低潮气量联合适度PEEP的肺保护性通气策略对成年患者手术后肺部并发症影响的Meta分析OA

Objective To systematically evaluate the impact of low tidal volume combined with moderate positive end-expiratory pressure(PEEP)lung-protective ventilation strategy on postoperative pulmonary complications and other clinical outcomes in adult surgical patients.Methods The computerized retrieval was conducted in PubMed,Embase,Cochrane Library,Web of Science and Chinese databases(CNKI,Wanfang,VIP,and CBM)from the establishment of the databases to June 2025.The randomized controlled trials(RCTs)of the comparisons between the low tidal volume(≤6-8 mL·kg-1)combined with moderate PEEP and conventional volume ventilation were included.The postoperative pulmonary complications were set as the primary outcome,and the in-hospital mortality and total length of hospital stay were set as the secondary out-comes.The Meta analysis was performed by using RevMan 5.4 and Stata 18.0.The binary outcomes adopted the relative risk(RR)and its 95%CI as the effect size indicator,and the continuous outcome adopted the mean difference(MD)and its 95%CI as the effect size indicator.The sensitivity analysis was conducted by a-dopting the one by one elimination method,and the publication bias was assessed by using the Begg's test and Egger's test.Results A total of 9 RCTs involving 7 592 patients were included.The primary outcome analysis showed that the lung-protective ventilation strategy of low tidal volume combined with moderate PEEP could reduce the risk of postoperative pulmonary complications,with a combined effect size of RR=0.92(95%CI:0.86-0.99,P=0.020),and low heterogeneity among studies(I2=0.0%,P=0.622).After sensitivity anal-ysis by sequentially excluding individual studies,the combined effect size RR ranged 0.91-0.93,and the 95%CI did not cross or only slightly approach 1.00.Neither Begg's test(P=0.929)nor Egger's test(P=0.841)indicated significant publication bias.The secondary outcome analysis showed that there was no statis-tically significant difference in in-hospital mortality between the low tidal volume combined with moderate PEEP group and the control group(RR=1.27,95%CI:0.70-2.31,Z=0.78,P=0.433),with low heteroge-neity among studies(I2=0.0%,P=0.417);there was no statistically significant difference in total length of hospital stay between the two groups(MD=0.01,95%CI:-0.07-0.08,Z=0.26,P=0.794),but there was high heterogeneity among studies(I2=71.9%,P=0.014).Conclusion The current RCT evidence indi-cates that the lung-protective ventilation strategy of low tidal volume combined with moderate PEEP could re-duce the risk of postoperative pulmonary complications in adult surgical patients,but it has no clear impact on in-hospital mortality and total length of hospital stay.Further validation through larger sample,multi-center and high-quality RCTs is still needed to confirm its clinical value.