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目的:评价肺保护性通气策略(LPVS)对术后肺部并发症(PPCs)中危患者腹部手术PPCs的影响。方法:择期胃肠道肿瘤手术患者100例，年龄50～80岁，性别不限，ASA分级Ⅱ或Ⅲ级，预计加泰罗尼亚外科患者呼吸风险评估(ARISCAT)评分26～44分，采用随机数字表法分为传统通气策略组(T组)和LPVS组(L组)，每组50例。T组Vn T10 ml/kg(理想体重)，FiOn 2 0.5；L组Vn T 6 ml/kg(理想体重)，FiOn 2 0.5、PEEP 6 cmHn 2O，每隔30 min进行1次手法肺复张(气道正压30 cmHn 2O，持续30 s)。于麻醉诱导前5 min(Tn 0)、气管拔管后30 min(Tn 1)、手术结束后24 h(Tn 2)时取血样，采用ELISA法测定测定血清IL-6、TNF-α、NF-κB、可溶性细胞间粘附分子1(sICAM-1)浓度；术后7 d随访PPCs的发生情况和严重程度。n 结果:最终T组纳入47例，L组纳入46例。与Tn 0时比较，Tn 1时T组血清IL-6、TNF-α、NF-κB和sICAM-1浓度升高(n P0.05)；与Tn 1时比较，Tn 2时T组血清IL-6、TNF-α、NF-κB和sICAM-1浓度降低，L组血清TNF-α和NF-κB浓度降低(n P<0.05)；与T组比较，L组Tn 1时血清IL-6、TNF-α、NF-κB和sICAM-1浓度降低，PPCs发生率及其严重程度降低(n P<0.05)。n 结论:LPVS可减轻腹部手术PPCs中危患者全身炎症反应，降低PPCs的发生风险和严重程度。“,”Objective:To evaluate the effect of lung-protective ventilation strategy (LPVS) on postoperative pulmonary complications (PPCs) in the patients at moderate risk for PPCs undergoing abdominal surgery.Methods:One hundred patients of both sexes, aged 50-80 yr, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, with risk scores of 26-44 points predicted by the Assess Respiratory Risk in Surgical Patients in Catalonia, scheduled for elective gastrointestinal surgery, were randomized into conventional ventilation group (group T) and LPVS group (group L), with 50 patients in each group.The tidal volume (Vn T) was 10 ml/kg (ideal body weight), and FiOn 2 was 0.5 in group T. Vn T was 6 ml/kg (ideal body weight), FiOn 2 was 0.5, PEEP was 6 cmHn 2O, and recruitment maneuvres were performed every 30 min (positive airway pressure 30 cmHn 2O, lasting for 30 s) in group L. Blood samples were collected at 5 min before induction (Tn 0), 30 min after extubation (Tn 1) and 24 h after the end of surgery (Tn 2) to detect the concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), nuclear factor kappa B (NF-κB), and soluble intercellular adhesion molecule-1 (sICAM-1). The patients were followed up for 7 days to record the development and severity of PPCs.n Results:Forty-seven cases were finally included in group T and 46 cases in group L. Compared with the baseline value at Tn 0, the serum concentrations of IL-6, TNF-α, NF-κB and sICAM-1 were significantly increased at Tn 1 in group T (n P0.05). Compared with those at Tn 1, the serum concentrations of IL-6, TNF-α, NF-κB and sICAM-1 were significantly decreased at Tn 2 in group T, and the serum concentrations of TNF-α and NF-κB were significantly decreased at Tn 2 in group L (n P<0.05). Compared with group T, the serum concentrations of IL-6, TNF-α, NF-κB and sICAM-1 were significantly decreased at Tn 1, and the incidence and severity of PPCs were decreased in group L (n P<0.05).n Conclusion:LPVS can reduce the systemic inflammatory responses and decrease the occurrence and severity of PPCs in the patients at moderate risk for PPCs undergoing abdominal surgery.