Objective To explore the guiding value of pulmonary ultrasound and diaphragmatic motion indexes in the extubation of elderly patients undergoing artificial pneumoperitoneum laparoscopic surgery under general anesthesia Methods The elderly patients who underwent general anesthesia artificial pneumoperitoneum laparoscopic surgery in Neijiang Second People′s Hospital from October 2020 to January 2022 were selected.The pulmonary ultrasound and diaphragmatic movement indexes, including pulmonary ultrasound score (LUS), mean diaphragmatic thickening fraction (DTF), diaphragmatic mobility (DD) and shallow rapid breathing index (RSBI), were examined before extubation. Patients were divided into success group and failure group according to the success of extubation. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of various indicators for weaning failure.Results A total of 102 patients were included, including 76 cases in the success group and 26 cases in the failure group. DTF and DD in the failure group were significantly lower than those in the success group ［(%:33.673±7.233 vs.45.962±8.725) (mm:11.040±2.163 vs13.340±3.181, all P＜0.05), and LUS and RSBI were significantly higher than those in the success group (16.350±3.452 vs.11.050±2.581) (times·min-1·mm-1:68.814±16.056 vs.57.870±14.829, all P＜0.05).C area under curve (AUC) They are 0.866, 0.707, 0.870 and 0.699 respectively, and DTF and LUS are of greater predictive value. When the optimal critical value of DTF was 41.3%, the sensitivity and specificity of predicting successful extubation were 72.4% and 84.6%, respectively; When the optimal critical value of LUS is 14 points, the sensitivity and specificity of predicting successful extubation are 84.2% and 84.6%, respectively. Multivariate logistic regression analysis shows that DTF and LUS are independent risk factors for extubation failure. Conclusion LUS, DTF, DD, and RSBI are closely related to the results of extubation/disembarkation in elderly patients with laparoscopic surgery, and LUS and DTF have higher clinical value in predicting extubation/disengagement failure