Abstract: Objective To analyze the predictive value of diaphragmatic mobility combined with diaphragmatic thickening rate in assessing diaphragmatic motion recovery during the awakening period of general anesthesia patients. Methods A retrospective study was conducted on 519 patients under general anesthesia who underwent elective non-thoracic or non-airway surgeries at our hospital between July 2021 and August 2025. According to different methods of extubation evaluation, they were divided into group A （285 cases were extubated based on ultrasound evaluation of diaphragm mobility and diaphragm thickening rate） and group B （234 cases were extubated based on clinical signs）. The incidence of adverse events during awakening period was compared between the two groups. Patients in group A were divided into a poor recovery group and a good recovery group with adverse events during awakening period as the outcome variable. The absolute difference in diaphragmatic mobility and diaphragmatic thickening rate at extubation （T2） and before anesthesia induction （T1）, expressed as “△”, along with confounding factors, were included in the models to determine whether △_T2-T1 diaphragmatic mobility and △_T2-T1 diaphragmatic thickening rate were independent risk factors for impaired diaphragmatic motion recovery during the post-anesthesia awakening period in general anesthesia patients, thereby evaluating the combined predictive value of these two parameters for diaphragmatic motion recovery. Results The incidence of adverse events in group A was lower than that in group B （P<0.05）. The dosage of muscle relaxants, △_T2-T1 diaphragmatic mobility, and △_T2-T1 diaphragmatic thickening rate were the independent influencing factors of adverse events of diaphragmatic motion recovery in awakening period （P<0.05）. The optimal cut-off values of △_T2-T1 diaphragmatic mobility and △_T2-T1 diaphragmatic thickening rate for predicting adverse events in patients undergoing general anesthesia were 3.8 mm and 6.3%. The area under the receiver operating characteristic （ROC） curve （0.911） predicted by the combination was greater than that predicted by either method （0.860 and 0.871）, with a sensitivity of 0.896 and a specificity of 0.925. Conclusion The combination of △_T2-T1 diaphragmatic mobility and △_T2-T1 diaphragmatic thickening rate based on diaphragmatic ultrasound assessment can effectively predict the risk of poor diaphragmatic motion recovery in patients who reach the diaphragm function ultrasound extubation criteria. For patients with △_T2-T1 diaphragmatic mobility ≥3.8 mm and △_T2-T1 diaphragmatic thickening rate ≥6.3%, postoperative respiratory monitoring should be strengthened to timely intervene potential risks and reduce the occurrence of adverse events.

Key words: Diaphragmatic mobility, Diaphragmatic thickening rate, General anesthesia recovery period, Diaphragmatic motion recovery, Predict