目的：系统评价围术期不同通气策略对肥胖患者通气和肺功能的影响,选择最佳通气策略。方法：电子检索EBSCO、PubMed、Spring、Ovid、Wiley、CNKI、维普、万方等数据库和谷歌学术，选择全麻诱导期和拔管后的给氧模式以及术中不同潮气量对肥胖患者通气和肺功能影响的随机对照试验，应用RevMan 5.3软件对纳入文献进行meta分析。结果：共纳入24篇RCT，946例患者。①麻醉诱导期头高位吸氧较平卧位吸氧无通气安全时限更长(MD=52.33, 95%CI37.19-67.47, P<0.001)，而自主呼吸时加用持续正压通气（continues positive airway pressure,CPAP）PaO2水平更高（MD=62.61, 95%CI19.09-106.12, P=0.005），转为机械通气后间歇正压通气(intermittent positive pressure ventilation,IPPV)+呼吸末正压通气(positive end expiratory pressure, PEEP)较单用IPPV无通气安全时限更长(MD=53.05, 95%CI21.72-84.39, P<0.001)，PaO2更高(MD=95.86, 95%CI 56.24-135.48, P<0.001)。②术中大潮气量比小潮气量通气联合PEEP获得更高的氧合指数(MD=30.71, 95%CI6.85-54.57, P=0.02)，但同时大潮气量通气可引起更高的气道压(MD=8.12, 95%CI7.34-8.90, P<0.001)。③拔管后采用无创正压通气(non-invasive positive pressure ventilation,NIPPV)较鼻导管吸氧PaO2更高(MD=11.3, 95%CI 3.63-18.96, P=0.004)。结论：肥胖患者诱导期宜采用头高位CPAP给氧以及IPPV +PEEP通气，术中采用大潮气量+高PEEP，术后拔管后采用NIPPV。
Objectives We conducted a systematic review of different perioperative ventilation mode on gas exchange and lung function for obese patients to identify the optimal strategy. Methods We searched the database of EBSCO, PubMed，Spring，Ovid，Wiley，CNKI ,VIP, Wanfang, et al. and Google scholar, the gas exchange and lung function in obese patients accepted different ventilation mode during induction and after extubation, and different tidal volume during surgery were assessed. The meta-analysis of the included randomized controlled trials （RCTs） was conducted by RevMan 5.3 software. Results Twenty-four RCTs with a total of 946 patients were enrolled.①During induction, head- up position can prolong the safe apnea duration compared with supine(MD=55.59, 95%CI40.70-70.48, P<0.001), PaO2 increased in continues positive airway pressure(CPAP) group in spontaneous respiration（MD=67.87, 95%CI14.53-121.20, P=0.01）. Compared with the group without Positive End Expiratory Pressure(PEEP), the safe apnea duration is longer （MD=62.41, 95%CI50.95-73.88, P<0.001）and PaO2 is higher（MD=91.34, 95%CI44.26-78.87, P=0.01） in intermittent positive pressure ventilation(IPPV) with PEEP group after transferring to mechanical ventilation. ②Large tidal volume with PEEP can provide higher oxygen index (OI) (MD=24.36, 95%CI2.87-45.84, P=0.03) compared with small tidal volume group, but can cause larger Ppeak (MD=8.12, 95%CI7.34-8.90, P<0.001) at the same time. ③PaO2 (MD=11.3, 95%CI3.63-18.96, P=0.004) is higher after extubation in non-invasive positive pressure ventilation (NIPPV) group compared with nasal catheter group. Conclusion The optimal ventilation strategy for obese patients is head-up position plus CPAP and IPPV with PEEP during induction, large tidal volume ventilation during surgery, and NIPPV after extubation.
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