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目的：探讨胃内二氧化碳压力(PgCO2)监测在指导急性呼吸窘迫综合征（ARDS)患者机械通气最佳呼气末正压(PEEP)选择中的临床应用。方法选择40例ARDS患者，随机分为两组：PgCO2及P-V曲线联合指导组（试验组，n=20），P-V曲线指导组（对照组，n=20）。对照组以P-V曲线低拐点对应压力值（PLip）+2 cmH2O作为最佳PEEP，实验组患者以P-V曲线低拐点对应压力值（PLip）+2 cmH2O为初始PEEP值，根据胃粘膜张力计监测所得PgCO2，以2 cmH2O为间隔递增调整PEEP值，记录的胃内二氧化碳压力（PgCO2）；同时记录两组患者的机械通气天数、死亡例数。结果①在12、24、48 h试验组氧合指数（FiO2/PaO2）高于对照组，P<0.01；②试验组机械通气天数少于对照组，P=0.02；③在2、6及12 h，试验组Cst明显高于对照组，P<0.01，在24 h高于对照组，P=0.026；④试验组与对照组预后的差异无统计学意义， P=0.176。结论以P-V曲线低拐点对应压力值加2 cmH2O（即PLip+2 cmH2O）作为初始PEEP值，并联合PgCO2调整PEEP值可以明显改善患者氧合，增加Cst，减少机械通气天数，但对患者预后无明显改善。“,”Objective To explore clinical application of gastric intramucosal carbon dioxide partial pressure monitoring in the choice of optimal positive end expiratory pressure in patients with acute respiratory distress syndrome, and search for a better way to set positive end expiratory pressure. Methods 40 patients with acute respiratory distress syndrome (ARDS) in the emergency Intensive care unit (EICU) were randomly divided into two groups, P-V curves-guided group (control group, n = 20) and combination of PgCO2 with P-V curve guided group (experimental group, n=20). In the control group, the optimal PEEP value was low inflection point (PLip) of the P-V curve with the addition of 2 cmH2O (PLip+2 cmH2O). In the experimental group, the optimal PEEP value was determined by the procedure as follows:PLip+2 cmH2O was pre-set as initial PEEP value and then PEEP was increasing regulated at an interval of 2 cmH2O value according to the value of PgCO2 monitored, yet the maximal PEEP was not more than 20 cmH2O. PaO2, PaCO2, PgCO2, SPO2 and Cst were monitored at 0, 2, 6, 12, 24 and 48 hours. The duration of mechanical ventilation and death cases were recorded. Results 1. Oxygenation indexes in the experimental group at 12, 24 and 48 hour were significantly higher than those in the control group,P<0.01;2. A decrease in duration of mechanical ventilation in the experimental group was found in comparison with that in the control group ,P<0.05;3. Cst of patients in the experimental group at 2, 6 and 12 hours were significantly higher than those in the control group ,P<0.01, and Cst of patients in the experimental group at 24 h were higher than those in the control group ,P=0.026. 4. No significant difference in prognosis between experimental group and control group was found ,P=0.176. Conclusion Determining optimal PEEP by combination of PLip+2 cmH2O with PgCO2 monitored might improve oxygenation, and Cst, reduce duration of mechanical ventilation, but not the prognosis.