Application Of Ultrasound-Guided Lung Recruitment In Patients Undergoing Thoracoscopic And Laparoscopic Resection Of Esophageal Cancer

Objective:To investigate the role of ultrasound-guided lung recruitment in patients undergoing thoracoscopic and laparoscopic resection of esophageal cancer,and to evaluate the severity of postoperative atelectasis by lung ultrasound(LUS).Methods:Forty patients with thoracoscopic and laparoscopic resection of esophageal cancer,aged>18,of American Society of Anesthesiologists physical status grade I-Ill were enrolled.The patients were randomly divided into two groups:control group(group A)and ultrasound-guided lung recruitment group(group B),with 20 cases in each group.After entering the room,the patients were established venous access and carried out routine monitoring:electrocardiogram,non-invasive blood pressure and pulse oxygen saturation.Endotracheal intubation was performed after routine anesthesia induction.All patients were treated with volumecontrol ventilation with tidal volume of 6mL/kg(ideal body weight)in the lateral position and 8mL/kg(ideal body weight)in the supine position,PEEP of 5 cmH2O,respiratory rate of 12-18 times/min,respiratory ratio of 1:2 and PETCO2 of 35-45mmHg.At the end of the operation,group B underwent lung recruitment under ultrasound guidance in the area with lung ultrasound score≥ 2 after lung ultrasound examination,set the airway pressure to increase gradually with a gradient of 5 cmH2O from 15 cmH2O until there was no lung collapse on ultrasound,immediately stop increasing the pressure,maintain the pressure at that time for 40 seconds,and the maximum airway pressure should not exceed 40 cmH2O.Group A did not intervene.The two groups of patients underwent pulmonary ultrasonography before anesthesia(T1),30 minutes after trachealextubation(T2)and one day after operation(T3).The age,gender,height,weight,BMI,ASA grade,duration of intraoperative lateral position,duration of intraoperative supine position,total duration of operation,mechanical ventilation time,intraoperative crystal and colloid volume,blood loss,urine volume,time in post anesthesia care unit(PACU),length of hospital stay Clinical pulmonary infection score(CPIS)on the third day after operation wasrecorded.Results:1.Finally37 patients were included in the study,18 in group A and 19 in group B.There was no significant difference between the two groups in age,gender,height,weight,BMI,ASA grade,length of intraoperative lateral position,length of intraoperative supine position,total operation time,mechanical ventilation time,intraoperative crystal and colloid volume,blood loss,urine volume,PACU time,length of hospital stay,CPIs score and LUS score at T1(P>0.05).2.At T2 and T3,the total score of LUS in group A was higher than that in group B,and the difference was statistically significant(P<0.05)3.At T2,the incidence of atelectasis in group A was significantly higher than that in group B(100%vs 68.4%)(P<0.05).At T3,the incidence of atelectasis in group A was significantly higher than that in group B(94.4%vs 63.2%)(P<0.05).4.The main areas of atelectasis were zone 4,zone 5 and zone 6 of both lungs.Conclusion:1.Ultrasound guided lung recruitment can reduce postoperative atelectasis in patients undergoing thoracoscopic and laparoscopic esophagectomy,and reduce postoperative pulmonary ultrasound score.2.Pulmonary ultrasound can evaluate the severity of postoperative atelectasis.