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目的:探讨呼气末正压(PEEP)肺保护性通气策略在超重患者腹腔镜手术中的作用。方法:选择40例拟在全身麻醉下行腹腔镜直肠癌根治术的超重患者，采用随机数字表法，将其分为PEEP组(P组)和对照组(C组)，麻醉诱导后气管插管前机械通气控制呼吸，P组设置PEEP＝5 cmHn 2O，C组不予以PEEP，两组其余设置相同。分别于麻醉诱导前(Tn 0)、气管插管后5 min(Tn 1)、气腹后5 min(Tn 2)、60 min(Tn 3)、开始缝皮时(Tn 4)观察记录心率(HR)、平均动脉压(MAP)、潮气量(Vt)、气道峰压(Ppeak)、气道平台压(Pplat)，计算肺的动态顺应性(Cdyn)；血气分析动脉血氧分压(PaOn 2)和二氧化碳分压(PaCOn 2)，计算氧合指数(OI)；观察术后3 d内肺部并发症情况。n 结果:两组患者一般情况及手术情况比较差异无统计学意义(n P>0.05)。与Tn 0时相比，两组患者在Tn 3、Tn 4时平均动脉血压均有所下降，各时间心率比较差异无统计学意义(n P>0.05)，两组患者血流动力学参数指标比较差异无统计学意义(n P>0.05)。与Tn 1时比较，P组Tn 2时Vt增加，C组Tn 3时Vt增加，组间比较Vt差异无统计学意义(n P>0.05)；与Tn 1时比较，两组在Tn 2、Tn 3时Ppeak和Pplat均升高(n P0.05)；与Tn 1时比较，两组在Tn 2、Tn 3时Cdyn均下降(n P0.05)。n 结论:全身麻醉诱导期开始给予呼气末正压肺保护性通气策略能有效提高动态肺顺应性，在超重患者腹腔镜术中可以改善氧合，促进肺功能恢复。“,”Objective:To investigate the effect of end-expiratory positive pressure of pulmonary protective ventilation strategy in overweight patients undergoing laparoscopic surgery.Methods:Forty overweight patients, 24 kg/mn 2≤BMI0.05). Compared with Tn 0, the mean arterial blood pressure of the two groups decreased at Tn 3 and Tn 4, and there was no significant difference in heart rate at each time (n P>0.05). There was no significant difference in hemodynamic parameters between the two groups (n P>0.05). Compared with Tn 1, VT increased at Tn 2 in group P and Tn 3 in group C, while there was no significant difference in VT between the two groups (n P>0.05); compared with Tn 1, Ppeak and Pplat increased at Tn 2 and Tn 3 in both groups, while there was no significant difference between the two groups (n P>0.05); compared with Tn 1, Cdyn of the two groups decreased at Tn 2 and Tn 3 (n P0.05).n Conclusions:Positive end-expiratory pressure of protective ventilation strategy from the induction period of general anesthesia can effectively improve dynamic lung cdyniance, improve oxygenation and promote pulmonary function recovery in overweight patients undergoing laparoscopic surgery.