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目的:评价驱动压(ΔP)滴定PEEP对机器人辅助前列腺癌根治术(RARP)老年患者肺损伤的影响。方法:择期行RARP患者46例，年龄65~80岁，BMI 19~28 kg/mn 2，ASA分级Ⅱ或Ⅲ级，加泰罗尼亚外科患者呼吸风险评估为中高风险，采用随机数字表法分为对照组(C组)和ΔP滴定组(D组)(n n＝23)。于麻醉诱导气管插管术后采用容量控制机械通气模式，C组术中采用5 cmHn 2O的固定PEEP；D组分别在机控呼吸后、建立Trendelenburg体位及气腹后滴定最适PEEP，首次滴定从4 cmHn 2O为起始，每隔4 min增加1 cmHn 2O，直到ΔP达到最小值或PEEP增加至12 cmHn 2O，第2次滴定在首次滴定的最适PEEP基础上按上述方法递增。D组分别于首次PEEP滴定完成后4 min(Tn 1，C组在固定PEEP机械通气后4 min)、建立Trendelenburg体位后2 h(Tn 2)、气管拔管后1 min(Tn 3)和术后2 h(Tn 4)时测定血清肺Clara细胞分泌蛋白(CC16)、肺泡表面活性物质-D(SP-D)、晚期糖基化终产物可溶性受体(sRAGE)及可溶性细胞间粘附分子(sICAM-1)的浓度；评估术后7 d内肺部并发症(PPCs)发生的情况。n 结果:与Tn 1时比较，2组Tn 2~4时血清CC16、SP-D、sRAGE和sICAM-1浓度升高(n P<0.05)；与C组比较，D组Tn 2~4时血清CC16、SP-D、sRAGE和sICAM-1浓度降低(n P0.05)。n 结论:ΔP滴定PEEP可减轻RARP老年患者肺损伤。“,”Objective:To evaluate the effect of driving pressure (ΔP)-guided PEEP titration on lung injury in elderly patients undergoing robot-assisted radical prostatectomy (RARP).Methods:Forty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-28 kg/mn 2, with Assess Respiratory Risk in Surgical Patients in Catalonia score assessed as medium to high risk, scheduled for elective RARP, were divided into control group (group C, n n=23) and ΔP titration group (group D, n n=23) using a random number table method.Volume-controlled mechanical ventilation was used after anesthesia induction and tracheal intubation.In group C, 5 cmHn 2O was used to fix PEEP.In group D, the optimal PEEP was titrated after computer-controlled breathing and after establishing Trendelenburg position and pneumoperitoneum, the first titration started from 4 cmHn 2O and increased by 1 cmHn 2O every 4 min until ΔP reached the minimum value or PEEP increased to 12 cmH n 2O, and the second titration was increased in increments as the method described above based on the optimal PEEP of the first titration.At 4 min after completion of the first PEEP titration (Tn 1, 4 min after mechanical ventilation with fixed PEEP in group C), 2 h after establishment of Trendelenburg position (Tn 2), 1 min after extubation (Tn 3) and 2 h after operation (Tn 4), serum concentrations of Clara cell protein (CC16), surfactant protein D (SP-D), soluble receptor for advanced glycation end-products (sRAGE) and soluble intercellular adhesion molecule-1 (sICAM-1). Pulmonary complications were assessed within 7 days after operation.n Results:The serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly higher at Tn 2-4 than at Tn 1 in two groups (n P<0.05). Compared with group C, the serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly decreased at Tn 2-4 (n P0.05).n Conclusions:ΔP-guided PEEP titration can reduce lung injury in elderly patients undergoing RARP.