Effect Of Applying Lung Recruit Maneuver Duringanestheticemergence On Atelectasis In Patients After Laparoscopic Colorectal Cancer Resection

BackgroundWith the development of laparoscopic surgery and the increasing maturity of anesthesia technology,laparoscopic colorectalcancer resection has gradually become the mainstream operation.The artificial pneumoperitoneum dependent on laparoscopic surgery and the special position,Trendelenburgposition,will reduce lung volume and compliance,affect lung ventilation and ventilation function,and even cause pulmonary complications such as atelectasis,hypoxemia and pneumonia,which increase the risk of postoperative extubation.The perioperative use of lung protective ventilation strategy is of great clinical significance for reducing the incidence of pulmonary complications and for the rapid rehabilitation of patient respiratory function.Pulmonary protective ventilation strategies include low tidal volume,appropriate PEEP,lung recruitment maneuvers,permissive hypercapnia,and low inhaled oxygen concentration.The lung recruitment strategy can promote the reopening of collapsed alveoli and also prevent atelectasis caused by low tidal volume.Although there are many studies on lung recruitment strategy,they focus on the intraoperative period,and there are very few reports on postoperative period such as awakening period from anesthesia and after return to the ward.This study hypothesized that the application of lung distraction strategy in the recovery period of anesthesia can also have a positive impact on patients.In this study,the lung recruitment maneuverswas used for laparoscopic colorectal cancer patients during the recovery period of anesthesia,and the lung imaging changes were monitored in real time through ultrasound technology,in order to provide some reference for the timing of the lung recruitment maneuvers.ObjectTo investigate the effect of lung recruitment maneuvers for laparoscopic colorectal cancer resection on lung ultrasound score and oxygenation after extubation and 24h after surgery.MethodAccording to the inclusion criteria,Thirty cases of elective laparoscopic colorectal cancer resection were selected.In the case of spontaneous breathing before anesthesia（T0）,5minutes after induction of anesthesia（T1）,at the end of surgery（T2）,5minutesafter extubation（T3）,and 24h after surgery（T4）,B-mode ultrasound was used to monitor pulmonary radiographic changes.And we do blood gas analysis at the same time.The LUS score at each time point.Pa O₂ and Fi O₂ were recordedseparately.Operation time,anesthesia time,pacu ventilation time,SPO₂,HR,BP,and manner were recorded simultaneously.ResultEight divisions LUS scores:patients in group LRM had lower LUS scores at time point T3 and T4than in group Con（P=0.041）;there was no statistical difference between two groups at time points T0,T1 and T2（P>0.05）.Twelve divisions LUS scores:patients in group LRM had lower LUS scores at time point T4 than in group Con（P<0.001）;there was no statistical difference between two groups at time points T0（P=0.161）.Group Con:there was no statistically significant difference in eight divisions LUS scores at T0,T1,and T2（P>0.05）;eight divisions LUS scores were higher at the T3 time point compared to the T0,T1,T2,and T4 time points（P=0.000）;eight divisions LUS scores were higher at the T4 time point compared to the T0 time point（P=0.016）,and the difference was not statistically significant compared to T1 and T2（P>0.05）;twelve divisions LUS scores were higher at the T4 time point compared to the T0 time point（P<0.001）.Comparison of LUS scores in each lung region between the two groups at T4 time point:no statistically significant difference in the comparison of LUS scores in the anterior lung region between the two groups（P=0.870）.The LUS scores in the lateral and dorsal lung regions were higher in the group Con than in the group LRM（P=0.002,P<0.001）.There was no statistically significant difference in the comparison of LUS scores in each lung region between the group LRM（P>0.05）.The difference in the comparison of LUS scores in each lung region between the group Con:the difference in LUS scores were statistically significant:the LUS scores in the dorsal lung region were higher than those in the anterior and lateral lung regions（P=0.00,P=0.043）;the LUS scores in the lateral lung region were higher than those in the anterior lung region（P=0,018）.Oxygenation index:patients in group LRM had higher LUS scores at time point T3 and T4than in group Con（P=0.002,P<0.001）;there was no statistically significant difference in oxygenation index at T0,T1,and T2（P>0.05）.There was no significant difference in the oxygenation index in the group LRM（P>0.05）.Group Con:there was no statistically significant difference in oxygenation index at T0,T1,and T2（P>0.05）;oxygenation indexwaslower at the T3 time point compared to the T0,T1,T2 time points（P<0.001）,and the difference was not statistically significant compared to T4 time point（P=0.716）;oxygenation indexwaslower at the T4 time point compared to the T0,T1and T2 time points.（P<0.001）.Conclusion1.The use of lung reversion ventilation strategy for patients with laparoscopic radical colorectal cancer during the recovery period of anesthesia can reduce the LUS score,improve the oxygenation index and facilitate the recovery of respiratory function.2.Using small tidal volume fixed PEEP during laparoscopic colorectal cancer resection could not completely avoid the occurrence of postoperative atelectasis.