Risk factors for complications of respiratory insufficiency after major abdominal surgery, especially upper abdominal surgery Postoperative pulmonary atelectasis, pneumonia, and complications such as asthma are one of the major factors in postoperative patient mortality and must be given high priority. Risk factors for pulmonary complications after major abdominal surgery include: i. Preoperative combined chronic respiratory disease, or old and frail, poor respiratory function, or a long history of smoking. Second, the upper abdominal surgery is traumatic and prolonged, the trachea makes increased secretions, and the surgery requires incision of the diaphragm or pleura. III. Intratracheal tube stimulation during anesthesia and incomplete intraoperative aspiration. Fourth, postoperative pain restricts activities and deep breathing, which affects effective sputum excretion and leads to incomplete lung expansion and reduced lung capacity. V. Postoperative wound pain often makes patients afraid to breathe deeply and cough, causing sputum to gather in the trachea and bronchi resulting in pulmonary atelectasis, which is easily complicated by pneumonia or even pulmonary sepsis. Therefore, preoperative pulmonary function exercise and smoking cessation in patients undergoing major abdominal surgery are beneficial for patients to correctly master the method of coughing up sputum after surgery, rapidly restore pulmonary function after surgery and reduce the occurrence of pulmonary complications. Pre-operative pulmonary physiotherapy is an effective way to increase pulmonary complications in elderly and frail patients, long-term smokers, and patients with chronic pulmonary insufficiency who undergo major upper abdominal surgery. Preoperative respiratory exercise is an effective way to increase the patient’s lung capacity and reduce complications. I. Thoracic breathing training: The patient is trained to inhale slowly from the nose to expand the thorax, and then exhale slowly from the mouth. Second, abdominal breathing training: the patient is in a supine, semi-recumbent or semi-sitting position, both knees gently bent, so that the abdominal muscles are relaxed, one hand on the sternal stalk to control the rise and fall of the chest, the other hand on the umbilicus, to feel the degree of abdominal bulge and help the abdominal muscles contract when breathing. After deep inhalation of the abdomen slowly bulge, hold the breath for about 2 seconds, then retract the lips and exhale slowly, the exhalation time is twice as long as the inhalation time. C. Coughing exercise training: Patients can adopt a sitting or semi-recumbent position, press the palm of the hand lightly against the chest, and when coughing with hand support, teach the patient to do a deep inhalation, cough from the deep part of the lungs; after three consecutive short inhalations, cough 1. IV. Simple balloon blowing exercise. The patient inhales deeply and then blows the balloon as big as possible, once every 2 hours. V. Cough training: The nursing staff stands on the patient’s side of the operation, puts one hand lightly on the patient’s shoulder, and the other hand gently closes the five fingers to form a hollow shape to rhythmically snap the patient’s back from bottom to top, and instructs him/her to cough after deep inspiration. VI. Quit smoking for 1 to 2 weeks before surgery and treat lung inflammation.