个体化PEEP通气策略对围手术期肺保护、肺不张及血流动力学的影响:系统性评价及荟萃分析

Effect of individualized PEEP ventilation strategy on perioperative lung protection,atelectasis and hemodynamics:A systematic review and Meta-analysis

目的 在全麻患者术中使用不同的方法(电阻抗断层成像、肺部超声、动/静态肺顺应性、驱动压、跨肺压)确定个体化呼吸末正压(PEEP),与传统的固定PEEP相比是否引起肺损伤、肺不张及血流动力学不稳定。方法 计算机检索PubMed、clinicaltrials.gov、Web of Science、Cochrane Library及中国知网,并筛选所有选定文章的参考列表和类似文献,搜索截至2023年1月的所有中英文出版物,使用Revman 5.3软件进行Meta分析。结果 研究了45篇文献,共3 767患者。Meta分析显示个体化PEEP组CC-16浓度、肺部超声评分及肺部并发症发生率与传统PEEP组相比明显降低(P<0.05)。个体化PEEP与术中更高的动态肺顺应性和更低的驱动压有关(P<0.000 01)。同时,个体化PEEP组相较于传统PEEP组对MAP(P=0.13)和HR(P=0.94)差异无统计学意义。结论 与传统PEEP相比,术中使用个体化PEEP增加了患者围手术期肺保护效应,降低了围手术期肺不张的发生率和严重程度。同时,并不引起围手术期血流动力学紊乱。

Objective To study the individualized positive end-expiratory pressure(PEEP)ventilation strategy on perioperative lung protection,atelectasis and hemodynamics in patients under general anesthesia.Methods Computer searches of PubMed;clinicaltrials.gov;Web of Science,the Cochrane Library,and CNKI Academic Journal Databases were conducted for all publications in English and Chinese as of January 2023.The reference lists and similar literature of all selected articles were screened.Meta-analysis was performed using RevMan 5.3 software.Results 45 papers with a total of 3767 patients were studied.Meta-analysis showed there was significantly differences in CC-16 concentrations,lung ultrasound scores,and pulmonary complication rates between individualized PEEP group and the conventional PEEP group(P<0.05).Individualized PEEP was associated with higher intraoperative dynamic lung compliance and lower driving pressures(P<0.00001).However,the individualized PEEP group had no significant effect on MAP(P=0.13)or HR(P=0.94)as compared with the conventional PEEP group.Conclusion Intraoperative use of individualized PEEP increased the perioperative pulmonary protective effect in patients and reduced the incidence and severity of perioperative pulmonary atelectasis.At the same time,it did not cause perioperative hemodynamic instability.