文章摘要
个体化PEEP对腹腔镜手术后肺部并发症影响的Meta分析
Effect of individualized PEEP on postoperative pulmonary complications during laparoscopic surgery: a meta-analysis
  
DOI：10.12089/jca.2023.08.012
中文关键词: 腹腔镜  肺保护性通气  呼气末正压  术后肺部并发症  Meta分析
英文关键词: Laparoscopy  Lung-protective ventilation  Positive end-expiratory pressure  Postoperative pulmonary complications  Meta-analysis
基金项目:湖北省技术创新专项重大项目（2019ACA167）
作者单位E-mail
陈鸣 430022,武汉市,华中科技大学同济医学院附属协和医院麻醉科  
马嘉敏 430022,武汉市,华中科技大学同济医学院附属协和医院麻醉科  
姚尚龙 430022,武汉市,华中科技大学同济医学院附属协和医院麻醉科 yaoshanglong@hust.edu.cn 
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中文摘要:
      
目的 评价术中采用个体化呼气末正压（PEEP）对腹腔镜手术后肺部并发症（PPCs）的影响。

方法 检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、维普，收集腹腔镜手术中使用个体化PEEP的随机对照试验（RCT），检索时间为建库至2022年1月。采用RevMan 5.4软件进行Meta分析。

结果 共纳入15篇RCT研究，共计患者917例，个体化PEEP组460例，对照组457例。与对照组比较，个体化PEEP组PPCs发生率明显降低（RR=0.27，95%CI 0.14～0.51，P<0.001），驱动压明显减小（MD=-3.06 cmH2O，95%CI -3.38～-2.23 cmH2O，P<0.001）。两组生理无效腔、MAP、血管活性药物、住院时间差异无统计学意义。

结论 与固定PEEP或呼气末零压通气比较，腹腔镜手术中应用个体化PEEP可降低PPCs发生率，同时不增加血流动力学紊乱的风险。
英文摘要:
      
Objective To evaluate the influence of individualized positive end expiratory pressure (PEEP) in laparoscopic surgery on postoperative pulmonary complications (PPCs).

Methods PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, and VIP were searched to collect randomized controlled trials (RCTs) using individualized PEEP in laparoscopic surgery from the date of database establishment to January 2022. Meta-analysis was performed using RevMan 5.4 software.

Results A total of 15 RCTs were included, with a total of 917 patients, 460 patients in the individualized PEEP group and 457 patients in the control group. Compared with the control patients, the individualized PEEP group had a reduced risk of PPCs (RR = 0.27, 95% CI 0.14 to 0.51, P < 0.001) and a reduced driving pressure (MD = -3.06 cmH2O, 95% CI -3.38 to -2.23 cmH2O, P < 0.001). There were no significant differences between the two groups in terms of physiological void chamber, MAP, vasoactive drugs, and length of stay.

Conclusion Compared with fixed PEEP or zero added PEEP, individualized PEEP in laparoscopic surgery was associated with fewer PPCs without increasing the risk of hemodynamic disturbance. However, more large-scale randomized clinical trials are needed to confirm this result．
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