... |
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