围手术期个体化呼气末正压通气的研究进展

Research advances in individualized positive end‑expiratory pressure during the perioperative period

全身麻醉手术机械通气过程中可能导致术后肺部并发症(postoperative pulmonary complication,PPC)的发生。由低潮气量、呼气末正压(positive end‑expiratory pressure,PEEP)通气、肺泡复张以及适宜吸入氧浓度组成的肺保护通气策略可以降低PPC的发生率,减轻PPC的严重程度。其中,PEEP可以显著降低全身麻醉手术机械通气时发生肺不张的风险,但是采用不当的PEEP则可能增加机械通气相关肺损伤。文章介绍了5种方法来确定术中个体化呼气末正压(individual positive end‑expiratory pressure,iPEEP),对iPEEP在围手术期的研究进展进行最新概述,以期寻找最适PEEP对机械通气进行指导,从而减轻呼吸机相关肺损伤(ventilator‑induced lung injury,VILI)。

Mechanical ventilation during general anesthesia may lead to postoperative pulmonary complication(PPC).A pul‑monary protective ventilation strategy consisting of low tide volume,positive end‑expiratory pressure(PEEP),and alveolar recruitment can reduce the incidence and severity of PPC.PEEP can significantly reduce the risk of atelectasis during mechanical ventilation under general anesthesia,and inappropriate PEEP may increase lung injury associated with mechanical ventilation.This paper describes five methods to determine individual positive end‑expiratory pressure(iPEEP)during operation,provides an up‑to‑date overview of iPEEP in the perioperative period to find the optimal PEEP for guiding mechanical ventilation and reducing ventilator‑induced lung injury(VILI).