摘要信息：摘 要 目的:探讨西维来司他钠对老年轻度阻塞性通气功能障碍患者胸腔镜手术后肺部并发症的影响。方法:选取择期行胸腔镜肺癌根治术的老年患者 180例，随机分成西维来司他钠组(S组)和乌司他丁组(U组)，每组90例。S组静脉泵注西维来司他钠，U组静脉泵注乌司他丁。比较两组至出院前的术后肺部并发症(PPCs)发生情况，麻醉诱导前 10 min (T)、切皮时(T,)、术毕即刻(T,)、术后 24h(T;)及72h(T)时的肺泡-动脉血氧分压差(P DO,)肺泡氧合指数(OI)和呼吸指数(RI);术前和术后2d时的第1秒用力呼气容积占预计值的百分比(FEV,%)、用力肺活量占预计值的百分比(FVC%)和FEV,FVC;术后气管导管拔管时间、麻醉后恢复室(PACU)入住时间及术后住院时间。结果:S组PACU停留时间短于U组;低氧血症、新出现肺部啰音和支气管痉挛发生率均低于U组;T~4时,PDO,和RI水平低于U组，0I水平高于U组:FEV,%、FVC%和FEV,FVC水平高于U组(P<0.05)。结论:西维来司他钠对老年轻度肺功能障碍患者行胸腔镜手术时具有一定的肺保护作用，可降低 PPCs 的发生。

摘要信息：目的 观察西维来司他钠在重症急性胰腺炎(SAP)合并肺损伤患者中的应用效果。方法 按随机数字表法将 2021年1月至 2023 年12月进行治疗的 84例SAP合并肺损伤患者分为对照组和观察组,各 42例。对照组采用鸟司他丁治疗,观察组于对照组的基础上加用注射用西维来司他钠治疗。比较两组炎症介质水平、肺郚超声评分([US)、血清淀粉酶(AMY)、尿淀粉酶(AMY),呼吸功能、肺损伤程度、病情严重程度、脏器功能、症状消失时间及不良反应发生情况。结果 观察组治疗后白细胞介素 -6(Ⅱ-6)、降钙素原(PCT)及C反应蛋白(CRP)水平均低于对照组,LUS 评分、AMY 和 UAMY 水平均低于对照组,氧合指数(PaO,Fi0,)与动脉血氧分压(PaO,)均高于对照组Muray 肺损伤量表(MLIS)评分、急性生理学和慢性健康状况Ⅱ(APACHEII)评分及序贯器官衰竭评分系统(SOFA)评分均低于对照组,呼吸困难、恶心呕吐及腹痛消失时间均短于对照组,差异有统计学意义(P<0.05):两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 SAP合并肺损伤患者采用注射用西维来司他钠与鸟司他丁联合治疗可减轻炎症反应,改善呼吸功能,保护脏器功能,减轻肺损伤,控制患者病情,且不良反应并未增加。

摘要信息：1、炎症介质 NE、TNF-α、I-6 的过多激活参与 SAP 的进程及相关肾损害，肾组织NF-xB 激活在其中起重要作用;2、SS 发挥肾器官保护的可能活性机理:影响血清中炎症介质 NE、TNF-α、Ⅱ-6 水平是主要环节，减少其释放;其次抑制肾组织 NF-KB 活化，减轻炎性因子对肾组织细胞造成损伤有关。

摘要信息：目的 探讨注射用西维来司他钠治疗急性胰腺炎引发的全身炎症反应综合征(SIRS)及急性肺损伤的疗效。方法，对一例急性胰腺炎引发SIRS及急性肺损伤的患者采取注射用西维来司他钠治疗，通过动态监测血淀粉酶、血脂肪酶、白细胞计数、血小板计数、总胆红素、肌酐、转氨酶、氧合指数、胸部CT变化等，对患者进行效果评价。结果，在常规治疗的基础上采取注射用西维来司他钠治疗7d后，患者SIRS表现得到改善，血淀粉酶、脂肪酶及白细胞计数较入院时下降:与初入重症医学科相比，患者氧合指数明显改善，双肺弥漫性浸润改变及双侧胸腔积液好转;用药期间患者未出现肝肾功能损伤、血小板减少等不良反应。结论，注射用西维来司他钠治疗急性胰腺炎引发的SIRS及急性肺损伤是安全有效的。

摘要信息：Background:Neutrophil infiltration plays a critical role in the pathogenesis of acute lung injury following liver transplantation (LT). Neutrophil elastase is released from neutrophils during pulmonary polymorphonuclear neutrophil activation and sequestration. The aim of the study was to investigate whether the inhibition of neutrophil elastase could lead to the restoration of pulmonary function following LT. Methods:In in vivo experiments, lung tissue and bronchoalveolar lavage fluid (BALF) were collected at 2, 4, 8, and 24 h after rats were subjected to orthotopic autologous LT (OALT), and neutrophil infiltration was detected. Next, neutrophil elastase inhibitors, sivelestat sodium hydrate (exogenous) and serpin family B member 1 (SERPINB1) (endogenous), were administered to rats before OALT, and neutrophil infiltration, pulmonary oxidative stress, and barrier function were measured at 8 h after OALT. Results:Obvious neutrophil infiltration occurred from 2 h and peaked at 8 h in the lungs of rats after they were subjected to OALT, as evidenced by an increase in naphthol-positive cells, BALF neutrophil elastase activity, and lung myeloperoxidase activity. Treatment with neutrophil elastase inhibitors, either sivelestat sodium hydrate or SERPINB1, effectively reduced lung naphthol-positive cells and BALF inflammatory cell content, increased expression of lung HO-1 and tight junction proteins ZO-1 and occludin, and increased the activity of superoxide dismutase. Conclusion:Neutrophil elastase inhibitors, sivelestat sodium hydrate and SERPINB1, both reduced lung neutrophil infiltration and pulmonary oxidative stress and finally restored pulmonary barrier function.

摘要信息：The purpose of this study was to evaluate the effect of sivelestat sodium hydrate, a selective inhibitor of neutrophil elastase in the systemic inflammatory response, pulmonary function, and the postoperative clinical course following esophagectomy. Patients with hypoxia associated with surgical stress in the intensive care unit (ICU) immediately after an esophagectomy were eligible for this study. The degree of hypoxia was calculated according to the ratio of arterial oxygen tension (PaO(2)) to the fractional concentration of inspired oxygen (FiO(2))-PaO(2)/FiO(2). Patients with PaO(2)/FiO(2) < 300 mmHg were enrolled in this study. Seven patients were treated with sivelestat, and 10 were not so treated. The degree of hypoxia, the criteria for systemic inflammatory response syndrome (SIRS), and the postoperative clinical course were compared between the two groups. The postoperative decreases in the PaO(2)/FiO(2) ratio were significantly suppressed in the sivelestat group (p < 0.05, by analysis of variance, or ANOVA). Furthermore, 9 of the 10 control group patients developed SIRS on postoperative day 2, whereas only 2 of 7 of the sivelestat group patients developed SIRS (p < 0.05). The postoperative increases in the heart rate were significantly suppressed in the sivelestat group (p < 0.05, ANOVA). The postoperative decreases in the platelet counts were significantly suppressed in the sivelestat group (p < 0.05, ANOVA). The duration of mechanical ventilation and the length of ICU stay for the sivelestat group were shorter than that for the control group. We demonstrated that the postoperative decreases in the PaO(2)/FiO(2) ratio following esophagectomy were significantly suppressed in the sivelestat-treated group. This clinical study showed that a neutrophil elastase inhibitor may thus be a potentially useful drug for treating acute lung injury following esophagectomy.

摘要信息：The objective of the study was to evaluate the efficacy of sivelestat, a selective neutrophil elastase inhibitor, on body fluid balance after transthoracic esophagectomy. Esophagectomy with elective lymphadenectomy may induce excessive release of neutrophil elastase, which then promotes vascular permeability and an excessive water shift from the intravascular space to the peripheral compartment. Body fluid imbalance after esophagectomy often leads to circular instability, a decrease of urine output, and a delay in the shift to a diuretic state. The study was designed as a case-control study with a historical control group. A retrospective analysis was performed to examine our hypothesis that sivelestat improves abnormal body fluid retention and prevents subsequent pulmonary complications. To reveal the direct influence of sivelestat on the postoperative course, we avoided using steroids or other diuretic agents. Eighty-eight patients who underwent thoracic esophagectomy with extended lymphadenectomy from 2000 to 2008 were divided into two groups: those treated from 2003 to 2008, who all received postoperative administration of sivelestat (n=60); and those treated from 2000 to 2002, who did not receive sivelestat and were used as the control group (n=28). Both groups received fluid management using the same protocol. The time to reach a diuretic state, time until extubation of the tracheal tube, and development of delayed respiratory dysfunction were compared between the groups using univariate and multivariate analysis. The time until a shift to a diuretic state was significantly shorter after treatment with sivelestat (p<0.0001) and with a shorter operation time (p<0.0001). The tracheal tube was extubated significantly earlier in the sivelestat group (p<0.0001) and the incidence of delayed respiratory dysfunction was also significantly lower (p=0.0028) in this group. Multivariate logistic regression analysis showed that a delay in a shift to a diuretic state was a strong independent risk factor for the time to tracheal extubation (odds ratio 2.539, p=0.0056) and occurrence of delayed respiratory dysfunction (odds ratio 1.989, p=0.0104). Sivelestat treatment was not independently associated with reduced pulmonary complications, but the diuretic state was strongly regulated by sivelestat treatment (odds ratio 0.044, p=0.0003). Thus, administration of sivelestat has a beneficial influence on recovery from body water imbalance through a more rapid return to a diuretic state after esophagectomy, which contributes to prevention of subsequent pulmonary complications.

摘要信息：Post-operative pulmonary complications such as systemic inflammatory response syndrome (SIRS), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are strongly associated with morbidity and mortality after esophagectomy. Post-operative administration of sivelestat sodium hydrate (sivelestat), a selective inhibitor of neutrophil elastase (NE), has been shown to improve the post-operative clinical course after esophagectomy. This study aimed to evaluate the effect of prophylactic administration of sivelestat on bronchial inflammatory responses. We randomized 24 patients into two groups. One group received 0.2 mg/kg/h sivelestat from the induction of anesthesia to post-operative day 1 (sivelestat group) and the other group received the same amount of physiological saline (control group). Bronchial alveolar epithelial lining fluid (ELF) samples were obtained from both groups at the induction of anesthesia and at the end of surgery. The serum and ELF levels of interleukin (IL)-6 and IL-8 were measured by enzyme-linked immunosorbent assay, and NE activity was spectrophotometrically determined using the same samples. Although IL-6 levels in the ELF significantly increased at the end of surgery compared with the pre-operative levels in both groups, the IL-8 levels and NE activity did not significantly increase at the end of the surgery compared to the corresponding pre-operative values in the sivelestat group. Moreover, IL-8 levels and NE activity in the ELF were significantly reduced at the end of surgery in the sivelestat group compared with corresponding values in the control group. The durations of ALI and ARDS were apparently shorter in the sivelestat group and the duration of SIRS was significantly shorter in the sivelestat group compared to the control group. We demonstrated that prophylactic use of sivelestat mitigated bronchial inflammation by suppressing NE activity and IL-8 levels in the ELF and shortened the duration of SIRS after transthoracic esophagectomy.

摘要信息：Sivelestat sodium hydrate is a selective inhibitor of neutrophil elastase (NE), and is effective in acute lung injury associated with systemic inflammatory response syndrome (SIRS). The effect of Sivelestat for postoperative clinical courses after transthoracic esophagectomy was investigated. Consecutive patients with carcinoma of the thoracic esophagus who underwent transthoracic esophagectomy between 2003 and 2004 were assigned to the Sivelestat-treated group (n = 18), and those between 1998 and 2003 were assigned to the control group (n = 25). The morbidity rate, duration of postoperative SIRS, mechanical ventilation, and intensive care unit (ICU) stay, and the sum of the sequential organ failure assessment scores at all time points after the operation were compared. Serum NE activities and serum concentrations of TNF-alpha, IL-1beta, IL-6, and high mobility group box chromosomal protein 1 (HMGB1) were measured. Postoperative complications developed in three patients in the control group, and one in the Sivelestat-treated group. The durations of SIRS, mechanical ventilation, and ICU stay were significantly shorter in the Sivelestat-treated group. Even in patients without complications, the durations of mechanical ventilation, and ICU stay were also significantly shorter, and the arterial oxygen pressure/fraction of inspired oxygen ratio at postoperative day 1 was significantly higher in the Sivelestat-treated group. Serum NE activities and serum concentrations of IL-1beta, IL-6, and HMGB1 were significantly suppressed in the Sivelestat-treated group. Postoperative Sivelestat treatment after transthoracic esophagectomy improves the condition of SIRS and postoperative clinical courses, even in patients without complications.

摘要信息：Aim:To evaluate the benefit and safety of sivelestat (a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy. Methods:Online databases including PubMed, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases (Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio (RR) was used to express the effect size of dichotomous outcomes, and mean difference (MD) or standardized mean difference was used to express the effect size of continuous outcomes. Results:Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I (2) = 76.3%, SMD = -1.41, 95%CI: -2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery (I (2) = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever. Conclusion:A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect.