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.

摘要信息：Sivelestat sodium hydrate (Ono Pharmaceutical Co., Osaka, Japan) is a selective inhibitor of neutrophil elastase (NE) and is effective in reducing acute lung injury associated with systemic inflammatory response syndrome (SIRS). We conducted a prospective randomized controlled study to investigate the efficacy of perioperative administration of sivelestat sodium hydrate to prevent postoperative acute lung injury in patients undergoing thoracoscopic esophagectomy and radical lymphadenectomy. Twenty-two patients with thoracic esophageal cancer underwent video-assisted thoracoscopic esophagectomy with extended lymph node dissection in our institution between April 2007 and November 2008. Using a double-blinded method, these patients were randomly assigned to one of two groups preoperatively. The active treatment group received sivelestat sodium hydrate intravenously for 72 hours starting at the beginning of surgery (sivelestat-treated group; n= 11), while the other group received saline (control group; n= 11). All patients were given methylprednisolone immediately before surgery. Postoperative clinical course was compared between the two groups. Two patients (one in each group) were discontinued from the study during the postoperative period because of surgery-related complications. Of the remaining 20 patients, 2 patients who developed pneumonia within a week after surgery were excluded from some laboratory analyses, so data from 18 patients (9 patients in each group) were analyzed based on the arterial oxygen pressure/fraction of inspired oxygen ratio, white blood cell count, serum C-reactive protein level, plasma cytokine levels, plasma NE level, and markers of alveolar type II epithelial cells. In the current study, the incidence of postoperative morbidity did not differ between the two groups. The median duration of SIRS in the sivelestat-treated group was significantly shorter than that in the control group: 17 (range 9-36) hours versus 49 (15-60) hours, respectively (P= 0.009). Concerning the parameters used for the diagnosis of SIRS, the median heart rates on postoperative day (POD) 2 were significantly lower in the sivelestat-treated group than in the control group (P= 0.007). The median arterial oxygen pressure/fraction of inspired oxygen ratio of the sivelestat-treated group were significantly higher than those of the control group on POD 1 and POD 7 (POD 1: 372.0 [range 284.0-475.0] vs 322.5 [243.5-380.0], respectively, P= 0.040; POD 7: 377.2 [339.5-430.0] vs 357.6 [240.0-392.8], P= 0.031). Postoperative white blood cell counts, serum C-reactive protein levels, plasma interleukin-1beta, tumor necrosis factor-alpha levels, and plasma NE levels did not differ significantly between the two groups at any point during the postoperative course, nor did serum Krebs von den Lungen 6, surfactant protein-A, or surfactant protein-D levels, which were used as markers of alveolar type II epithelial cells to evaluate the severity of lung injury. Plasma interleukin-8 levels were significantly lower in the sivelestat-treated group than in the control group on POD 3 (P= 0.040). In conclusion, perioperative administration of sivelestat sodium hydrate (starting at the beginning of surgery) mitigated postoperative hypoxia, partially suppressed postoperative hypercytokinemia, shortened the duration of SIRS, and stabilized postoperative circulatory status after thoracoscopic esophagectomy.

摘要信息：Purpose:The goal of this retrospective study was to evaluate the effects of perioperative administration of sivelestat sodium hydrate, a selective neutrophil elastase inhibitor, on the clinical course after radical surgery for esophageal cancer. Methods:The effects of sivelestat on postoperative systemic inflammatory reactions and respiratory function were examined in 53 patients who underwent radical surgery for esophageal cancer between April 2004 and March 2005 with (n = 26, sivelestat group) and without (n = 27, control group) the administration of sivelestat. Results:The average age in the sivelestat group was higher than that in the control group, but there were no other differences in the background factors between the two groups. The postoperative oxygenation (PaO(2)/FiO(2) ratio) did not differ between the groups, but the decrease in oxygen saturation (SpO(2)) was significantly inhibited in the sivelestat group compared with the control group (p < 0.01). A significant inhibition of the increase in the CRP level also occurred in the sivelestat group (p < 0.01). The patients in the sivelestat group were also hospitalized for shorter periods compared to those in the control group. Conclusion:The early administration of sivelestat to patients receiving radical surgery for esophageal cancer can inhibit postoperative systemic inflammatory reactions and it might also have a beneficial effect on the prognosis.

摘要信息：Background:This study was undertaken to assess the value of administering perioperative sivelestat sodium hydrate (SSH), a selective neutrophil elastase inhibitor, after video-assisted thoracoscopic oesophagectomy for cancer. Method:Thirty-one consecutive patients with thoracic oesophageal cancer selected to undergo video-assisted thoracoscopic oesophagectomy with lymph node dissection between March 2007 and March 2009 were assigned randomly to a treatment group that received SSH intravenously for 7 days from the beginning of surgery (16 patients) and a control group that received saline (15). The primary endpoint was pulmonary function based on the arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P/F ratio) during the first 9 days after surgery. Secondary endpoints included platelet count, serum C-reactive protein (CRP) concentration, plasma neutrophil elastase-α(1)-antitrypsin complex level, duration of mechanical ventilation and systemic inflammatory response syndrome (SIRS), and length of intensive care unit (ICU) and hospital stay. Results:The mean P/F ratio of patients who received SSH was significantly higher than that of the control group on postoperative days 1-5 and 7. Duration of mechanical ventilation and SIRS, and length of ICU stay were significantly shorter in the treatment group. Serum CRP concentration on postoperative day 9 was significantly lower (P = 0·048), platelet counts on days 2, 3 and 5 were higher (P = 0·012, P = 0·049 and P = 0·006 respectively), and the incidence of postoperative acute lung injury was significantly lower following SSH treatment (P = 0·023). Conclusion:Perioperative sivelestat may maintain postoperative pulmonary function following video-assisted oesophagectomy.

摘要信息：目的 研究西维来司他钠对重症脑卒中患者血乳酸、C反应蛋白(CRP)以及转化生长因子 β,(TGF-β)的影响。方法 42 例重症脑卒中患者,随机分为A组 (19 例)和B组 (23 例);A 组患者接受综合治疗,B组患者在A组基础上加用西维来司他钠治疗。另选取15例轻症脑卒中患者作为C组。比较三组患者血乳酸、CRP 及血TGF-B,水平。结果 治疗前及治疗2、7d后,A组血乳酸分别为(2.81±0.96)、(2.23±0.77)、(1.85±0.52)mmol/L, CRP 分别为(98.49±5.16)、(56.72±7.72)、(31.22+7.14)mg。治疗前及治疗2、7d后,B组血乳酸分别为(3.08±0.87)、(2.31±0.85)、(1.78±0.63)mmoI/L,CRP分别为(95.33±6.11)、(48.74±5.69)、(26.88+5.73)mg。C组血乳酸、CRP分别为(2.08+0.52)mmoI、(18.34+5.88)mg。C组血乳酸低于A组和B组治疗前,差异具有统计学意义(P<0.05);C组 CRP水平低于A组和B组治疗前及治疗 2、7d后,差异具有统计学意义(P<0.05);但A组和B组治疗前血乳酸、CRP 水平比较差异均无统计学意义(P>0.05)。治疗 2、7d后,A组和B组血乳酸、CRP水平均低于本组治疗前,B组CRP水平低于A组,差异具有统计学意义(P<0.05);但A组和B组治疗2、7d后血乳酸水平比较差异无统计学意义(P>0.05)。治疗前及治疗2、7d后A组血 TGF-B,分别为(92.16±20.25)、(112.09+35.92)、(183.04+21.22)Hg/,B组血TGF-B,分别为(88.58+22.77)、(168.02+58.16)、(212.13 +33.44)μgL,C组血TGF-B,为(110.25+20.46)μg/。C组的血TGF-β,水平高于B组和A组治疗前,差异具有统计学意义(P<0.05);A组和B组治疗前血 TGF-B,水平比较差异无统计学意义(P>0.05)。治疗 2、7d后,A组和B组血TGF-B,水平均高于本组治疗前,且B组高于A组,差异具有统计学意义(P<0.05)。A组和B组治疗7d后血TCF-B,水平均高于C组,差异具有统计学意义(P<0.05)。结论，西维来司他钠可以降低重症脑卒中患者血乳酸及 CRP水平,提高血TGF-B,水平,可改善重症脑卒中患者的预后。

摘要信息：目的 观察中性粒细胞弹性蛋白酶(NE)抑制剂对高血压性脑出血(HICH)患者实施穿刺引流术后氧化应激和炎性介质的影响及对神经功能的保护作用。方法 选择2016年1月至2017年6月收治的146 例 HICH 患者为研究对象,根据随机数字分为观察组(75 例)和对照组(71例)。对照组患者行软通道穿刺引流术后予常规临床治疗;观察组患者通过微量泵静脉注射NE抑制剂西维来司钠注射液0.20 mg/(kg·h),连续用药7 d。术前与术后3 d、7 d,检测两组患者的氧化应激指标与血清炎性因子指标;术后7d评估神经功能缺损评分。结果:术后3d、7d,观察组的血清丙二醛水平显著低于对照组,超氧化物歧化酶和谷胱甘肽过氧化物酶水平均显著高于对照组。术后3d7d,观察组多形核白细胞比例、肿瘤坏死因子、白介素(Ⅱ)-6、8、超敏C反应蛋白均显著低于对照组(均 P<0.05)。术后7 d,观察组的 NIHSS 评分低于对照组(8.3 +2.2 us 9.2±1.9),差异有统计学意义(P<0.05):总有效率高于对照组(88.0%u 78.9%)，但差异无统计学意义(P>0.05)。结论 HICH术后加用 NE 抑制剂能明显抑制机体氧化应激反应和炎性反应,有助于患者术后神经功能的改善。

摘要信息：[摘要] 目的 探讨中性粒细胞弹性蛋白酶(NE)与皮层下动脉硬化性脑病(SAE)的相关性。方法 选择 SAE 患者 60 例,按 GOTO 分型分为I型、Ⅱ 型及 Ш型即 A、B、C组,各 20 例,另选健康体检者 20 例设为对照组,检测各组血浆 NE含量。结果，对照织与病例组 NE含量差异均有统计学意义(均 P< 0.05):不同严重程度组间 NE含量差异有统计学意义(P< 0.05):I型与Ⅲ型组 NE含量差异有统计学意义(P< 0.05)。结论SAE 患者血浆 NE水平随着病情严重程度加重而升高。

摘要信息：【摘要】目的 探讨重度脑卒中患者急性期血浆中性粒细胞弹性蛋白酶(NE)的含量、变化及其临床意义。方法收集重度急性脑卒中患者 20 例(实验组),分别监测发病后 12h、24h、48h、72h及7d的血浆中NE含量,健康对照组 20 例。结果 实验组在7d观察中死亡2例,健康对照组 NE 含量(17.7±8.0)ng/ml。重度脑卒中患者发病72h时血浆中 NE含量与健康对照组、12h及7d时间点差异有统计学意义(均P< 0.05),其血浆中 NE 含量在发病 24h开始升高,72h时达到高峰,7d后复査恢复正常。结论、重度脑卒中患者血浆中 NE 含量升高,呈动态变化。在发病后 72h达高峰,此时更易发生炎症级联反应甚至导致 SIRS,为进一步研究相关问题提供了一定的理论依据。

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：百草枯是一种高效能剧毒性接触型除草剂，中毒者临床病死率高，中毒表现以急性肺损伤为主，同时伴有肝、肾等多器官损伤，经口服中毒者病死率高达50%～70%[1-2]，多数死于呼吸衰竭，目前无特效解毒药。百草枯致死摄入剂量约为20～40 mg/kg，相当于5～15 mL 20%百草枯水溶液[3]，口服量大于40 mL百草枯水溶液属于爆发型中毒患者[4]，多在1 d内出现肺水肿，数小时至数天内发生急性呼吸窘迫综合征或多器官功能衰竭，多数1～4 d内死亡，临床存活率极低。本例患者口服百草枯约100 mL，属于爆发型中毒患者，转入院时已出现严重急性呼吸窘迫综合征，应用西维来司他钠及一氧化氮（NO）吸入等联合疗法成功救治并康复出院，属极为罕见病例，现报道如下，仅供临床参考。