郭启政,宋萌昭,甘桂芬,潘 纯

急性呼吸窘迫综合征（ARDS）是临床危重症领域的常见急症，以肺泡上皮与毛细血管内皮损伤、肺容积减少、严重低氧血症为核心特征，机械通气是其关键支持治疗手段。呼气末正压（PEEP）作为有创呼吸机的核心参数，通过维持肺泡开放、改善氧合、调节肺力学特性等机制发挥肺保护作用，但不当PEEP设置可能诱发气压伤、容积伤等二次损伤。本文系统综述PEEP影响ARDS肺损伤的核心生理学机制，包括肺泡复张与通气/血流比例调节、炎症反应调控、肺屏障功能保护等保护机制，以及过高PEEP导致的肺损伤风险机制，同时梳理PEEP个体化设置的优化策略与近年研究进展，结合30项权威文献探讨当前争议与未来方向，为临床优化ARDS机械通气策略、降低肺损伤风险提供理论依据。

有创呼吸机；PEEP；急性呼吸窘迫综合征；肺损伤；生理学机制；机械通气

[1] Costa A,Sakho B,Gomez S,et al.Ventilator-Associated Lung Injury:Pathophysiology,Prevention,and Emerging Therapeutic Strategies[J]. International Journal of Molecular Sciences,2025,26(21):10448-10448. [2] Moraes D R L,Lima D L M,Ribeiro A P A,et al.Integrative Physiological Study of Radiation-Induced Lung Injury:Effects on Cardiac Function and Kidney Integrity.[J].Journal of applied physiology(Bethesda,Md.:1985),2025, [3] Damia A,Marongiu I,Spinelli E,et al.Physiology,imaging and proteomics of non-ventilated vs.non-perfused lung injury:an experimental study[J].Intensive Care Medicine Experimental,2025,13(1):63-63. [4] Shen L H,He J,Lin F.TREM2 signaling pathway in sepsis-induced acute lung injury:physiology,pathology,and therapeutic applications [J].Frontiers in Medicine,2025,12 1546292-1546292. [5] 臧梓君.血管内皮损伤引起的凝血失调在肺损伤中的作用研究[D].吉林大学,2025. [6] Zhou X,Tian L,Xiong W,et al.Ferroptosis and hyperoxic lung injury:insights into pathophysiology and treatment approaches[J].Frontiers in Pharmacology,2025,16 1568246-1568246. [7] Deshwal H,Elkhapery A,Ramanathan R,et al.Patient-Self Inflicted Lung Injury(P-SILI):An Insight into the Pathophysiology of Lung Injury and Management[J].Journal of Clinical Medicine,2025,14(5):1632-1632. [8] Qosa H,Younis R I,Sahasrabudhe V,et al.Opportunities and Challenges of Hepatic Impairment Physiologically Based Pharmacokinetic Modeling in Drug Development-An IQ Perspective.[J].Clinical pharmacology and therapeutics,2025,117(6):1682-1686. [9] Lintao X,Xinping C,Qingwen H,et al.Exploring the bioactive substances and mechanisms of Chuanxiong Rhizoma treating acute lung injury based on combined network pharmacological,phytochemical,and pharmacological investigations[J].Guidelines and Standards of Chinese Medicine,2024,2(4):182-194. [10] Kapur R.Key features of the underlying pathophysiology of transfusion-related acute lung injury.[J].Expert review of hematology, 2024,18(1):57-64. [11] Hall S,Berger G,Lehmann C.COVID-19 Lung Injury:Unique and Familiar Aspects of Pathophysiology[J].Applied Sciences,2024, 14(23):11048-11048. [12] Zhang J,Yan W,Dong Y,et al.Early identification and diagnosis,pathophysiology,and treatment of sepsis-related acute lung injury:a narrative review.[J].Journal of thoracic disease,2024,16(8):5457-5476. [13] Kutumova O E,Akberdin R I,Egorova S V,et al.Physiologically based pharmacokinetic model for predicting the biodistribution of albumin nanoparticles after induction and recovery from acute lung injury[J].Heliyon,2024,10(10):e30962-. [14] Mairi Z,Aristomenis E.Pathophysiology of acute lung injury in patients with acute brain injury:the triple-hit hypothesis[J].Critical Care,2024,28(1):71-71. [15] 马宣,邹明丽,姜莎莎,等.急性呼吸窘迫综合征患者肺损伤程度与肺动脉压力的关系[J].中国分子心脏病学杂志,2024, 24(01):5853-5857. [16] Spinelli E,Damia A,Damarco F,et al.Pathophysiological profile of non-ventilated lung injury in healthy female pigs undergoing mechanical ventilation.[J].Communications medicine,2024,4(1):18-18. [17] 王晶.反比通气对腹腔镜下胃减容术肥胖患者呼吸力学及肺损伤的影响[D].内蒙古医科大学,2023. [18] 宋洋,贺晓楠.miR-762与sTREM-1 sFLT-1在急性肺损伤中的相关性研究[J].河北医学,2022,28(11):1822-1826. [19] 贾圣男,姜东辉,王吕国,等.压力调节容量控制通气模式在ARDS病人机械通气治疗中的应用效果评价[J].河北医学,2022, 28(11):1836-1840. [20] 王旭亮.驱动压导向机械通气治疗急性呼吸窘迫综合征患者的研究进展[J].医疗装备,2022,35(10):191-193. [21] 徐盼盼,郑诚,张楚明,等.脓毒症患者血清NAMPT､SIRT1表达与急性肺损伤的相关性研究[J].浙江中西医结合杂志, 2022,32(03):231-234. [22] 李霞,庄伟,马冲,等.丙氨酰谷氨酰胺辅助乌司他丁治疗重症急性胰腺炎肺损伤的效果及对肺功能､炎症反应､免疫功能的影响[J].中国医药导报,2022,19(07):92-95. [23] Sarah A,William H,Mohammad B,et al.Effect of Therapeutic Hypothermia on Physiologic,Histologic and Metabolomic Markers of Lung Injury in Experimental Acute Respiratory Distress Syndrome[J].The FASEB Journal,2021,35(S1): [24] 王文杰,李敏,樊清波,等.气道压力释放通气对急性呼吸窘迫综合征患者呼吸力学､血流动力学及肺损伤情况的影响[J].河南医学研究,2021,30(11):1978-1980. [25] 黄一桂,陈钰,符征高,等.血浆单核细胞趋化蛋白1､可溶性髓系细胞触发受体1及高迁移率族蛋白B1水平对急性肺损伤患者病情及预后的评估价值[J].中华危重症医学杂志(电子版),2021,14(01):25-29. [26] 李晗,陈强,韩旭东.ARDS患者自戕式肺损伤的机制和干预措施[J].中华重症医学电子杂志(网络版),2021,7(01):66-70. [27] 党红星,许峰.输血相关的循环超负荷及急性肺损伤[J].中国实用儿科杂志,2020,35(12):947-953. [28] 胡嫒,陈唯韫,黄宇光.输血相关急性肺损伤发病机制及防治措施研究进展[J].中国医学科学院学报,2020,42(05):674-680. [29] 杨扬.输血相关性急性肺损伤发病机制及最新研究进展[C]//中国输血协会.中国输血协会第十届输血大会论文摘要汇编(2020.10天津).天津市血液中心;,2020:249. [30] Bryn N.Vaping,lung damage,and cytopathology:A new twist in the medical mystery:Accumulating evidence has clarified the role of cytopathology in the diagnosis of vaping-associated lung injuries and implicated vitamin E acetate as a likely culprit.[J].Cancer cytopathology,2020,128(3):153-154.

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