文章来源：中国知网

摘要信息：推荐意见 1 ：对于 ARDS 患者，应当在诊断的同时评估氧合状况用以指导抗炎药物使用，推荐标准治疗基础上早期（至少 48 h 内）联合应用西维来司他钠。（证据级别 ：中等质量 ；推荐级别 ：强推荐） 推荐意见 2 ：推荐 ARDS 患者同步检测 IL-6 等炎症因子以评估炎症水平，高炎症表型 ARDS 患者中使用西维来司他钠等抗炎药物可能有效。（证据级别 ：低质量 ；推荐级别 ：弱推荐） 推荐意见 3 ：对于存在 ARDS 高危因素的低氧血症患者应用西维来司他钠可早期改善氧合。（证据级别：低质量；推荐级别 ：弱推荐） 推荐意见 4 ：ARDS 患者中可尝试西维来司他钠与其他抗炎药物联合治疗，可能通过多途径抑制炎症带来获益。（证据级别 ：低质量 ；推荐级别 ：弱推荐） 推荐意见 5 ：对于脓毒症并发 ARDS 的患者，可参考西维来司他钠在 ARDS 患者中的应用。（证据级别 ：中等质量 ；推荐级别 ：强推荐） 推荐意见 6 ：脓毒症患者即使未并发 ARDS，应用西维来司他钠可能有潜在心、肺及肠道等器官功能保护作用。（证据级别 ：低质量 ；推荐级别 ：弱推荐） 推荐意见 7 ：急性中毒患者应尽量明确中毒机制，对于靶器官为肺或合并其他 ARDS 高危因素的患者可以在常规治疗基础上联合应用西维来司他钠等抗炎药物。（证据级别 极低质量 ；推荐级别 ：弱推荐） 推荐意见 8 ：创伤合并高炎症状态患者可继发 ARDS及其他多器官功能障碍，对于此类患者或创伤性湿肺患者应用西维来司他钠可能有潜在获益。（证据级别 ：低质量 ；推荐级别 ：弱推荐）

文章来源：PubMed

摘要信息：Objective: Neutrophil elastase (NE) plays an important role in the development of acute respiratory distress syndrome (ARDS). Sivelestat sodium, as a selective NE inhibitor, may improve the outcomes of patients with sepsis-induced ARDS in previous studies, but there is a lack of solid evidence. This trial aimed to evaluate the effect of sivelestat sodium on oxygenation in patients with sepsisinduced ARDS. Methods: We conducted a multicenter, double-blind, randomized, placebo-controlled trial enrolling patients diagnosed with sepsisinduced ARDS admitted within 48 hours of the advent of symptoms. Patients were randomized in a 1:1 fashion to sivelestat or placebo. Trial drugs were administered as a 24-hour continuous intravenous infusion, for a minimum duration of 5 days and a maximum duration of 14 days. The primary outcome was the proportion of PaO2/FiO2 ratio improvement on Day 5 after randomization, deffned by a greater than 50% improvement in PaO2/FiO2 compared with that on ICU admission or PaO2/FiO2 reached over 300 mmHg on Day 5. Results: The study was stopped midway due to a potential between-group difference in mortality observed during the interim analysis. Overall, a total of 70 patients were randomized, of whom 34 were assigned to receive sivelestat sodium and 36 placebo. On day 5, 19/ 34 (55.9%) patients in the sivelestat group had PaO2/FiO2 ratio improvement compared with 7/36 (19.4%) patients in the placebo group (risk difference, 0.36; 95% CI, 0.14 to 0.56, p<0.001). The Kaplan–Meier curves showed a signiffcantly improved 28-day survival rate in patients receiving sivelestat than those not (hazard ratio, 0.32; 95% CI, 0.11 to 0.95; p=0.041). Conclusion: In patients with sepsis-induced ARDS, sivelestat sodium could improve oxygenation within the ffrst ffve days and may be associated with decreased 28-day mortality. Keywords: sepsis, acute respiratory distress syndrome, neutrophil elastase, sivelestat, oxygenation

文章来源：中国知网

摘要信息：目的 探析西维来司他钠联合俯卧位通气在急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）中的疗效。方法 确认研究样本为50例ALI/ARDS患者，来源潍坊市第二人民医院，研究起止时间2023年10月至2024年9月，以随机数字法设计分组，分成对照组（25例，常规治疗）和试验组（25例，在对照组的基础上增加静脉泵入西维来司他钠联合俯卧位通气治疗）。评价组间血气指标[动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）]、临床指标、病死率及并发症发生情况。结果 试验组血气指标高于对照组（P<0.05）；试验组症状缓解时间及住院时间均短于对照组（P<0.05）；试验组并发症总发生率低于对照组（P<0.05）。结论 西维来司他钠与俯卧位通气联合使用，有助于改善ALI/ARDS患者的血气水平，加速症状缓解，缩短住院时间，并降低并发症的发生率。

文章来源：中国知网

摘要信息：目的 观察西维来司他钠联合亚胺培南西司他丁钠治疗重症肺炎的临床效果及对炎性指标和血气指标的影响。方法 回顾性选取2021年6月—2023年6月福建医科大学附属闽东医院收治的重症肺炎患者62例，按照治疗用药不同分为联合注射组与单药注射组，各31例。单药注射组给予注射用亚胺培南西司他丁钠治疗，联合注射组在单药注射组基础上给予注射用西维来司他钠治疗，2组均用药1周。比较2组用药前后炎性指标[C反应蛋白（CRP）、降钙素原（PCT）、白介素-6（IL-6）、中性粒细胞与淋巴细胞比值（NLR）]、肺炎胸片吸收评价量表（PCRAES）评分、临床肺部感染指数（CPIS）评分、血气指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数],临床症状消失时间。结果 用药1周后，2组血清CRP、PCT、IL-6水平及NLR均降低，且联合注射组低于单药注射组（P<0.05或P<0.01）;2组PCRAES、CPIS评分均降低，且联合注射组低于单药注射组（P<0.05或P<0.01）;2组PaO2、氧合指数升高，PaCO2降低，且联合注射组升高/降低幅度大于单药注射组（P<0.05或P<0.01）。联合注射组退热时间与咳嗽、胸闷、肺部湿啰音消失时间均短于单药注射组（P<0.05或P<0.01）。结论 西维来司他钠联合亚胺培南西司他丁钠治疗重症肺炎的效果显著，可有效改善临床症状，在减轻机体炎性反应的同时保护肺组织，提高肺功能，加快病情恢复。

文章来源：PubMed

摘要信息：Background. Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including the use of high flow nasal oxygen (HFNO), expanding use of pulse oximetry in place of arterial blood gases, use of ultrasound for chest imaging, and the need for applicability in resource-limited settings. Methods. A Consensus Conference of 32 critical care ARDS experts was convened, had six virtual meetings (June 2021-March 2022), and subsequently obtained input from members of several critical care societies. The goal was to develop a definition that would: (1) identify patients with the currently accepted conceptual framework for ARDS; (2) facilitate rapid ARDS diagnosis for clinical care and research; (3) be applicable in resource-limited settings; (4) be useful for testing specific therapies; and (5) be practical for communication to patients and caregivers. Results. The committee made four main recommendations: (1) Include HFNO with a minimum flow rate of  30 liters/min; (2) Use arterial oxygen tension (PaO2)/FiO2  300 mmHg or SpO2/FiO2 < 315 (if SpO2  97%) to identify hypoxemia; (3) Retain bilateral opacities for imaging criteria but add ultrasound as an imaging modality, especially in resource-limited areas; and (4) In resource-limited settings, do not require PEEP, oxygen flow rate, or specific respiratory support devices. Conclusions. We propose a New Global Definition of ARDS that builds on the Berlin Definition. The recommendations also identify areas for future research, including the need for prospective assessments of feasibility, reliability, and prognostic validity of the proposed Global Definition.

文章来源：PubMed

摘要信息：Objective:We aimed to evaluate the protective effects of sivelestat sodium on the basis of corticosteroid therapy in patients with moderate-to-severe acute respiratory distress syndrome (ARDS).Methods:We retrospectively investigated 127 patients with confirmed moderate-to-severe ARDS treated in the intensive care unit (ICU) at Dazhou Central Hospital. Patients were divided into the control group (corticosteroids alone) and the combination therapy of steroids and sivelestat sodium (CTSSS) group according to the therapeutic interventions. The primary outcome was in-hospital mortality. And the baseline characteristics and laboratory findings of patients were collected for analysis.Results:The overall mortality rate in 127 patients was 48.8%. There was no statistically significant difference in in-hospital mortality between the CTSSS group and the control group (45.3% vs. 56.1%). In the subgroup of patients aged < 80 years or with an Acute Physiology and Chronic Health Evaluation (APACHE) II score < 30, CTSSS could reduce the risk of mortality (odds ratio [OR] = 0.41, 95% confidence interval [CI], 0.17-0.96, p=0.041; OR = 0.31, 95% CI, 0.13-0.77, p=0.012; respectively). Among patients aged 80 years or older, those with CTSSS exhibited a significantly elevated risk of mortality (OR = 13; 95% CI, 1.20-140.73; p=0.035).Conclusion:Compared with corticosteroids alone, CTSSS could improve oxygenation index, increase lymphocyte count, protect extrapulmonary organs and reduce in-hospital mortality rate in patients with moderate-to-severe ARDS in specific subgroups (age < 80 years or APACHE II score < 30). It might be advisable to avoid CTSSS in moderate-to-severe ARDS patients aged 80 years or older. Prospective studies involving larger sample sizes are needed to verify these findings.

文章来源：PubMed

摘要信息：Objective:Sivelestat may reduce postoperative pulmonary injury after total arch replacement (TAR). This study aimed to evaluate whether the preoperative PaO2/FiO2(P/F) ratio affects the efficacy of sivelestat in reducing postoperative pulmonary injury in patients with acute aortic dissection (AAD) who underwent TAR using deep hypothermic circulatory arrest (DHCA). Methods:Data of patients with AAD who underwent TAR using DHCA in a tertiary hospital between February 1, 2022, and December 30, 2022, were retrospectively reviewed. The patients were divided into the sivelestat and control groups. Three subgroup analyses were performed based on the postoperative P/F ratio. The primary clinical outcomes were assessed to determine the efficacy and safety of sivelestat in managing postoperative pulmonary dysfunction in patients undergoing cardiopulmonary bypass. Results:A total of 187 patients were included, with 95 in the sivelestat group and 92 in the control group. No significant differences were found in the clinical variables between the two groups (all P > 0.05), except for some improvements in the inflammatory biomarker levels (including white blood cell count, neutrophil count, and C-reactive protein). Subgroup analysis revealed that sivelestat treatment significantly increased the P/F ratio on the 4th day and 3rd day after TAR in patients with mild lung injury (P = 0.02) and moderate lung injury (P = 0.03), respectively. Additionally, sivelestat reduced the levels of several postoperative inflammatory biomarkers in both subgroups. Conclusions:Among patients with AAD with mild or moderate preoperative lung injury, defined by a low P/F ratio, sivelestat significantly improved the postoperative P/F ratio and attenuated inflammatory responses after TAR. These findings suggest an important avenue for further research.

文章来源：中国知网

摘要信息：目的 比较西维来司他钠与乌司他丁对急性Stanford A型主动脉夹层（ATAAD）手术患者术后切口感染的效果。方法 回顾性分析2022年1月至2023年1月行ATAAD患者109例，分为观察组（50例）和对照组（59例）。观察组患者接受西维来司他钠治疗，对照组患者接受乌司他丁治疗。主要结局指标为术后至出院前的切口感染发生率。次要结局指标为术后肺部并发症（PPCs）、术后气管导管拔管时间、重症监护室（ICU）入住时间及术后住院时间；麻醉诱导前10 min（T0）、切皮时（T1）、术毕即刻（T2）、术后24 h （T3）及术后72 h（T4）时测量患者肺泡-动脉血氧分压差(PA-aDO2)、肺泡氧合指数（OI）及呼吸指数（RI）。术前1 d、术后1 d及术后3 d时分别采集患者外周静脉血样本，测定白细胞计数（WBC）、中性粒细胞数量（NEUT）、中性粒细胞百分比（NEUT%）及C反应蛋白（CRP）水平。结果 对照组术后切口感染发生率为13.6%（8/59）,观察组为4.0%（2/50）,观察组低于对照组（P<0.05）。观察组患者术后气管导管拔管时间及ICU停留时间均较对照组缩短（P<0.05）。术后至出院前，与对照组比较，观察组高碳酸血症发生率降低（P<0.05）。观察组和对照组PPCs总发生率分别为10.0%和38.0%,前者较后者降低（P<0.05）。观察组T1～4时PA-aDO2和RI低于对照组、OI高于对照组（P<0.05）。观察组术后1 d和3 d时WBC、NEUT和NEUT%以及CRP水平均低于对照组，差异有统计学意义（P<0.05）。结论 与乌司他丁相比较，西维来司他钠可降低ATAAD患者术后切口感染发生率，抑制炎症反应。

文章来源：中国知网

摘要信息：目的 探讨西维来司他钠治疗急性呼吸窘迫综合征（ARDS）的临床疗效及其应用价值。方法 回顾性分析2022年10月至2023年10月平顶山市第一人民医院诊治的80例ARDS患者分为对照组（40例）、观察组（40例）。对照组接受常规治疗，观察组接受西维来司他钠治疗。统计对比两组临床疗效及治疗前后生理生化指标[动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）]、Murray肺损伤评分、急性生理功能和慢性健康状况评分系统Ⅱ（APACHEⅡ）、炎症因子[超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）]、血管内皮功能[血管生成素-2（Ang-2）、可溶性晚期糖基化终产物受体（sRAGE）、内皮素-1（ET-1）、一氧化氮（NO）]。比较两组不良反应发生率与病死率。结果 观察组总有效率（90.00%）较对照组（72.50%）升高（P<0.05）;与对照组比较，观察组治疗后SaO2、PaO2升高，Murray评分、APACHEⅡ评分降低（P<0.05）;与对照组比较，观察组治疗后血清hs-CRP、IL-6、PCT、Ang-2、sRAGE、ET-1水平降低，血清NO水平升高（P<0.05）;两组不良反应发生率比较差异无统计学意义（P>0.05）;观察组病死率低于对照组（P<0.05）。结论 西维来司他钠治疗ARDS的效果确切，可改善血气指标，抑制炎症反应，减轻肺损伤，改善血管内皮功能，降低病死率，具有一定安全性。

文章来源：PubMed

摘要信息：患者平均年龄65岁（35 ~ 87岁），女性2例，男性13例。这些数据最好的描述是一个具有比例残差的单室模型。西维来司他钠表观分布体积和表观清除率分别为20.88 L和1.79 L/h。西维来司他钠清除率受协变量总胆红素（TBIL）的影响，提示建议在TBIL水平升高的患者减少剂量。