目的 评价驱动压导向个体化呼吸末正压（PEEP）通气对机器人辅助前列腺癌根治术 （RALP）老年患者脑血流动力学和局部脑氧饱和度（rSO2）的影响。方法 择期全麻 RALP 老年患者 80 例， 年龄 65～80 岁，体质量指数 19～28 kg/m2 ，ASA 分级Ⅰ- Ⅲ级。采用随机数字表法分为传统肺保护性通气组（A 组，n = 40）和驱动压导向个体化PEEP 通气组（B 组，n = 40）。A 组 Trendelenburg 位调整完成后 10 min予以固定5 cmH2O PEEP进行小潮气量肺保护通气；B组则在气腹体位建立、平卧位后分别进行PEEP 滴定。两组均以上述 PEEP 通气至拔除气管导管。分别于麻醉诱导前即刻（T0）、气管插管后 5 min（T1）、 CO2气腹建立后 5 min（T2）、气腹⁃Trendelenburg 位后 5 min（T3）、PEEP 滴定后 5 min（T4，对应 A 组加用 PEEP 通气后 10 min）、呼气末正压滴定后 60 min（T5）、手术结束后 5 min（T6）记录平均动脉压（MAP），测量大脑 中动脉收缩期血流速度（VS）、舒张期血流速度（VD）及平均血流速度（VM）、搏动指数（PI），计算脑灌注压 （CPP）；记录 T1⁃6肺顺应性（Cdyn）、动脉氧分压（PaO2）及动脉二氧化碳分压（PaCO2）；记录 T0⁃6 rSO2；记录术后 1 周肺部并发症。结果 与 A 组比较，B 组 T5⁃6时 Cdyn 和 PaO2升高，术后肺部并发症（PPCs）发生率明显 降低（P < 0.05），两组之间 MAP、CPP、rSO2差异无统计学意义（P > 0.05）。结论 驱动压导向个体化 PEEP 应用于 RALP 中是安全有效的，可以改善术中肺氧合功能和顺应性，降低术后肺部并发症发生率，并且不会对脑血流动力学和rSO2产生明显影响。 

Objective To evaluate the effect of driving pressure⁃guided individualized positive end⁃expira⁃ tory pressure（PEEP）on intracranial pressure and regional cerebral oxygen saturation（rSO2）in elderly patients undergoing robot ⁃ assisted laparoscopic radical prostatectomy（RALP）. Methods Eighty patients with elective general anesthesia for RALP，aged 65 to 80 years，with BMI 19 to 28 kg/m2 ，and ASA classification I to Ⅲ，were selected. A randomized number table method was used to divide the patients into conventional pulmonary protective ventilation（group A）and individualized PEEP with driving pressure guidance（group B）. In group A，5 cmH20 PEEP was fixed 10 minutes after the Trendelenburg position was adjusted for low tidal volume lung protection venti⁃ lation；In group B，PEEP titration was performed after the establishment of pneumoperitoneum position and supine position. The air was ventilated with the PEEP until the tracheal tube was removed. The mean arterial pressure （MAP）was recorded immediately before anesthesia induction（T0），5 minutes after endotracheal intubation（T1）， 5 minutes after CO2 pneumoperitoneum establishment（T2），5 minutes after pneumoperitoneum Trendelenburg position（T3），5 minutes after positive end⁃expiratory pressure titration（T4，10 minutes after PEEP ventilation in group A），60 minutes after positive end⁃expiratory pressure titration（T5），and 5 minutes after surgery（T6）. Systolic blood flow velocity（VS），blood flow velocity diastolic period（VD），mean blood flow velocity（VM），and pulsation index（PI）of the middle cerebral artery were measured，and cerebral perfusion pressure（CPP）were calculated； T1⁃6 lung compliance（Cdyn），arterial partial pressure of oxygen（PaO2）and arterial partial pressure of carbon dioxide（PaCO2）and T0 ⁃ 6 rSO2 were recorded；Pulmonary complications were recorded one week after operation. Results Compared with group A，group B had higher Cdyn and PaO2 at T5⁃6 and a significantly lower incidence of pulmonary complications（P < 0.05），with no significant differences in MAP，CPP and SO2 between the two groups （P > 0.05）. Conclusion Individualized PEEP guided by driving pressure in RALP is safe and effective. It can improve the pulmonary oxygenation function and compliance during operation，reduce the incidence of postopera⁃ tive pulmonary complications，and have no significant impact on cerebral hemodynamics and rSO2.