| Objective:To evaluate the incidence of neonatal atelectasis under different oxygen concentrations by pulmonary ultrasound during anesthesia mechanical ventilation,and to explore the effect of pulmonary reexpansion strategy guided by pulmonary ultrasound on neonatal pulmonary gas-exchange function.Methods:1.In this prospective randomized controlled study,63 neonates with GI malformations who underwent caesarean section in Kunming Children’s Hospital from January 2020 to January 2021 were selected and randomly divided into three groups A,B and C,with 21 cases in each group.Due to the low oxygen reserve and high incidence of difficult airway in neonates.Uncertainty in the timing of preoxygenation and anesthesia induction interferes with preoperative pulmonary ultrasound findings.Therefore,after tracheal intubation,all children underwent pulmonary recruitment maneuvers and ultrasonography was used to ensure that all lung tissue was in a retensioned state before surgery.The oxygen concentration was maintained at 30%in group A,40%in group B,and 50%in group C during mechanical ventilation.At the end of the operation,the lung consolidation due to mechanical ventilation with different oxygen concentrations was recorded.Pulmonary resuscitation maneuvers were performed again before extubation of the neonatal,and lung ultrasound was performed to ensure that there was no postoperative lung tissue collapse.Arterial blood gases were collected before and after each of the two pulmonary resuscitation maneuvers to observe the effect of the pulmonary resuscitation maneuver on the oxygenation index.Primary observation:pulmonary consolidation score;secondary observations:intraoperative areas of pulmonary atelectasis,changes in oxygenation index,pulmonary atelectasis,incidence of hypoxemia,and postoperative pulmonary complications at 72 hours.2.Monitoring and recording:Basic information and clinical data were collected from neonates who met the inclusion criteria.The basic information of the children included:name,sex,age and weight;clinical information:① Pre-operative planned surgical and anesthesia methods,medical history,pre-operative vital signs,imaging and laboratory findings.② Intraoperative The lung consolidation score and the area of occurrence of lung consolidation after surgery;oxygenation index at each time point,oxygenation index recording time points before preoperative ultrasound-guided pulmonary resuscitation(T1),after preoperative ultrasound-guided pulmonary resuscitation(T2),before postoperative ultrasound-guided pulmonary resuscitation(T3),and after postoperative ultrasound-guided pulmonary resuscitation(T4);recording the occurrence of hypoxemia during the child’s anesthesia mechanical ventilation;recording the child’s room admission Status,type and dose of anesthesia-inducing drugs,number of intubation,number of aspiration,operating department,operating site,operating time,anesthesia time,and infusion volume.③Pulmonary complications within 72 hours after surgery(including fever,hypoxemia,laryngospasm,bronchospasm,pneumothorax,etc.).3.Observation index:primary observation index:lung consolidation score;secondary observation index:intraoperative lung atelectasis area,oxygenation index changes,lung atelectasis,hypoxemia incidence,postoperative lung complications at 72 hours.4.To analyze the correlation between different oxygen concentrations and the occurrence of pulmonary atelectasis,and to explore the effect of pulmonary ultrasound-guided pulmonary resuscitation strategy on the improvement of oxygenation index in children.Results:1.Statistically significant differences in lung consolidation scores between different oxygen concentration groups were found in group A(5.08±2.691),group B(6.85±1.994)and group C(9.77±2.619)while two-by-two comparisons(t-test)showed that the differences in lung consolidation scores between the 30%with 50%oxygen concentration groups(p<0.001)and between 40%with 50%group(p<0.01)were statistically significant.And the difference between the 30%and 40%groups was not statistically significant(P>0.05).According to the mean and 95%confidence interval showed that the oxygen concentration 50%group had a significantly higher lung consolidation score than the 30%and 40%groups.2.Oxygenation indices were measured at different time points T1(251.51 ±71.832),T2(375.54±78.021),T3(294.56±76.380),and T4(387.33±62.878),with significant changes in oxygenation indices before and after ultrasound-guided pulmonary resuscitation for T1 compared to T2(p<0.001),T3 compared to T4(p<0.001),and a more significant decrease in oxygenation index occurred in T2 compared to T3(p<0.001).3.A total of 63 neonates were included,and the number of cases of pulmonary atelectasis was 52(82.54%),with a higher incidence of pulmonary atelectasis in the back(81%),and more so in the right side(51%).4.Three groups of newborns,30%oxygen concentration group of 6 cases of children with mild hypoxemia(oxygen saturation between 80～90%),a few minutes after remission.Two cases had moderate hypoxemia(the lowest oxygen saturation was 75%and 74%respectively)and were corrected immediately after pulmonary reexpansion.There was no hypoxemia in the other two groups.There were no related pulmonary complications(fever,hypoxemia,laryngospasm,bronchospasm,pneumothorax)in the three groups at 72 h after operation.Conclusion:1.These are the results of our study,40%FIO2 may be the oxygen concentration that neither causes significant pulmonary atelectasis nor hypoxemia during maintenance of mechanical ventilation in neonates under anesthesia.However,There may also be lower lung consolidation scores and no hypoxemia between 30%oxygen concentration and 40%,but we have not studied it.2.Pulmonary atelectasis is present in most anesthetized patients and occurs mainly in gravity-dependent areas,more on the right than on the left.3.Lung ultrasound-guided pulmonary resuscitation strategy can significantly improve neonatal pulmonary gas-exchange function.It is important to note that pulmonary resuscitation maneuvers should be performed intermittently during mechanical ventilation,and a significant decrease in oxygenation index occurred when comparing T2 and T3.It indicates that with the prolongation of mechanical ventilation time,new pulmonary atelectasis will still reappear and affect the oxygenation function of the patient. |
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