设置最佳呼气末正压的临床应用进展

术后肺部并发症（PPCs）是全身麻醉后常见的并发症。俯卧位手术围术期呼吸管理复杂且机械通气导致的呼吸机相关肺损伤（VILI）发生率高。肺保护性通气策略（LPVS）不仅可以降低围术期VILI发生率，还可以预防PPCs，改善预后。相较于固定的呼气末正压（PEEP）值，基于患者个体差异设置最佳PEEP更具有优势及和应用前景，是肺保护通气最有效的措施之一。本文对LPVS与最佳PEEP的可行性以及设置最佳PEEP的临床应用进行综述，以期为全身麻醉尤其是俯卧位手术患者提供更好的肺保护，减少术后肺部并发症的发生。

Progress in clinical application of setting optimal positive end-expiratory pressure

Postoperative pulmonary complications (PPCs) are common complications after general anesthesia surgery. Respiratory management in the perioperative period of prone surgery is complex, and the incidence of ventilator-induced lung injury (VILI) is high due to mechanical ventilation. Not only do lung protective ventilation strategies (LPVS) reduce the incidence of VILI, but also prevent PPCs and improve prognosis. Compared with the fixed positive end expiratory pressure (PEEP) value, setting the optimal PEEP based on individual patient differences has more advantages and application prospects, which is one of the most effective measures for lung protection ventilation. This article mainly reviews the feasibility of LPVS and optimal PEEP and the clinical application of optimal PEEP to provide better lung protection and to reduce the occurrence of postoperative lung complications in patients with general anesthesia in prone position surgery.