ABSTRACT
Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.
ABSTRACT
Objective To retrospectively analyze the clinical characteristics ,pathological features and aetiology of pulmonary carcinoid tumourlets .Methods The clinical data of 10 patients with pulmonary carcinoid tumourlets in the West China Hospital of Sichuan University from April 1976 to October 2013 were collected for conducting the retrospective analysis and combining the lite‐raute review .Results Of the total 10 patients ,3 cases were male and 7 cases are female .9 cases were accompanied by bronchiecta‐sis ,1 case was complicated with lung adenocarcinoma .The clinical manifestations were lack of specificity ,which were dominated by repeated cough ,expectoration ,dyspnea and hemoptysis .The microscopic pathological examination suggested that there were differ‐ent degrees of inflammation reaction or fibrous tissue hyperplasia .All patients had no carcinoid syndrome ,lymph node and distant metastasis .10 cases received the surgical treatment .6 cases were pulmonary hypoplasia ,in which 1 case was carcinoid tumourlets complicating pulmonary sequestration .The postoperative follow up lasted for 5 - 80 months .8 cases had no recurrence and 2 cases were loss of follow up .Conclusion For the middle‐aged women patients with bronchiectasis and poor therapeutic effect ,complica‐ting carcinoid tumourlets should be vigilant ,active surgery combined with the pathologic examination is a suitable clinical decision .