| Objective:The purpose of this study was to investigate the effects of respiratory exercise guided by a WeChat-based platform on diaphragm function and postoperative rehabilitation in elderly patients undergoing laparoscopic radical gastrectomy.Methods:A total of 150 patients scheduled for laparoscopic radical gastrectomy,109 males and 41 females,aged 65～80 years,American Society of Anesthesiologists（ASA）Ⅱ-Ⅲ,were divided into three groups of equal size according to random number table method:control group（group A）,preoperative respiratory exercise group（group B）,and perioperative respiratory exercise group（group C）.The patients in group A received routine preoperative preparation.The patients in group B were asked to receive a preoperative respiratory exercise intervention strategy.The patients in group C were asked to receive a respiratory exercise intervention strategy both preoperatively and postoperatively.The preoperative intervention time was the waiting time for a bed before surgery,which required a minimum of 5 days,and the postoperative intervention time was 5 days after surgery.Patients in groups B and C were asked to enter the doctor-patient communication WeChat group and upload exercise videos in the WeChat group at the designated time each day.Patients’general information（age,gender,ASA classification,BMI,history of smoking,history of hypertension,history of diabetes）and surgical data（operating time,anesthesia time,intraoperative fluid volume,intraoperative bleeding volume and urine volume）were recorded.Hemodynamic indexes（MAP、heart rate、SpO2）were recorded before induction of anesthesia（T1）and at 1 hour after the start of surgery（T2）.Peak of airway pressure（Ppeak）and dynamic lung compliance（Cdyn）were recorded at 10 min after anesthesia intubation（t1）,10 min after the start of pneumoperitoneum（t2）,60 min after the start of pneumoperitoneum（t3）and 10 min after the cessation of pneumoperitoneum（t4）.Diaphragmatic function[diaphragmatic mobility（DM）under calm breathing and deep breathing]were recorded at the appointment of hospitalization（T0）,T1,30 min after extubation（T3）,1 day after surgery（T4）,and 7 days after surgery（T5）.The occurrence of postoperative pulmonary complications（PPCs）（pulmonary infection,atelectasis,pleural effusion,respiratory failure）within 7 days after surgery was recorded.Arterial blood gas analysis parameters（pH,PaO2,PaCO2）were recorded at T1、T4、T5.Hospital Anxiety and Depression Scale（HADS）scores were recorded at T0、T1、T5.The Visual Analogue Scale（VAS）pain scores were recorded at T4、T5.The postoperative length of stay,total length of stay,and patient satisfaction were recorded.Results:（1）A total of 150 patients were included in this study,of which 1 patient was excluded due to intermediate open abdomen,5 patients were excluded due to irregular respiratory exercise,and 1 patient was excluded due to incomplete ultrasound data collection,resulting in the inclusion of 143 patients,50 in group A,47 in group B,and 46 in group C.（2）Comparison of general and intraoperative data:there were no statistically significant differences in general information,surgical data,hemodynamic indexes,Ppeak and Cdyn in the three groups（P>0.05）.（3）Comparison of diaphragm function:there was no statistically significant difference in DM under the deep breathing state at T0 in the three groups of patients（P>0.05）.Compared with group A,the DM under deep breathing state at T1、T3、T4、T5 was significantly greater in patients in groups B and C（P<0.05）,and there was no statistically significant difference in DM under deep breathing state at T1、T3、T4、T5 in patients in group C compared with group B（P>0.05）.There was no statistically significant difference in DM under the calm breathing state at the above five time points in all three groups of patients（P>0.05）.（4）Comparison of PPCs within 7 days after surgery:compared with group A,the incidence of PPCs within 7 days after surgery was significantly lower in patients in group C（P<0.05）,and the difference in PPCs within 7 days after surgery was not statistically significant in patients in group B（P>0.05）,There was no statistically significant difference in PPCs within 7 days postoperatively in group C patients compared with group B（P>0.05）.（5）Comparison of arterial blood gas analysis:there was no statistically significant difference in PaO2 at T1、T4 in the three groups of patients（P>0.05）.Compared with group A and group B,PaO2 at T5 was significantly higher in patients in group C（P<0.05）.There was no statistically significant difference in PaO2 at T5 in patients in group B compared with group A（P>0.05）.The differences in pH and PaCO2 at T1、T4、T5 were not statistically significant in the three groups of patients（P>0.05）.（6）Comparison of anxiety and depression:there was no statistically significant difference in HADS anxiety scores and depression scores between the three groups of patients at T0（P>0.05）.Compared with group A,patients in groups B and C had significantly lower HADS anxiety scores and depression scores at T1、T5（P<0.05）.Compared with group B,there was no statistically significant difference in HADS anxiety scores and depression scores between patients in group C at T1、T5.（7）Comparison of postoperative recovery and patient satisfaction:the differences in pain scores at T4、T5 were not statistically significant in the three groups（P>0.05）.The postoperative hospital stay and total hospital stay were significantly shorter in groups B and C compared with group A（P<0.05）,and the difference in postoperative hospital stay and total hospital stay was not statistically significant in group C compared with group B（P>0.05）.Patient satisfaction was significantly higher in groups B and C compared with group A（P<0.05）,and there was no statistically significant difference in patient satisfaction in group C compared with group B（P>0.05）.Conclusion:（1）Preoperative respiratory exercise and perioperative respiratory exercise can effectively improve diaphragm function in elderly patients undergoing laparoscopic radical gastrectomy.（2）Perioperative respiratory exercise can significantly reduce the incidence of PPCs in elderly patients undergoing laparoscopic radical gastrectomy within 7 days after surgery,while preoperative respiratory exercise can not.（3）Perioperative respiratory exercise can significantly improve oxygenation and accelerate the recovery of respiratory function in elderly patients undergoing laparoscopic radical gastrectomy during the postoperative recovery period,while preoperative respiratory exercise can not.（4）Preoperative breathing exercises and perioperative breathing exercises can significantly reduce anxiety and depression in elderly patients undergoing laparoscopic radical gastrectomy.（5）Preoperative respiratory exercise and perioperative respiratory exercise can significantly shorten the length of stay and improve patient satisfaction in elderly patients undergoing laparoscopic radical gastrectomy.（6）Respiratory exercise guided by a WeChat-based platform can promote postoperative recovery of elderly patients undergoing laparoscopic radical gastrectomy and may be worthy of wide application in clinical practice. |
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