Effect of individualized lung protective ventilation guided by lung ultrasound on postoperative diaphragm function in elderly patients
Objective To investigate the effect of individualized lung protective ventilation guided by lung ultrasound on postoperative diaphragm function in elderly patients.Methods A total of 80 elderly pa-tients who underwent laparoscopic radical resection of colon cancer at Taizhou People's Hospital from January to December 2023 were selected as the research subjects.They were randomly divided into the traditional lung protective ventilation group(T-LP group)and the personalized lung protective ventilation group based on lung ultrasound(U-LP group)using a random number table method,with 40 cases in each group.The T-LP group implemented traditional mode lung protective ventilation strategy using low tidal volume(VT),sustained fixed positive end expiratory pressure(PEEP),and fixed lung recruitment maneuver(RM)pressure.The U-LP group implements personalized lung protective ventilation strategies based on lung ultrasound titration of indi-vidualized PEEP and RM pressure on the basis of the T-LP group.Before induction of general anesthesia,15 minutes after extubation,30 minutes after extubation,and preparation to leave the postanesthesia recovery u-nit(PACU),two sets of records diaphragmatic ultrasound monitoring indicators during quiet breathing(QB)and deep breathing(DB)include diaphragmtic excursion(DE)[quiet breathing diaphragm excursion(DEQ),deep breathing diaphragmtic excursion(DED)],diaphragmtic thickness(DT)[quiet inspiratory diaphragm thickness(DTQi),calm expiratory diaphragm thickness(DTQe),deep inspiratory diaphragm thickness(DT-Di),deep expiratory diaphragm thickness(DTDe)],and diaphragmtic thickening fraction(DTF)[calm breath-ing diaphragmtic thickening fraction(DTFQ),deep breathing diaphragm thickening fraction(DTFD)[.In addi-tion,record the time it takes to stop using muscle relaxants when train of four ratio(TOFr)≥90％,the time it takes to remove the tube until the Aldrete score is greater than 9 points,and the number of cases requiring the reversal of residual muscle relaxants with sugammadex.Results Compared with before induction of general anesthesia,the diaphragm ultrasound indicators such as DEQ,DED,DTQi,DTQe,DTFQ,DTD;and DTFD in the T-LP group were significantly reduced,thinned,or decreased upon leaving the PACU(P＜0.05),while the DTD;indicator in the U-LP group was significantly thinned(P＜0.05).Compared with the T-LP group,the DEQ in the U-LP group increased significantly upon leaving the PACU(P＜0.05),and the DED,DTD;and DTFD increased or thickened significantly at 15 and 30 minutes after extubation and upon leaving the PACU(P＜0.05).The DTQi,DTQe,and DTDe increased significantly at 30 minutes after extubation and upon leav-ing the PACU(P＜0.05),and the time for extubation to achieve an Aldrete score of 9 was significantly shortened(P＜0.05).Conclusion The implementation of individualized lung protective ventilation based on lung ultrasound has a slight impact on the postoperative diaphragm function in elderly patients with laparo-scopic radical resection of colon cancer,which is more conducive to the recovery of postoperative diaphragm function,and shortens the retention time in PACU,which is worthy of clinical promotion.
Lung ultrasoundIndividualized lung protective ventilationElderly patientsLapa-roscopic colon cancer surgeryDiaphragmatic function
万方数据
维普
