Nghiên cứu biến đổi các chỉ số khí máu động mạch và cơ học phổi khi áp dụng nghiệm pháp huy động phế nang trong gây mê phẫu thuật bụng ở người cao tuổi TT TIENG ANH

THE EDUCATION & TRAINING MINISTRY

THE SCIENTIFIC AND MEDICAL STUDY INSTITUTION 108
------------------------

LAI VAN HOAN

RESEARCH ON THE VARIATIONS OF ARTERIAL BLOOD
GASES AND PULMONARY MECHANICS DURING
GENERAL ANESTHESIA APPLYING ALVEOLAR
RECRUITMENT MANEUVERS FOR ABDOMINAL
SURGERY IN THE ELDERLY
Speciality: ANESTHESIOLOGY AND SICU
Code : 62.72.01.22
THE SUMMARY OF MEDICAL PROJECT FOR DOCTORS

HANOI – 2021


The project is completed at:
THE SCIENTIFIC AND MEDICAL STUDY INSTITUTION 108

The scientific instructors:
1. Vice Professor.Dr Cong Quyet Thang
2. Vice Professor.Dr Le Thi Viet Hoa

Reviewers:
1.
2.
3.
The project will be demonstrated with the institutional council

examiners at
THE SCIENTIFIC AND MEDICAL STUDY INSTITUTION 108

at

....... ................. ............ 2021

The project can be mentioned at:
1. The national Library of Vietnam
2. The library of
INSTITUTION 108

THE SCIENTIFIC AND MEDICAL STUDY


1

INTRODUCTION
Thanks to the development of modern medicine, the job of taking
care of people’s health is increasing so that the average longevity is
higher too. Whereas, in Vietnam as well as in many other countries, the
rate of elderly patients who need external medicine intervention is
rising. Besides, there is the rise of chronic diseases such as high blood
pressure, heart failure, COPD,… That leads to a high rate of strokes and
complications during the anesthesia and surgery of elderly people.
There are some emotionless methods in surgery, however, the
method of anesthesia with the internal alveolus is still chosen for big
surgery which is related to a lot of organs with long time such as
abdominal surgery....
This is the emotionless method with such advantages, especially in

the case of needing to control the moving blood and respiration of the
patients. However, the job of putting the internal alveolus pipes and
breathing machine during the anesthesia will impact the breathing
system because the ventilating in the machine is completely different
from natural breathing.
The more time you use the breathing machine, the more changes
will happen and this is the element which may cause complications in
breathing after the surgery of the patients.
With other elements such as using the medicine in the opioid
family, stretching muscles, this will lead to the hurt of the muscles in
abdominal muscles, combining-side muscles because of the surgery ….
These are the main reasons for complications in breathing. Any
breathing complication can cause the lack of oxygen and increase CO2
in the blood system, decreasing the number of the functions in breathing
such as the volume of moving air, the volume of crusted air, ….
A lot of methods which have been studied and applied to reduce the
danger of collapsing lungs during the artificially ventilating. The above
methods have been studied by a lot of scientists and have given good
results in preventing collapsing lungs in anesthesia with the internal
putting alveolus and artificial ventilation, especially with long-time


2

surgery or with the danger of high collapsing lungs.
Controlling the pressure in order to open lungs has been studied,
with the opening pressure of +40 cmH2O which shows the ability of
good alveolus, it helps to increase the rate of alveolus in participating in
exchanging air. As well as that, maintaining the level of PEEP
+5cmH2O will help to mobilize alveolus by controlling the pressure

better in the process of using a machine to breathe. Mobilizing alveolus
by pressure and other methods all influence the patients but it is not
very clear, especially with elderly people.
In Vietnam, the methods of mobilizing alveolus (HĐPN) in
anesthesia have been studied. Therefore, we study the above methods
with the following aims:
1. Evaluating the changing of numbers in pressure of the blood
artery and mechanical lungs when applying the method of mobilizing
alveolus combined with PEEP +5cmH2O in abdominal anesthesia
surgery of elderly people.
2. Comparing the changing of the numbers in pressure of the
blood artery and mechanical lungs between the 2 groups with and
without mobilizing alveolus combined with PEEP +5cmH2O in
abdominal anesthesia surgery of elderly people.
3. Investigating some unexpected uses in the circulation and
respiration of the method of mobilizing alveolus combining with
PEEP +5cmH2O in anesthesia surgery in the abdominal of elderly
people.


3

Chapter 1
Overall
1.1 Anatomizing the respiration system
1.1.1 Anatomizing the respiration system
1.1.2 Mechanical respirations
1.1.3 Moving and exchanging air
1.1.4 The change in respiration of elderly people
1.2 The influence of anesthesia-surgery abdominal on respiration

1.2.1 Abdominal Surgery
1.2.2 The influence of anesthesia on respiration
1.2.3 The mechanism causing the collapse of lungs in anesthesiasurgery
There are a lot of different points of view in explaining the
mechanism of the collapsing lungs in anesthesia-surgery but there are 3
main types of mechanism which are most accepted: absorption
mechanism, compression mechanism and the mechanism of reducing
the surfactant. [35], [67], [125]
1.2.3.1 Absorption mechanism
Collapsing lungs because of absorption appears more often with
anesthesia patients with two factors. They are the increasing of blood
oxidizing and reducing the rate of exchanging air-perfusion (V/Q).
When the patients experience the duration of anesthesia, they are
usually set up the maximum oxygen mode (100%) before setting up the
artificial respiration [100]. [19], [94].
The second mechanism of the collapsing lungs is the low V/Q rate.
Basically, arteries are absorbing oxygen more quickly than the little
alveolus which are supplying air. This can happen easily in breathing
pipes which are limited or blocked. FRC continues to reduce more
when patients are lying face up [60], [95].
1.2.3.2 Compression mechanism
Collapsing lungs because of compression appears when the
pressure at pleura is higher than the pressure inside the lungs, and the
alveolus cannot maintain the open status longer. The anesthesia patients
are so sensitive with this kind of collapsing lungs for lots of reasons.


4

When lying face up, the anesthesia patients will have increasing

pressure at pleura because the weight of the organs inside the abdominal
is against the horizon muscles and the weight of the patients’ chests.
The both mechanisms have significant meanings in collapsing lungs
when being compressed [46]. [55], [61], [62].
1.2.3.3 Reduced Surfactant
The last mechanism of collapsing lungs is reducing the surfactant
in the alveolus sides. The surfactant is produced by the pneumocystis
cells type 2, it reduces the stretching surface and helps to increase the
ability of lungs stretching. When the surfactant reduces, the alveolus
will have a lot of difficulty in closing-opening, and when they close, it
will hardly be open again.
The appearance of collapsing lungs is the important element in the
illness mechanism of complications about lungs after surgery such as
the reduction of oxidizing blood, infected lungs and the reaction of
inflammation. The complications of infected lungs after surgery in the
first 4 hours are the main causes of the collapsing at the positions
belonging to lungs [54], [103].
1.2.4 The strategy of reducing complications after surgery
1.3 The method of mobilizing alveolus
1.3.1 Definition
1.3.2 History
1.3.3 Methods of mobilizing alveolus
* Mobilizing alveolus with the pressure +40 cmH2O
Mobilizing alveolus with the continuous pressure 40 cmH2O in a
period of 40 seconds. This method has been proved that it is effective to
improve oxidizing blood, easy to put in clinical practice and safe. After
mobilizing alveolus, we move to the method of breathing before
mobilizing alveolus.
Watching: Before, during and after the surgery, watch the artery, SpO2
and the electrocardiogram [1], [92].

Get again the X-ray of the lungs after the technique in order to
check the complications of spilling the air pleura, mediastinum. The
films should be made at least 15 minutes after the mobilizing alveolus.


5

Blood test should be done before and after 15 minutes and 3 hours
after mobilizing alveolus.
The activity of the breathing machine, pressure of pipes, volume.
1.3.4 Assignment
1.3.5 Anti-assignment
1.3.6 The time of mobilizing alveolus
1.3.7 Complications of mobilizing alveolus
1.4 Some studies about mobilizing alveolus
1.4.1 The study of mobilizing alveolus in the world
1.4.2. The study of using mobilizing alveolus in Vietnam

Chapter 2
THE OBJECTS AND METHODS OF STUDYING
2.1 The objects of the study
2.1.1 The standard of selecting patients:
The patients who are 60 years old or over 60 who are assigned to
have open abdominal surgery.
The whole body anesthesia with internal alveolus and artificial
breathing.
Type of health ASA 1-3
The duration of anesthesia is 120 minutes or over
Body mode number BMI less than 30kg per square metre
The patient agrees to do it.

2.1.2 The standard of refusing
Remove the patients who have one of the following standards:
Chronic respiration: COPD (Type GOLD III or IV), serious or
unable controlling asthma.
Used to have lung surgery before.
The X-ray of lungs has unusual pictures, injured lungs.
Lung cancer
Deformed chest and chest diseases


6

Serious nerve diseases
Traumatic brain injury, increasing internal skull
Serious heart failure (Type III, IV)
Instant coronary artery syndrome
Patients with arrhythmia
Patients with kidney failure who have regular dialysis
Patients with infected strokes or bleeding strokes
Patients with the history of allergy to anesthesia medicine,
stretching muscles medicine, and opioids.
2.1.3 The standard of removing out of the study
The cases with strokes in surgery have to be moved to the positive
recovery units with a breathing machine for more than 24 hours.
2.2 The method of the study
2.2.1 The study design
Study-intervene random objects with comparison.
2.2.2 The size of the study model
The size of the model is assigned: n1 = n2 ≥ 37
Group 1: The ‘intervention’ with artificial breathing as well as

controlling volume and carrying out the study of mobilizing alveolus
with the pressure + 40cmH2O in 40 seconds and maintaining the level
PEEP +5cmH2O.
Group 2: The ‘opposite’ with artificial breathing as well as
controlling volume with the beginning setting up mode during the
surgery.
2.2.3 The time and the place of the study
* The place of the study: Anesthesia-Recovery Department, Huu Nghi
Hospital.
* The time of the study: From October 2016 to October 2019
2.2.4 Means of the study
2.2.5 The Procedure
2.2.5.4 The procedure of mobilizing alveolus with machine Avance
CS2
After the patients have the average blood pressure higher than


7

65mmHg, mobilize alveolus with the procedure of using Vital Capacity
with breathing machine Avance CS2.
+ Step 1: Choose menu Procedures on the right tab of the screen.
Choose Vital Capacity on the window.
+ Step 2: Establish the number to carry out:
- Pressure Hold: Pressure to keep opening lungs at 40cmH2O
- Hold Time: The time to keep the pressure of opening lungs 40
seconds.
- PEEP on Exit: The level PEEP after mobilizing lungs 5cmH2O
+ Step 3: Touch Start Vital Capacity in order to run the program.
The lungs will be pumped with the setting up pressure, time then return

to level PEEP chosen and continue ventilating for the patients as usual.
+ Step 4: Repeat the procedure every 60 minutes.
At the moment of ‘mobilizing alveolus’ by keeping the pressure of
breathing pipes at +40cmH2O, PEEP constantly +5cmH2O and
maintaining in 40 seconds. This procedure will be repeated after every
60 minutes until the surgery finishes.

Screen 2.4. The procedure of mobilizing alveolus
2.2.6 The number of the study
2.2.6.1 The main aims
Changing mechanical lungs
- Changing the exhaling volume (TVexp).


8

- Changing the pressure of breathing pipes before and after
mobilizing alveolus: Pmean, Ppeak, Plat.
- Changing the stretching of lungs (Compliance).
- Changing the exhaling ventilation (Mvexp).
- The number of times to mobilize alveolus: Group mobilizing
alveolus.
* The changing of substance in blood artery:
- Changing PaO2
- Changing the rate PaO2/FiO2
- Changing PaCO2
- Changing pH blood
- Changing HCO32.2.6.2 Influence on circulation, respiration and unexpected
symptoms.
- Changing about moving blood: Heart frequency (times/minute),

HATT (mmHg), HATTr (mmHg), HATB (mmHg).
- Changing SpO2 (%)
- Taking notes all the unexpected effects related to artificial
ventilation with the both groups:
+ Pressure Injury: Spilling air pleura, spilling air mediastinum,
spilling air under skin.
+ Moving blood: Going down pressure, slow heart frequency,
disordered heart frequency.
+ Respiration: Reducing the level of oxygen saturation bouncing
artery (SpO2%)
2.2.6.3 The general standards of the patients
* Characteristics of the two groups before surgery
- Age (year),
- Sex (male/female),
- Health (ASA),
- The BMI number = weight/(height)2,
- History of the patient
- Temperature
- Breathing frequency (beat/minute)


9

- Central Vein Pressure (CVP): cmH2O
Subclinical: Measuring the ventilatory lúng, X-ray the core lungs
straight, blood formula: red blood cells, white blood cells, platelets ,
Hemoglobin.
* Characteristics of Anesthesia and Surgery
- Surgical Organs.
- Anesthesia time (minute)

- Surgery time (minute)
- Medicine using during anesthesia
- Changing the concentration of the least anesthesia gas in alveolus
(MAC).
- Changing the concentration of exhaling CO2 (EtCO2).
2.2.7 The moment of collecting data
2.2.8 Some standards and definitions
2.2.9 Handling data
2.2.10 Morality in the study
2.2.11. The study charts


10

Chapter 3
THE RESULT OF THE STUDY
3.1 General characteristics
3.1.1 General characteristics of the patients
3.1.2 Clinical-subclinical characteristics before surgery
3.2. Ventilating characteristic and mechanical lungs in mobilizing
alveolus
3.2.2 Changing the volume of exhaling breathing air before and
after mobilizing alveolus

Chart̀ 3.3: Changing of Tvexp after times of mobilizing alveolus
Comments: With 6 times of mobilizing alveolus, the average value of
exhaling volume (TVexp) after mobilizing alveolus is higher than that
before mobilizing alveolus. With the 5 previous times, the difference
has its meaningful statistic p < 0.01.
3.2.6 Changing of stretching lungs after mobilizing alveolus

Chart 3.4: Changing of stretching lungs after mobilizing alveolus


11

Comments : After mobilizing alveolus, the level of stretching lungs is
higher than that before the time of mobilizing alveolus.
3.3 Changing the mechanical number of lungs in the two anesthesia
groups
3.3.1 Changing the volume of the exhaling air of the two groups
3.3.2 Changing the stretching lungs of the two groups

Chart 3.5: Changing compliance of the two groups in anesthesia
Comments: The average value of the Compliance at the moment before
mobilizing alveolus in the ‘opposite’ group and ‘intervention’ group is
similar with p>0.05. After mobilizing alveolus, the Compliance of
‘intervention’ group is higher than the other one with
p < 0.01.
3.4 Changing the number of blood air artery
3.4.1 Changing the number PaO2 of the both groups

Chart 3.6: Changing PaO2 of the both groups


12

Comments: The number PaO2 at the moment after mobilizing alveolus
5 minutes and before finishing breathing machine is higher than that
before mobilizing alveolus. This improvement has its meaningful

statistic with
p < 0.05.
3.4.2 Changing the rate PaO2/FiO2 of the two groups

Chart̀ 3.7: Changing P/F of the two groups in anesthesia
Comments: The average rate PaO2/FiO2 at the moment after mobilizing
alveolus 5 minutes is higher than that before mobilizing alveolus has its
meaningful statistic with p < 0.01.
3.5 Influence on circulation, respiration and unexpected
symptoms.
3.5.1 Changing in moving blood
* Changing average blood pressure in mobilizing alveolus

Chart 3.11: Changing average blood pressure in mobilizing alveolus
Comments: The moment after mobilizing alveolus, the average blood
pressure reduction has its meaningful statistic compared with that before


13

mobilizing alveolus. The difference in blood pressure at the three
moments above has their meaningful statistic with p<0.05.
3.5.3 Unexpected effects of the two groups


14

Chapter 4
COMMENTS
4.1 General characteristics

4.1.1 General characteristics of the patients
* Age, BMI.
The average age of the ‘intervention’ group is 74.58 ± 8.45, the
highest is 94 and the lowest is 61. The average age of the ‘opposite’
group is 76.35 ± 9.46, the highest is 96 and the lowest is 60. The
average age of the study objects in our study is similar to the study
results of Ngo Minh Diep [4], who carried out the study of abdominal
surgery with elderly people at Huu Nghi Hospital, which showed the
average age in the study was 72.6 ± 7,4.
Ahsan M. Arozullah [23] with colleagues analyzed the elements in
order to estimate the respiratory failure after surgery. Scientists
analyzed 81719 patients from 44 hospitals, which illustrated
complications of lungs appear with 2746 patients (3.4%). By analyzing
the risk number of respiratory failure from the simplifying model
logistic regression, which showed that there were many factors leading
to respiratory failure after surgery, whereas, people above 70 are more
dangerous 2.6 times, 60 – 69 higher 1.99 times compared with the age
of 50.
David J. Bentrem [30] said, with elderly people, the rate of
catching diseases around surgery is 1.2- 2 times higher and the rate of
death is 2.9 – 6.7 times than young patients. Any kind of surgery,
elderly people are able to have more heart complications such as instant
heart strokes, stopped-beating heart, lung complications such as
infected lungs, congested lungs and respiratory failure and urinary
complications (infected urinary pipes and kidney failure). Chun Kevin
Yang [118] estimated the risk of respiratory complications after surgery
showed that elderly people at 80 or above had to take more risks to
respiratory complications after surgery.
Sandy Y. Kim [64] analyzed from 18 studies showed that the rate
of death after pancreas surgery was 2 times higher than with people at

80 or above and had more risks of lung complications with OR 1.72.


15

4.2 Characteristics of ventilation and mechanical lungs in
mobilizing alveolus
During the study, we selected the level Vt= 6ml/kg, PEEP =
+5cmH2O, the duration of mobilizing alveolus with the pressure
+40cmH2O in 40 seconds. The duration of mobilizing alveolus was
repeated every hour in the anesthesia. The duration of mobilizing
alveolus with the pressure +40cmH2O in 40 seconds is the duration
which was applied to a lot of studies for patients with lung injury and
needed breathing machines. The duration has been approved to be
familiar with mobilizing alveolus patients who use breathing machines
to recover. However, in anesthesia, this process hasn’t been applied
much. We choose the pressure for opening lungs is 40cmH2O, which is
based on a lot of studies, whereas one is the study of the scientist called
H. U. Rothen [92], it was declared on British Journal of Anesthesia. He
evaluated the ability of opening lungs with different levels of pressure
and showed the square of collapsed alveolus was 6.4cm2 at the helping
pressure Paw = 0cmH2O, the square of collapse alveolus was 5.9cm2 at
the pressure 20cmH2O, the square of collapsed alveolus was 3.5cm2 at
the pressure 30cmH2O and reduced to 0.8 cm2 ở 40cmH2O. Therefore,
the pressure of +40cmH2O helped the best to open lungs with the square
of collapsed alveolus reducing to nearly zero. With another study of
H. U. Rothen, he showed that the pressure +40cmH2O helped to
open lungs well, the square rate of collapsed alveolus reduced
gradually according to the maintaining pressure, the square rate of
collapsed alveolus reduced gradually until the 26th second.

* Choosing level PEEP
In our study, we choose the PEEP level +5cmH2O for both
groups. Whereas, the PEEP level is maintained during the process after
putting internal alveolus until taking out. This is the most selected
PEEP level by scientists. For example, T. Bluth chose the PEEP
level for overweight patients with BMI ≥ 35 as
4cmH2O. Ana Fernandez-Bustamante [43] chose the PEEP level
maintained in the study was +5cmH2O for the three groups.


16

Dr H.U. Rothen [92] showed the PEEP level +30cmH2O helped
improve the collapsed alveolus in anesthesia, however, when repeating
the times of mobilizing alveolus with the PEEP level +30cmH2O
showed that the rate of collapsed lungs did not reduce anymore. But
when increasing the PEEP level to +40cmH2O, the rate of collapsed
lungs would go down clearly and turn to zero after maintaining the
pressure of mobilizing alveolus +40cmH2O continuously in 8 seconds.
In conclusion, the rate of opening lungs or the rate of reducing
collapsed alveolus were proportional with the mobilizing pressure and
the time using to mobilize alveolus.
The strategy of ventilation to protect lungs is applied to a lot of
surgery, the process of anesthesia and surgery with one ventilating lung
which is also effective. The study of MiHye Park [88] showed that
ventilation with low Vt and using PEEP to mobilize alveolus have less
complications compared with normal ventilation.
Changing the level of Compliance after mobilizing alveolus
According to Table 3.16 and chart 3.4, we see that the level of
stretching lungs before and after mobilizing alveolus has some

differences.
The Compliance at the later time was higher than the former
one at the moments of mobilizing alveolus. The difference has its
statistic with p < 0.01.
According to Pereira [89], when analyzing the influence of PEEP
based on the compliance in internal surgery and abdominal open
surgery, he analyzed and compared between the group using stable
PEEP
+4 cmH2O and the group using optimal PEEP under the evaluation of
CTR. Analyzing on the internal surgery group, the level of compliance
the stable PEEP +4 cmH2O changed from 33.5 ± 8.1 at basic level
compliance went up at 77.1 ± 14.0 in the process of mobilizing alveolus
and went down to 39.6 ± 7.2 when finish the optimal process. With the
optimal PEEP, the compliance went up from 37.7 ± 9.7 when being
mobilized to 75.3 ± 8.6 and maintained at 67.6 ± 6.7 when finishing the
process.Similar to the internal surgery, the open abdominal surgery had


17

the same results, the group using PEEP +4 cmH2O had the level of
changing compliance respectively in the process of mobilizing was
42.1 ± 15.7 at the basic level increasing to 75.9 ± 18.0 when mobilizing
and reduced when finishing the process, it was 48.8 ± 13.2. The group
using optimal PEEP showed that the compliance changed from 43.5 ±
7.9 to 71.9 ± 15.7 and maintained at 66.2 ± 14.2. The optimal PEEP
assigned in internal surgery was +12 and abdominal open surgery was
+10.
Changing compliance of the two groups
Based on the results of Table 3.19 and Chart 3.5, after

mobilizing alveolus, the level of Compliance of the ‘intervention’ group
is higher than the ‘opposite’ group, the difference has its meaningful
statistic with p < 0.01.
Dr D. Aretha [22] analyzed and compared between the two
groups with and without mobilizing alveolus on the maternity patients.
The results were evaluated for changing mechanical lungs with the level
compliance during the anesthesia process. The data was noted at the
moments before mobilizing alveolus, after 3 minutes, after 10 minutes
and 20 minutes. The results of the study showed that mobilizing
alveolus helped improve the compliance remarkably compared with the
group which didn’t use mobilizing alveolus. Before mobilizing
alveolus, the compliance of the two groups was similar to 33.6 ± 6.8,
with the group using mobilizing alveolus was 31.1 ± 7.9 at ‘opposite’
group. After mobilizing alveolus, the compliance of mobilizing group
increased clearly and the difference has its meaningful statistic in
comparison with the group without mobilizing alveolus at the moments
3 minutes after mobilizing alveolus, the compliance of the mobilizing
group was 51.5 ± 12.8 comparing with 29.6 ± 7.2, at the moment of 10
minutes the compliance of mobilizing group was 49.9 ± 11.2 comparing
with 30.6 ± 8.1 at ‘complications’ group and at the moment of 20
minutes the compliance of mobilizing group was 45.0 ± 9.8 comparing
with 31.6 ± 8.8 at ‘opposite’ group.
Changing the level of mechanical lungs of the two groups in
anesthesia


18

From the results in Table 3.18, we have the results of the
changing volume of exhaling air of the both groups. The moment after

mobilizing alveolus, TVexp of ‘intervention’ group is 456.3 ± 61.2
ml/time, it is higher than ‘complications’ group with 405.43 ± 91.36
ml/time and higher than the moment before mobilizing 409.2 ± 66.9
ml/time.
According to Table 3.20 in our study, there is no difference
between the two groups in the number Ppeak at the moments during the
process of anesthesia with p > 0.05.
In the study of D. Aretha [22], the top pressure Ppeak reduced
at mobilizing group, pressure before mobilizing was 24 cmH2O went
down to 20 cmH2O. The reducing has its statistic. Therefore, our results
are different from those of the scientist. We see that the pressure has
changed but only a little and it doesn’t have its meaningful statistic
between the two groups. There is the difference maybe because of the
difference between the two methods. The scientist used the PEEP level
increasing step by step to mobilize alveolus while we used high
pressure continuously. Therefore, the pressure of patients’ breathing
pipes in the scientist’s study would have some changes with the PEEP
level. The studies with PEEP level increasing gradually in order to
mobilize alveolus often have the level Ppeak which increases gradually
and the limited of Ppeak is high.
4.2.1 Changing the air blood level in artery
Based on Table 3.22 and Chart 3.6, we find that the index
number PaO2 of ‘intervention’ group is 207.5 ± 17.99 mmHg which is
higher in statistic than the ‘opposite’ group, 9.4 ± 6,5 mmHg at the
moment after the first time mobilizing alveolus 5 minutes. This is the
time which has the most difference about PaO2 between the two
groups. Moreover, after taking out the internal alveolus pipes for 30
minutes, the PaO2 of ‘intervention’ group is higher than the ‘opposite’
group with the difference of p<0.01.
Our study results are similar to those of the scientist Nguyen

Trung Kien[81]. In Nguyen Trung Kien’s study the PaO2 before
surgery of the two group is similar with the PaO2 of ‘intervention’


19

group was 86 mmHg and ‘opposite’ group was 84 mmHg.After
pumping CO2 to creat surgery scene 1 hour, the PaO2 of ‘intervention’
group was 207 mmHg and ‘opposite’ group was 189 mmHg, after oneday surgery, the PaO2 ‘intervention’ group was 98 mmHg and ‘opposite
group was 91 mmHg. As it shown, in the study, when there is
mobilizing alveolus, the index PaO2 will be improved for patients,
however, the improving level shows that the difference almost at the
moment of mobilizing, after mobilizing, the one reduces gradually.In
the study, we evaluate PaO2 right after taking out the internal pipes 30
minutes so the difference is bigger than the one the scientist who
evaluated 1 day after the surgery. However, the difference still shows
that mobilzing helps improve breathing function for patients, although
there are a lot of other influences on surgery such as controlling the pain
after surgery.
* Changing the rate P/F of the two groups
Based on the results of Table 3.23 and Chart 3.7, the average rate
PaO2/FiO2 at the moment after mobilizing 5 minutes is higher with
meaningful statistics than that before mobilizing, with < 0.01. The time
finishing breathing machine and taking out the internal alveolus pipes,
the P/F of ‘intervention’ group is higher than before mobilizing, the
meaningful difference with p<0.05. After mobilizing 5 minutes, the P/F
of ‘intervention’ group is higher than that of ‘opposite ‘group, the
meaningful difference with p<0.01. At the moment of finishing the
breathing machine and after taking out the internal alveolus pipes 30
minutes, the P/F of ‘intervention’ group is higher than that of ‘opposite’

group with p<0.05.
Sowoon Ahn analyzed the influence of mobilizing on the index
of blood oxidizing of patients during the anesthesia process, with 60
patients participating in the study who were mobilized alveolus with
pressure 40 cmH2O in 40 seconds. The index PaO2 was analyzed and
evaluated before and after mobilizing. As a result, after mobilizing, the
index PaO2 improved more clearly in ‘intervention’ group than
‘opposite’ group, detail at the time 10 minutes after mobilizing, the
PaO2 of ‘intervention’ group is 219 ± 33 mmHg comparing with 193 ±


20

35 mmHg of ‘opposite’ group. At the time of 60 minutes after
mobilizing the PaO₂ of ‘intervention’ group is 214 ± 42 mmHg
compared with 188 ± 41 mmHg at ‘opposite’ group. Therefore, the
mobilizing with pressure 40 cmH2O in 40 seconds helps improve the
blood oxidizing level.
4.3. Influencing on circulation, respiration and unexpected
symptoms.
4.3.1 Changing in moving blood
* Changing in heart frequency when mobilizing alveolus
According to Table 3.29 and Chart 3.9, heart beat at the moment
after mobilizing alveolus 1 minute is lower than that before mobilizing.
After 5 minutes mobilizing alveolus, the heart beat comes back similar
to the level before mobilizing. The least heart frequency is 63 times per
minute and the highest is 94 times per minute. There is no difference in
heart frequency at the three moments with p > 0.05.
According to the study results of András Lovas [70] and his
colleagues to evaluate the influence of mobilizing alveolus on

circulation showed that the heart frequency has little change when
mobilizing alveolus, however, the results showed that the process of
mobilizing alveolus often reduced heart beat and was the first causes of
its influence on nerve system X, since then that would lead the
influence on heart beat and heart frequency often reduced. It was also in
his study, there were other scientists found that heart beat could go up
during the mobilization, but the reasons were estimated to increase heart
beat was the reaction of CO changing process in mobilizing alveolus.

* Changing the average blood pressure in mobilizing alveolus group
From the results at Table 3.31 and Chart 3.11, the moment
after mobilizing, the average blood pressure has meaningful statistics
before mobilizing. The moment 5 minutes after mobilizing, the average
blood pressure increases more than that at the moment right after
mobilizing. The difference in average blood pressure at the three
moments above has meaningful statistics with p < 0.05.


21

The analysis of András Lovas in mobilizing alveolus on blood
pressure showed that the mobilizing process had influenced a lot on the
left heart volume. Analyzing animals showed that it reduced the volume
of left ventricles at the end of the diastole period. This related tightly to
the changing previous factors which was the result of positive pressure
in the chest for a long time.


22

IN CONCLUSION
After study 82 patients who had open abdominal surgery,
whereas there were 45 patients belonged to ‘intervention’ group and 37
patients of ‘opposite’ group, we conclude that:
1. Effects on Blood air in arteries
- The method of mobilizing alveolus with pressure +40 cmH2O
in 40 seconds is able to increase blood oxidization.
- The PaO2 of ‘intervention’ group after is higher than before
mobilization, in detail: After mobilizing 5 minutes (207.5 ±
17.99mmHg comparing with 167.8 ± 14.34mmHg; p < 0.01) ; before
finishing breathing machine (181.4 ± 12.3 mmHg so với 167.8 ±
14.34mmHg, p < 0.05).
- The rate PaO2/FiO2 of ‘intervention’ group after is higher
than before mobilizing alveolus, in detail: after mobilizing alveolus 5
minutes (397.27 ± 26.9 mmHg comparing with 358.7 ± 17.88mmHg; p
< 0.01); before finishing breathing machine (369.47 ± 20.0 mmHg
comparing with 358.7 ± 17.88 mmHg; p < 0.05); after taking out
internal breathing pipes (373.8 ± 22.47 mmHg comparing with 358.7 ±
17.88 mmHg; p < 0.05).
There is no difference about the index level pH, HCO3- between
the two groups at the moment of study.
2. Effects on improving mechanical lungs
- The volume of exhaling air of ‘intervention’ group is higher
than with meaningful statistic than that of ‘opposite’ group at the
moment of mobilizing alveolus (456.3 ± 61.2ml comparing with 405.43
± 91.36ml, p< 0.01).
- There is difference between the two groups ‘intervention’ and
‘opposite’ (52.4 ± 4.9 ml/cmH2O in comparison with 45.1 ±3.0
ml/cmH2O, p < 0.01) at the moment of mobilizing alveolus.
There is no difference among the numbers of mechanical lungs

such as Pplat, Ppeak, MV of the two groups at the moment of study.
3. . Influencing on circulation and unexpected symptoms


23

- The major unexpected symptom is low blood pressure (with
44.44%), however this low blood pressure recovers immediately as
soon as stopping the technique and there is no bad effects on the
patients or during the surgery.
- Some other unexpected symptoms are slow heart beat with
6.67%, disordered heart beat with 4.44%.