| Objectives: 1.The change of diaphragm thickness can reflect the diaphragmatic systolic function.Ultrasound can be used to evaluate the diaphragmatic function of perioperative diaphragm in patients with general anesthesia,which can provide a reference for the recovery of respiratory function after extubation.2.To observe the correlation between diaphragm thickness,diaphragm recovery rateand TOF,and to explore the significance of ultrasonographic observation of diaphragm thickness changes in the application of clinical muscle relaxants and extubationMethods: Part one: 60 patients with limb surgery were selected,ASA ?~? grade,heart function ?~? grade,no history of respiratory disease,no thoracic surgery,no thoracic deformity,no chronic metabolic diseases,pleural effusion or huge tumor,no serious neuromuscular conduction dysfunction,not used drugs that affect muscle structure,muscle relaxation monitoring site within 3 months without trauma,nearly 4 weeks without respiratory tract infection history.Pulmonary function test: FEV1 / FVC> 70% and FEV1 ? 80% of the expected value.Divided by age: adult group(18 to 64 years old,group A),the elderly group(? 65 years old,group O),each group of 30 people.Subjects take supine position,spontaneous breathing.The 5-12 MHz line array ultrasound probe placed in 8,9 intercostal-right side of the axillary line,perpendicular to the chest wall.Record the image of diaphragm both at the end of expiration and inspiration at the following time points:(T1)Before induction,calm breathing state;(T2)Before induction,to the subject propofol 2.0mg / kg,sedative state;(T3)Mechanical ventilation(or muscle relaxation),gave the subject rocuronium 0.6mg / kg,until the subject's TOF value reached 0%;(T4)Postoperative recovery,the subject's rise time ? 5s,TOF ? 90%,calm breathing and inhalation of air pulse oxygen saturation continued to stabilize at 90% or more.Measure the thickness ofdiaphragm at the end of expiration and inspiration,The evaluation of the diaphragmatic thickening fraction was calculated asthe following formula:? Tdi% =(Thickness at end inspiration-Thickness at end expiration)/ Thickness at end expiration×100%.The degree of metabolism of muscle relaxants refers to Train of four stimulation values.TOF value is calibrated at T2 time point.Part two: Using the same inclusion criteria,20 patients with limb surgery were selected.Using the same method of operation,record the image of diaphragm both at the end of expiration and inspiration at the following time points:(T1)Before induction,calm breathing state;(T2)Mechanical ventilation(or muscle relaxation),gave the subject rocuronium 0.6mg / kg,until the subject's TOF value reached 0%;(T3)Every 10% from TOF began to recover to extubation;(T4)Extubation.Record the TOF value for the above time point(The calibration method of TOF is the same as part one).Measure the thickness ofdiaphragm at the end of expiration and inspiration.The evaluation of the diaphragmatic thickening fraction was calculated asthe following formula:? Tdi% =(Thickness at end inspiration-Thickness at end expiration)/ Thickness at end expiration × 100%.The evaluation of the diaphragm recovery rate was calculated asthe following formula:?Tdi%(RV)=Thickness at end expiration/Thickness at end expiration before induction×100%.Results: Part one: At the time point of T1,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi%were higher in the adult group than that in the elderly group(P<0.05).At the T2 time point,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi% were higher in the adult group than that in the elderly group(P<0.05).At the time point of T3,the thickness of diaphragmat the end of expiration and inspirationwere higher in the adult group than that in the elderly group(P<0.05),but there was no significant difference in ? Tdi% between the adult group and the elderly group(P>0.05).At the T4 time point,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi% were higher in the adult group than that in the elderly group(P<0.05).At the T2 time point,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi% in the adult group and the elderly group were lower than that in the T1 time point(P<0.05).At the time point of T3,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi% in the adult group and the elderly group were lower than that in the T1 and T2 time points(P<0.05).At the T4 time point,the thickness of diaphragmat the end of expiration and inspiration,and? Tdi% in the adult group and the elderly group were lower than that in the T1 and T2 time points(P<0.05),but greater than that in the T3 time point(P<0.05).Part two: The thickness of diaphragmat the end of expirationbefore induction was greater than that of TOF = 0(P<0.05).There was no significant difference in the thickness of diaphragmat the end of expiration between TOF =51-60% and TOF = 0(P> 0.05).When the TOF value was 61-90%,the thickness of diaphragmat the end of expiration was greater than that of TOF = 0(P<0.05).During anesthesia,the thickness of diaphragmat the end of expiration and inspiration,and ? Tdi% were lower than those before induction(P<0.05).There was a significant positive correlation between the thickness of diaphragmat the end of expiration and the TOF value by the Pearson correlation test,both at? Tdi%(RV)and the TOF value.When ?Tdi%(RV)> 90%,it suggests that the diaphragm function has been basically restored.Conclusions: 1.In a calm state,the elderly's diaphragm systolic function is less than adults.2.Ultrasonographic changes in diaphragm thickness were synchronized with postoperative respiratory recovery.3.There was a significant positive correlation between diaphragm thickness changes and TOF value.4.When the diaphragm thickness than the complete muscle relaxation state began to change,it suggests that the diaphragm contractility began to recover.5.When the thickness of diaphragmat the end of expiration is 90% of the thickness of the diaphragm before induction,it suggests that the diaphragm function has been basically restored 6.Ultrasound observation of diaphragm thickness changes in the application of muscle relaxants and extubation has the potential predictive value. |
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