目的探讨呼气末正压(PEEP)在小儿毛细血管渗漏综合征(CLS)中的合理应用。方法将32例机械通气CLS患儿随机分为实验组与对照组。实验组:动态调整PEEP,渗漏期选择较低PEEP,恢复期根据液体负荷、水肿程度、尿量及呼吸指数、氧合指数预先上调PEEP,维持渡过CLS,以后根据病情下调呼吸机参数至撤机。对照组渗漏期选择低PEEP,监测病情,发现肺渗漏、肺水肿指征后及时上调PEEP,以后根据病情下调呼吸机参数至撤机。比较两组患儿肺水肿发生率、机械通气时间、预后。结果实验组16例均临床治愈出院。无一例肺水肿并发症,平均机械通气时间4.8 d。对照组16例中并发肺水肿5例,放弃治疗1例,死亡1例。平均机械通气时间6.7 d。结论动态调整PEEP,渗漏期选择低PEEP,恢复期根据液体负荷、水肿程度、尿量及呼吸指数、氧合指数预先上调PEEP,维持渡过CLS,能减少肺水肿发生率,缩短机械通气时间,并发症少,预后好。 Objective To investigate the rational application of positive end expiratory pressure (PEEP) in children with capillary leak syndrome (CLS). Methods 32 cases of CLS children with mechanical ventilation were randomly divided into experimental group and control group. In the experimental group, PEEP was dynamically adjusted and PEEP was selected during the period of recovery. The recovery period was adjusted according to fluid load, edema, urine output, and respiratory index. Oxygenation index was used to increase PEEP and maintain CLEP. Weaning. In the control group, low PEEP was selected during the leaking period to monitor the disease. PEEP was found after pulmonary leakage and pulmonary edema indications were found, and ventilator parameters were adjusted to weaning according to the condition. The incidence of pulmonary edema, mechanical ventilation time and prognosis in both groups were compared. Results The experimental group of 16 patients were cured and discharged. No case of pulmonary edema complications, the average time of mechanical ventilation 4.8 d. Control group of 16 cases of pulmonary edema in 5 cases, give up treatment in 1 case, 1 died. Mean mechanical ventilation time 6.7 d. Conclusions The PEEP is dynamically adjusted and the low PEEP is selected during the period of recovery. According to the fluid load, edema, urine output and respiratory index, the oxygenation index increases the PEEP in advance and maintains the CLEP during the recovery period, which can reduce the incidence of pulmonary edema and shorten the duration of mechanical ventilation , Less complications, good prognosis.