个体化呼气末正压对需要气腹并采用头低脚高位患者术中氧合及术后肺部并发症的影响：一项系统评价和Meta分析

Effects of individualized positive end-expiratory pressure on intraoperative oxygenation and postoperative pulmonary complications in patients requiring pneumoperitoneum with Trendelenburg position: a systematic review and meta-analysis.

作者信息

Gao Lingqi, Zhang Bingyan, Qi Jiazheng, Zhao Xu, Yan Xiaojie, Li Bing, Shen Jingjing, Gu Tingting, Yu Qiong, Luo Mengqiang, Wang Yingwei

机构信息

Department of Anesthesiology, Huashan Hospital, Fudan University.

Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai.

出版信息

Int J Surg. 2025 Jan 1;111(1):1386-1396. doi: 10.1097/JS9.0000000000002041.

BACKGROUND

Whether individualized positive end-expiratory pressure (PEEP) improves intraoperative oxygenation and reduces postoperative pulmonary complications (PPCs) remains unclear. This systematic review and meta-analysis examined whether individualized PEEP is associated with improved intraoperative oxygenation and reduced PPCs for patients needing pneumoperitoneum with the Trendelenburg position during surgery.

METHODS

Medline, Embase, the Cochrane Library, and www.clinicaltrials.gov were searched for randomized controlled trials evaluating the effects of individualized PEEP on intraoperative oxygenation and PPCs in patients who required Trendelenburg positioning with pneumoperitoneum. The primary outcome was the oxygenation (PaO 2 /FiO 2 ) during the procedure. Secondary outcomes included PPCs, intraoperative respiratory mechanics (driving pressure, compliance), and vasopressor consumption. DerSimonian-Laird random effects models were used to calculate mean differences (MDs) and log risk ratios (log RRs) with 95% confidence intervals (CIs). The Cochrane Risk-of-Bias tool 2.0 was applied to assess the risk of bias in included studies. The protocol of this meta-analysis has been registered in PROSPERO.

RESULTS

We included 14 studies (1121 patients) that employed different individualized PEEP strategies. Compared with control groups, individualized PEEP groups exhibited a significantly improved intraoperative PaO 2 /FiO 2 (MD=56.52 mmHg, 95% CI: [33.98-79.06], P <0.001) and reduced incidence of PPCs (log RR=-0.50, 95% CI: [-0.84 to -0.16], P =0.004). Individualized PEEP reduced driving pressure while improving respiratory compliance. Intraoperative vasopressor consumption was similar between both groups. The weighted mean PEEP in the individual PEEP groups was 13.2 cmH 2 O [95% CI, 11.7-14.6]. No evidence indicated that one individualized PEEP strategy is superior to others.

CONCLUSIONS

Individualized PEEP seems to work positively for lung protection in the Trendelenburg position and pneumoperitoneum in patients undergoing general anesthesia.

背景

个体化呼气末正压通气（PEEP）是否能改善术中氧合并减少术后肺部并发症（PPCs）尚不清楚。本系统评价和荟萃分析探讨了个体化PEEP与手术期间需要气腹并采用头低脚高位患者术中氧合改善及PPCs减少是否相关。

方法

检索Medline、Embase、Cochrane图书馆和www.clinicaltrials.gov，查找评估个体化PEEP对需要头低脚高位并气腹患者术中氧合及PPCs影响的随机对照试验。主要结局是术中氧合（动脉血氧分压/吸入氧浓度[PaO₂/FiO₂]）。次要结局包括PPCs（术后肺部并发症）、术中呼吸力学（驱动压、顺应性）和血管升压药用量。采用DerSimonian-Laird随机效应模型计算平均差（MDs）和对数风险比（log RRs）及95%置信区间（CIs）。应用Cochrane偏倚风险工具2.0评估纳入研究的偏倚风险。本荟萃分析方案已在国际前瞻性系统评价注册库（PROSPERO）登记。

结果

我们纳入了14项采用不同个体化PEEP策略的研究（1121例患者）。与对照组相比，个体化PEEP组术中PaO₂/FiO₂显著改善（MD = 56.52 mmHg，95% CI：[33.98 - 79.06]，P < 0.001），PPCs发生率降低（log RR = -0.50，95% CI：[-0.84至-0.16]，P = 0.004）。个体化PEEP降低了驱动压，同时改善了呼吸顺应性。两组术中血管升压药用量相似。个体化PEEP组的加权平均PEEP为13.2 cmH₂O [95% CI，11.7 - 14.6]。没有证据表明一种个体化PEEP策略优于其他策略。