Application And Effect Evaluation Of Ultrasound-guided Lung Reexpansion Strategy In Elderly Patients Undergoing Laparoscopic Radical Gastrectomy Under General Anesthesia

Objective:To explore the application and effect evaluation of ultrasound-guided lung reexpansion strategy in elderly patients undergoing radical gastrectomy under general anesthesia.Method:A total of 120 elderly patients who received laparoscopic radical gastrectomy in our hospital from January 2021 to December 2022 were selected as research objects,aged 60-80 years,ASA grade Ⅰ toⅢ.The above subjects were randomly divided into two groups with 60 cases in each group by random number table method:ultrasound-guided lung reexpansion group（Group P）and control group（group C）.Both groups were given combined static and inhalation anesthesia during the operation.At the end of surgery,group P would like to implement lung reexpansion under the guidance of ultrasound,while group C would like to implement lung reexpansion by controlled dilation only.Pulmonary ultrasound examination（12-zone method）was performed 5min before anesthesia induction（T₀）,at the end of surgery（T₁）,30 min after extubation（T₂）and 1 day after surgery（T₃）,and ultrasound scores were performed at the later stage after retention of ultrasound images.pulse oxygen saturation（SpO₂）of T0,T1,T2 and T3 were recorded.Arterial blood gas was extracted from two groups at four time points,and PaO₂/FiO₂was calculated.The incidence of atelectasis,pneumonia,pleural effusion and hypoxemia within 1 day after the operation was recorded,and rechecked by CT examination.In addition,the postoperative extubation time and hospital stay of the two groups were recorded.Logistic regression analysis of the factors affecting atelectasis after laparoscopic radical gastrectomy in senile patients.Result:（1）Compared with the ipsilateral anterior region,LUS in the two groups were increased in the two inferior anterior region,two inferior anterior region,two superior posterior region and two inferior posterior region during T₁-T₃（P<0.05）;Compared with group C,LUS in the two inferior anterior regions,two inferior lateral regions,two superior posterior regions and two inferior posterior regions in group P were decreased at T₂and T₃（P<0.05）.（2）Compared with T₀,MAP and HR at T₂were decreased in both groups（P<0.05）.There was statistical significance in MAP and HR between the two groups（P<0.05）.（3）Compared with group C,PaO₂/FiO₂in group P at T₂and T₃was higher than that in group C,and the difference was statistically significant（P<0.05）.（4）Compared with group C,the incidence of atelectasis and hypoxemia in group P was significantly reduced 1 day after surgery.（5）Age high or low,average pneumoperitoneum pressure high or low,pneumoperitoneum time long or short and whether or not use lung reexpansion strategy under lung ultrasound were independent factors influencing the high risk of atelectasis in elderly patients undergoing laparoscopic radical gastrectomy.Conclusion:In elderly patients undergoing radical gastrectomy,atelectasis often occurs in the two lower areas.In this study,pulmonary ultrasound guidance for pulmonary reexpansion can reduce the incidence of atelectasis and hypoxemia in elderly patients after radical gastrectomy.It is safe and effective and worthy of clinical application.