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：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：背景：缺血再灌注损伤（IRI）常导致肾脏损害。虽然中性粒细胞胞外陷阱（NETs）的存在一直被观察到，但它们对IRI的具体影响尚未确定。西维来司他钠是中性粒细胞弹性酶的抑制剂，对NET的形成至关重要，可能为肾脏IRI提供治疗方法，值得进一步研究。 方法：建立小鼠早期肾IRI模型，经损伤标志物和组织学检查证实。免疫荧光和Western blot证实NETs在肾I/R中的作用。通过一套全面的方法进一步评估肾功能和病理，包括周期性酸希夫染色（PAS）和末端脱氧核苷酸转移酶dUTP Nick末端标记（TUNEL）染色，酶联免疫吸附试验（ELISA），实时肾小球滤过率（RT-GFR）监测，聚合酶链反应（PCR），生化分析，以及额外的Western blot和免疫荧光试验。 结果：我们首先量化了肾IRI小鼠的NET表达，并在24小时达到峰值。随后，给予西维来司他钠治疗，导致MPO、CitH3降低，并减轻了肾小管损伤。此外，它还导致血清肌酐、血尿素氮（BUN）、中性粒细胞明胶酶相关脂钙蛋白（NGAL）和肾损伤分子-1 （KIM-1）水平降低。降低肾组织炎症标志物白介素-6 （IL-6）和肿瘤坏死因子-α (TNF-α)的丰度，减轻氧化应激指标丙二醛（MDA）和4羟基烯醛（4HNE）的水平，并伴有肾I/R小鼠肾细胞凋亡减少和GFR升高。 结论：西维来司他钠通过下调中性粒细胞NETs，减少炎症、氧化应激和细胞凋亡，从而改善肾IRI，从而增强肾功能。

文章来源：中国知网

摘要信息：目的 探讨儿童使用西维来司他钠治疗脓毒症和急性呼吸窘迫综合征的安全性和有效性。方法 回顾性收集空军军医大学第一附属医院儿科重症监护室2021年1月至2024年7月收治的使用西维来司他钠的重症患儿的资料，并以“西维来司他钠”、“脓毒症”、“急性呼吸窘迫综合征”和“儿童”为中文检索词检索知网、万方和维普等数据库，以“Sivelestat sodium”、“Sepsis”、“Respiratory distress syndrome”和“Child”为英文检索词检索PubMed、Embase、Web of Science数据库，检索日期截至2024年7月30日。结果 共收集到9例病例，其中我院6例，文献报道3例，年龄中位数为4岁5个月，男性5例（55.6%）。9例患儿中，5例在用药后白细胞计数（WBC）、降钙素原（PCT）和白介素-6（IL-6）较前明显好转，3例C反应蛋白（CRP）明显改善；4例患有脓毒症患儿用药后PCT均明显改善，其中3例IL-6明显改善，2例WBC明显下降。在7例患有急性呼吸窘迫综合征或呼吸衰竭的患儿中，有2例在用药后氧合指数（PaO2/FiO2）明显改善。结论 西维来司他钠有助于降低WBC、IL-6、PCT和CRP的水平，抑制重症患儿者体内炎症反应，有助于改善急性呼吸窘迫患儿PaO2/FiO2比值。

文章来源：PubMed

摘要信息：Background Recent studies suggest that neutrophil elastase inhibitor (Sivelestat) may improve pulmonary function and reduce mortality in patients with acute respiratory distress syndrome. We examined the association between receipt of sivelestat and improvement in oxygenation among patients with acute respiratory distress syndrome (ARDS) induced by COVID-19. Methods A large multicentre cohort study of patients with ARDS induced by COVID-19 who had been admitted to intensive care units (ICUs). We used propensity score matching to compare the outcomes of patients treated with sivelestat to those who were not. The diferences in continuous outcomes were assessed with the Wilcoxon signed-rank test. Kaplan–Meier method was used to show the 28-day survival curves in the matched cohorts. A log-rank P-test stratifed on the matched pairs was used to test the equality of the estimated survival curves. A Cox proportional hazards model that incorporated a robust sandwich-type variance estimator to account for the matched nature of the data was used to estimate hazard ratios (HR). All statistical analyses were performed with SPSS 26.0 and R 4.2.3. A two-sided p-value of < 0.05 was considered statistically signifcant. Results A total of 387 patients met inclusion criteria, including 259 patients (66.9%) who were treated with sivelestat. In 158 patients matched on the propensity for treatment, receipt of sivelestat was associated with improved oxygenation, decreased Murray lung injury score, increased non-mechanical ventilation time within 28 days, increased alive and ICU-free days within 28 days (HR, 1.85; 95% CI 1.29 to 2.64; log-rank p < 0.001), shortened ICU stay and ultimately improved survival (HR, 2.78; 95% CI 1.32 to 5.88; log-rank p = 0.0074). Conclusions Among patients with ARDS induce by COVID-19, sivelestat administration is associated with improved clinical outcomes.

文章来源：中国知网

摘要信息：目的：探讨西维来司他钠联合气道压力释放通气（APRV）治疗小儿重度急性呼吸窘迫综合征（ARDS）的临床效果。方法：前瞻性选取2021年5月至2023年5月该院收治的重度ARDS患儿102例，按照随机数字表法分为对照组和研究组，各51例。对照组患儿给予APRV+基础对症治疗，研究组患儿给予西维来司他钠+APRV+基础对症治疗。比较两组患儿的临床症状体征、临床疗效和并发症发生率，治疗前后的肺功能指标、动脉血气指标和炎症因子水平。结果：研究组患儿的总有效率为94.12%（48/51）,明显高于对照组的80.39%（41/51）,差异有统计学意义（P<0.05）。研究组患儿机械通气时间、气促消失时间、肺部啰音消失时间和住院时间较对照组缩短，差异均有统计学意义（P<0.05）。治疗3、7 d后，两组患儿的血氧分压（PaO2）、动脉血氧饱和度（SaO2）高于治疗前，血二氧化碳分压（PaCO2）低于治疗前；且研究组患儿PaO2、SaO2和PaCO2的变化幅度大于对照组，差异均有统计学意义（P<0.05）。治疗3、7 d后，两组患儿的最大呼气压、最大呼气流量、最大吸气压和最大呼气中段流量较治疗前升高，且研究组患儿高于对照组；治疗3、7 d后，两组患儿血清C反应蛋白、肿瘤坏死因子α、巨噬细胞移动抑制因子-1和白细胞介素6水平较治疗前降低，且研究组患儿低于对照组，差异均有统计学意义（P<0.05）。研究组患儿的并发症发生率为5.88%（3/51）,低于对照组的21.57%（11/51）,差异有统计学意义（P<0.05）。结论：西维来司他钠联合APRV治疗小儿重度ARDS的疗效显著，能有效抑制患儿血清炎症因子释放，改善患儿血气分析指标、临床症状和肺功能，且能减少并发症的发生。