基于体重指数调整全身麻醉期间呼气末正压：一项随机对照试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
肺保护性通气对于预防术后肺部并发症至关重要。尽管维持较低的驱动压和优化呼气末正压（PEEP）非常重要，但理想的策略仍存在争议。本研究旨在评估基于体重指数（BMI）调整PEEP与标准PEEP相比，是否能够降低驱动压并减少围手术期肺通气量损失。
方法
这是一项随机对照、患者盲法、单中心优效性试验，采用两个平行组。接受全身麻醉手术且需要气管插管的成年患者被随机分配到标准呼气末正压（PEEP）组（PEEP = 5 cmH₂O ； PEEP-5组）或根据体重指数（BMI）设定的PEEP组（PEEP = BMI/3 cmH₂O ； PEEP-BMI/3组）。所有患者均采用容量控制模式通气，潮气量为潮气量7 ml/kg预测体重。术前和术后均采用肺部超声评估肺通气评分。
结果
共纳入60例患者并随机分组。BMI调整组驱动压显著降低（中位数7.9 vs 8.9 cmH₂O，p=0.027），呼吸系统顺应性更高（0.95 vs 0.83 ml/cmH₂O/kg，p=0.020）。肺部超声显示，分配至BMI/3组的患者术后肺通气损失减少。分配到BMI调整组的患者需要的补充氧气较少，新发生的肺不张较少，并且术后血氧饱和度更高。
对于无严重肺部疾病且接受非心胸外科手术并需气管插管的患者，基于BMI/3计算调整呼气末正压（PEEP）可改善肺呼吸力学并减少术后肺通气损失。该方法为接受全身麻醉的患者提供了一种简便实用的个体化PEEP调整方法。
原始文献：Selpien H, Penon J, Thunecke D, et al. Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a randomised controlled trial. Anaesthesia. 2025 Nov;80(11):1322-1332. doi: 10.1111/anae.16656. Epub 2025 Jun 23. PMID: 40551551; PMCID: PMC12519930.
Adjustment of positive end-expiratory pressure based on body mass index during general anaesthesia: a randomised controlled trial
ABSTRACT
Introduction: Lung-protective ventilation is essential for preventing postoperative pulmonary complications. While maintaining a low driving pressure and optimising PEEP is of importance, the ideal strategy remains contentious. This study evaluated whether adjusting PEEP based on BMI, compared with standard PEEP, could reduce driving pressure and peri-operative loss of lung aeration.
Methods: We conducted a randomised controlled, patient-blinded, single-centre superiority trial with two parallel groups. Adult patients undergoing surgery with general anaesthesia who required tracheal intubation were assigned randomly to either standardised PEEP (PEEP = 5 cmH2O; group PEEP-5) or PEEP set according to BMI (PEEP = BMI/3 cmH2O; group PEEP-BMI/3). Patients’ lungs were ventilated using a volume-controlled mode with tidal volumes of 7 ml.kg-1 predicted body weight. Lung aeration scores were assessed using ultrasound pre- and postoperatively.
Results: Sixty patients were enrolled and allocated randomly. Adjustment of PEEP according to BMI/3 was associated with a significantly lower driving pressure, with a median (IQR [range]) of 8.9 (7.1-10.4 [5.2-14.9]) cmH2O in group PEEP-5 and 7.9 (7.2-8.5 [5.9-14.1]) cmH2O in group PEEP-BMI/3 (p = 0.027) and higher mean (SD) respiratory system compliance (group PEEP-5, 0.83 (0.20) ml cmH2O-1 kg-1 predicted body weight vs. group PEEP-BMI/3, 0.95 (0.17) ml cmH2O-1 kg-1 predicted body weight; p = 0.020). Lung ultrasound revealed a reduced postoperative loss of lung aeration in patients allocated to the BMI/3 group. Patients allocated to the BMI-adjusted group required less supplemental oxygen, had less newly developed atelectasis and had higher oxygen saturations upon arrival in the post-anaesthesia care unit.
Discussion: In patients without major pulmonary disease who were undergoing non-cardiothoracic surgeries with tracheal intubation, adjusting PEEP based on a calculation of BMI/3 improved lung mechanics and reduced postoperative loss of lung aeration. This approach provides a straightforward and pragmatic method for individualising PEEP in patients undergoing general anaesthesia.