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目的:探讨肺保护性通气策略对老年患者全身麻醉腹部手术术后肺内氧合的影响。方法:104例拟行择期腹部手术(预计手术时间≥2 h)的老年患者，数字抽签随机分为肺保护通气组(52例，2例术后撤回同意书)和传统通气组(52例)。全身麻醉后气管插管机械通气，保护通气组呼吸参数设置为氧浓度分数50%、潮气量6 ml/kg、呼吸频率14～16次/min、呼气终末正压5 cmHn 2O(1 cmHn 2O＝0.098 kPa)，每30 min进行1次肺复张，采用压控持续膨肺，膨肺压力30 cmHn 2O，持续30 s；传统通气组呼吸参数设置为氧浓度分数50%、潮气量10 ml/kg、呼吸频率10～12次/min。记录两组患者一般状况和术中出入量、基础值和术后第3天的肺泡动脉血氧分压差、氧合指数及用力肺活量、1 s量、1 s率。记录术后第1天的改良临床肺部感染评分。n 结果:保护通气组术后第3天氧合指数高于传统通气组患者，(351.1±57.3比324.5±55.0，n F＝0.364，n P<0.05)；呼气终末正压低于传统通气组[(25.7±10.9)mmHg(1 mmHg＝0.133 kPa)比(31.4±11.9)mmHg，n F＝0.026，n P3分为13.6%(6/44)比32.7%(17/35)，差异有统计学意义(n F＝6.249，n P0.05)。n 结论:肺保护性通气改善老年患者全身麻醉下腹部大手术后肺换气功能，改善肺内氧合，减少术后肺部并发症。“,”Objective:To investigate the effects of lung protective ventilation on postoperative intrapulmonary oxygenation in elderly patients undergoing abdominal surgery under general anesthesia.Methods:A total of 104 elderly patients(operation time≥2 hours)planned for elective abdominal surgery were randomly divided into two groups by random lottery numbers: the lung protective ventilation group(Group P, n=52, with 2 cases withdrawing consent after surgery)and the traditional ventilation group(Group T, n=52). Patients received endotracheal intubation and mechanical ventilation after general anesthesia.For Group P, respiratory parameters used for assessment included the fraction of inspiration On 2(FiOn 2)50%, tidal volume 6 ml/kg, respiratory rate 14-16 times/min, and positive end expiratory pressure(PEEP)5 cmHn 2O(1 cmHn 2O=0.098 kPa). Sustained lung inflation was performed once every 30 min with lung inflation pressure set at 30 cmHn 2O for 30 s. For Group T, parameters for assessment were FiOn 2 50%, tidal volume 10 ml/kg and respiratory rate 10-12 times/min.General condition, liquid intake and output, baseline and third day post-surgery values for alveolar-arterial oxygen partial pressure difference, oxygenation index, forced vital capacity(FVC), forced expiratory volume in 1s(FEVn l)and FEVn 1/FVC ratio on the third day after surgery were recorded for both groups.The modified clinical pulmonary infection score on the first day after surgery was also recorded.n Results:The oxygenation index was higher and the alveolar-arterial oxygen partial pressure difference was lower on the third day after surgery in Group P than in Group T(351.1±57.3, n vs.(324.5±55.0), (25.7±10.9)mmHg(1 mmHg=0.133 kPa)n vs.(31.4±11.9)mmHg, n F=0.364 and 0.026, n P 3 on the first day after surgery between Group P and Group T(13.6% or 6/44n vs.32.7% or 17/35, n F=6.249, n P0.05).n Conclusions:Lung protective ventilation can improve pulmonary gas exchange after major abdominal surgery under general anesthesia in elderly patients, improve intrapulmonary oxygenation and reduce postoperative pulmonary complications.