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：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。

摘要信息：Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. Our previous reports revealed that prophylactic sivelestat administration at CPB initiation suppresses the postoperative acute inflammatory response due to CPB in pediatric cardiac surgery. The purpose of this study was to compare the effects of sivelestat administration before CPB and at CPB initiation in patients undergoing pediatric open-heart surgery. Twenty consecutive patients weighing 5-10 kg and undergoing ventricular septal defect closure with CPB were divided into pre-CPB (n = 10) and control (n = 10) groups. Patients in the pre-CPB group received a 24 h continuous intravenous infusion of 0.2 mg/kg/h sivelestat starting at the induction of anesthesia and an additional 0.1 mg/100 mL during CPB priming. Patients in the control group received a 24-h continuous intravenous infusion of 0.2 mg/kg/h sivelestat starting at the commencement of CPB. Blood samples were tested. Clinical variables including blood loss, water balance, systemic vascular resistance index, and the ratio between partial pressure of oxygen and fraction of inspired oxygen (P/F ratio) were assessed. White blood cell count and neutrophil count as well as C-reactive protein levels were significantly lower in the pre-CPB group according to repeated two-way analysis of variance, whereas platelet count was significantly higher. During CPB, mixed venous oxygen saturation remained significantly higher and lactate levels lower in the pre-CPB group. Postoperative alanine aminotransferase and blood urea nitrogen levels were significantly lower in the pre-CPB group than in the control group. The P/F ratio was significantly higher in the pre-CPB group than in the control group. Fluid load requirement was significantly lower in the pre-CPB group.Administration of sivelestat before CPB initiation is more effective than administration at initiation for the suppression of inflammatory responses due to CPB in pediatric open-heart surgery, with this effect being confirmed by clinical evidence.

摘要信息：Cardiopulmonary bypass (CPB) evokes activation of a systemic inflammatory response. Sivelestat has been used clinically to treat acute lung injury associated with systemic inflammatory response syndrome. This prospective, doubleblind, randomized study was designed to evaluate the effects of sivelestat in the perioperative period of elective pediatric open-heart surgery with CPB. Twenty-six consecutive pediatric patients weighing between 5 and 10 kg and undergoing open-heart surgery with CPB were divided into a sivelestat group (n = 13) and a control group (n = 13). The patients in the sivelestat group were administered a continuous intravenous infusion of 0.2 mg/kg/hour of sivelestat, and the patients in the control group were administered the same volume of 0.9% saline from the initiation of CPB to 24 hours after surgery. Blood samples were drawn for the measurement of cytokines, polymorphonuclear elastase (PMN-E), white blood cell count (WBC), neutrophil count (NC), and C-reactive protein (CRP). There were no significant differences in cytokine data between the two groups. The peak PMN-E and WBC levels were significantly increased in the control group (P = 0.049, P = 0.039). The WBC and NC levels immediately after surgery in the control group were significantly greater than those in the sivelestat group (P = 0.049, P = 0.044). The peak CRP level in the control group was significantly greater than the sivelestat group (P = 0.04), and the CRP level on postoperative day 4 in the control group was significantly greater than in the sivelestat group (P = 0.014). This study showed that sivelestat attenuates the perioperative inflammatory response in pediatric heart surgery with CPB.

摘要信息：Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double-blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB. Thirty consecutive patients, weighing 5-10 kg and undergoing open heart surgery with CPB, were assigned to sivelestat (n = 15) or control (n = 15) groups. From CPB initiation to 24 h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2 mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha, polymorphonuclear elastase (PMN-E), C-reactive protein (CRP), as well as the white blood cell (WBC) count, platelet count, and neutrophil count (NC) were measured. PMN-E levels, IL-8 levels, WBC count, NC, and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two-way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB.

摘要信息：[摘要] 目的 探讨西维来司他钠对急性 Stanford A型主动脉夹层(AAAD)手术患者围术期急性肺损伤(ALI)的影响。方法招募2021年12月至2022年6月期间于河南省胸科医院手术室急诊行手术治疗的AAAD 患者 72 例,采用随机数字表法将其分为西维来司他钠组(S 组)和乌司他丁组(U 组),每组36 例。S组患者于麻醉前 10 min 经静脉以 0.2 mg/(kg·h)的速率泵注西维来司他钠注射液直至机械通气脱机。U 组患者于麻醉前 10 min 以2万 U/kg的剂量经静脉泵注乌司他丁直至机械通气结束脱机。于麻醉诱导后切皮前(T)术毕即刻(T,)、术后 24 h(T;)及48 h(T)时采集桡动脉血行血气分析,计算肺泡-动脉血氧分压差(PDO,)肺泡氧合指数(0D)和呼吸指数(RI) 。于T~T 时抽取中心静脉血测定肿瘤坏死因子(TNF-)、白细胞介素6(Ⅱ6)和白细胞介素8(Ⅱ8)水平。于术前1d及术后1d、3 d时抽取外周静脉血并测定白细胞计数(WBC)中性粒细胞计数(NEUT)和中性粒细胞百分比(NEUT%)及C反应蛋白(CRP)水平。记录患者术后肺部并发症(PPC)发生率及不良反应发生率。结果与U组比较,S组患者术后机械通气时间及 ICU 入住时间更短差异有统计学意义(P<0.05)。在T,~T 时间点,S组PDO,和 RI水平显著低于U组(P<0.05),0I水平显著高于U组(P<0.05);血清 TNF-、ⅡL6、Ⅱ8水平均显著低于U组(P<0.05)。与术前1d相比,两组术后1 d3 d的 WBC、NEUT、NEUT%及 CRP 水平均显著增高(P<0.05),S 组水平低于U组(P<0.05)。S 组术后高碳酸血症、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,差异有统计学意义(P<0.05)。结论西维来司他钠可抑制 AAAD 手术患者炎性反应,减轻围术期 ALI,降低 PPCs 发生率,改善患者早期预后。

摘要信息：摘要:目的 探讨西维来司他钠对急性: Stanford A型主动脉夹层(ATAAD)患者术后谵妄(POD)的预防作用及其机制。方法 纳入急诊行ATAAD手术患者80例,跟据随机数字表法分为西维来司他钠组及对照组各40例。西维来司他钠组于手术麻醉诱导前10 min静脉泵注西维来司他钠直至手术结束,对照组以相同的速率静脉泵注相同体积的生理盐水直至手术结束。术后3d内采用3min谵妄诊断量表(3D-CAM)对患者POD发生情况进行评估;于术后24h时采集患者外周静脉血,采用改良的Ficoll密度梯度离心法提取外周血单个核细胞(PBMCs),比色法检测PBMCs内铁离子(Fe”)浓度、丙二醛(MDA)含量及超氧化物歧化酶(SOD)活性,Westem bloting法检测PBMCs内长链脂酰辅酶A合成酶(ACSL4)及谷胱甘肽过氧化物酶4(GPX4)蛋白。记录围手术期情况及不良反应发生情况。结果 西维来司他钠组POD发生率低于对照组(P<0.05),两组POD严重程度评分及POD持续时间比较差异均无统计学意义。西维来司他钠组PBMCS内Fe”浓度及MDA含量低于对照组,SOD活性高于对照组(P均<0.05)。西维来司他钠组 PBMCS内ACSL4蛋白表达低于对照组,GRX4蛋白表达高于对照组(P均<0.05)。西维来司他钠组ICU人住时间及术后住院时间少于对照组(P均<0.05):两组不良反应发生率差异均无统计学意义。结论，西维来司他钠可预防急性ATAAD手术患者POD的发生,其机制可能与抑制铁死亡从而减轻神经损伤有关。

摘要信息：摘要:目的 观察西维来司他钠对行体外循环心脏瓣膜置换术老年患者肺功能的保护作用,探讨其可能机制。方法 2021年10月-2022年10月河南省人民医院行体外循环心脏膜置换术老年患者 76例,38 例麻醉诱导前10 min静脉泵注西维来司他钠 0.2 mg/(kg·h)至机械通气脱机者为观察组,38 例以相同速率静脉泵注生理盐水至机械通气脱机者为对照组。2组分别于切皮前(T)、术毕即刻(T,)、术后 24 h(T)、术后 48 h(T,)采集颈内静脉血,采用Ficoll密度梯度离心法分离外周血单个核细胞(PBMC),采用实时荧光定量 PCR 法检测 PBMCs 中白细胞介素(IL)-18.IL-1β mRNA 相对表达量,采用 Western blot 法检测 PBMCS NLRP3,caspase-1、消皮素 D(GSDMD)蛋白相对表达量,观察 T, 时 PBMCs形态变化。2 组分别于 T、T、T,、T,时采集桡动脉血行血气分析,测定 a(O,)、pa(CO,),计算肺泡-动脉血氧分压差(PDO2)、氧合指数(OI)和呼吸指数(RI)。记录2组体外循环时间、主动脉阻断时间、手术时间、麻醉时间、术中失血量及液体人量,术后机械通气时间、CU 治疗时间、首次下床活动时间、住院时间等;比较2组术中窦性心动过缓/过速、低血压/高血压、呯吸抑制及术后皮肤瘙痒、恶心呕叶、感染等发生情况。结果 观察组,时 pa(0,)pa(CO,)、血氧饱和度、P. DO,、RI、0I与对照组比较差异均无统计学意义(P>0.05),T、T、T;时 PDO,、RI 均低于对照组(P<0.05),01均高于对照组(P<0.05):2 组 T、T、T,时 PDO,,RI均高于 T 时(P<0.05),O1均低于T时(P<0.05)。T,时对照组 PBMCs 肿胀、变圆,气泡状突出物形成,形态大小不一,细胞膜裂解形成碎片,细胞间隙增宽、排列紊乱;观察组 PBMCs形态改变较对照组明显减轻。观察组 PBMCSIL-18、IL-1βmRNA 及 NLRP3、caspase-1.GSDMD蛋白相对表达量 T,时与对照组比较差异均无统计学意义(P>0.05),T、T、T;时均低于对照组(P<0.05);2 组T 、T,、T,时 IL-18、IL-1β mRNA 及 NLRP3,caspase-1、GSDMD 蛋白相对表达量均高于 T,时(P<0.05)。观察组术后机械通气时间[(33.3±8.0)h]、ICU 治疗时间[(51.9±7.8)h]均短于对照组[(39.9±9.6)、(61.7±8.4)h(t=3.256,P=0.002;t=5.270,P<0.001),体外循环时间、主动脉阻断时间、手术时间、麻醉时间、术中失血量及液体入量、围手术期悬浮红细胞及血浆输注量、首次下床活动时间,术后住院时间与对照组比较差异均无统计学意义(P>0.05)。2组术中均无呼吸抑制和深静脉血栓发生,术中窦性心动过缓、窦性心动过速、低血压、高血压及术后恶心呕吐、皮肤瘙痒、感染发生率比较差异均无统计学意义(P>0.05)。结论 西维来司他钠通过调控 NLRP3 炎性信号通路抑制 PBMCs 细胞焦亡保护行体外循环心脏瓣膜置换术老年患者术后肺功能,不增加围手术期不良事件的发生。

摘要信息：【摘要】 目的 探讨西维来司他钠对体外循环(CPB)下心脏瓣膜置换术老年患者术后早期康复的影响。方法 招募于本院手术室接受择期 CPB下心脏瓣膜置换术的患者 80 例,依据随机数字表法将其分成对照组(C组)和西维来司他钠组(S组),每组 40 例。记录术中及术后任何不良事件包括实性心动过缓或低血压/高血压、术后感染等。记录住院时间及 90 天死亡率。3个月后,使用问卷收集与睡眠有关的数据、生活质量、焦虑和疼痛。结果 C组共有 13 例患者(32.5%)在术后3d内发生术后谵妄(POD),S组共有5例患者(12.5%)在术后3d内发生POD,组间比较有显著差异(P、0.05)，两组术后13d时白细胞计数,中性粒细胞计数和中性粒细胞百分比较术前1d均增高,但S组均显著低于C组(P<0.05)。与C组比较,S组患者术后机械通气时间及 ICU入住时间均显著缩短(P<0.05)。术后 90d随访时,MMSE评分与基线相比无差异(P>0.05)。术后共有4例(10.0%)患者出现神经认知功能障碍(POCD)。两组间POCD发生率无差异(P>0.05)。术中心动过缓或低血压/高血压,术后感染等不良事件发生率在两组间均接近,差异无统计学意义(P>0.05)。在术后 90d的随访期内,两组均无患者死亡。两组在术后住院时间上无显著差异(P>0.05)。使用EQ5D问卷对两组患者的生活质量进行评估,结果显示,两组患者在统计学上无显著差异(P>0.05)。术后3个月,两组间的睡眠质量无显著差异(P>0.05)。结论 西维来司他钠可降低 CPB下心脏瓣膜置换术老年患者 POD发生率,缩短术后机械通气时间及 ICU入住时间,有益于术后早期康复。