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）的效果及其预后影响因素。方法选择2020年4月至2022年3月北京市大兴区人民医院ARDS患者160例,根据治疗方案不同分2组,各80例。对照组接受常规治疗,观察组在对照组基础上加用西维来司他钠。比较2组动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）及血清C反应蛋白（CRP）、降钙素原（PCT）水平变化。多因素Logistic回归分析影响西维来司他钠治疗ARDS预后的因素。结果 治疗后观察组PaCO2及血清CRP、PCT水平较对照组低,PaO2、PaO2/FiO2较对照组高（P<0.05）;观察组死亡患者年龄>60岁比例、基线急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）高于存活患者,发病距入院时间长于存活患者,红细胞体积分布宽度（RDW）大于存活患者（P<0.05）;多因素Logistic回归分析,年龄、呼气终末正压（PEEP）水平、基线APACHEⅡ评分、发病距入院时间、RDW水平与西维来司他钠治疗ARDS预后有关（P<0.05）。结论 西维来司他钠治疗ARDS能有效减轻炎症,改善血气指标,但仍具有较高预后不良风险,其影响因素包括年龄、发病距入院时间、基线APACHEⅡ评分、RDW水平等,积极监测上述指标对提高ARDS救治成功率及预后改善有重要意义。

文章来源：中国知网

摘要信息：目的：探讨西维来司他钠对脂多糖(LPS)诱导的大鼠心肌细胞损伤的保护作用。方法：海南省人民医院于2021年7月—2022年2月采用LPS建立大鼠H9c2心肌细胞损伤模型，分为对照组、LPS组、西维来司他钠+LPS组。其中西维来司他钠+LPS组分为高浓度组(LPS+high，10 μg/mL)、中浓度组(LPS+medium，4.8 μg/mL)、低浓度组(LPS+low，1.6 μg/mL)。LPS诱导心肌细胞损伤6 h后，检测心肌细胞上清液中的白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、丙二醛(MDA)、乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)的水平，对比各组上述因子水平的差异性。结果：与对照组比较，LPS组及低浓度组、中浓度组、高浓度组的IL-6、TNF-α、IL-1β、LDH水平均显著升高，SOD均下降，差异均有统计学意义(P<0.05)；与对照组比较，LPS组及低浓度组、中浓度组的MDA水平均显著升高(P<0.05)；与LPS组比较，低浓度组、中浓度组、高浓度组的IL-6、TNF-α、IL-1β、MDA、LDH均下降，SOD水平均升高，差异均有统计学意义(P<0.05)。结论：西维来司他钠可减少LPS诱导的心肌细胞炎症因子和氧化应激因子的产生，减轻心肌细胞损伤，从而起到保护心肌细胞的作用。

摘要信息：Background:Acute lung injury (ALI) is one of the most common critical illnesses in clinical practice, with sepsis being the most common cause of ALI. Sivelestat sodium (SV) hydrate is a highly effective inhibitor of neutrophil elastase, specifically targeting ALI related to systemic inflammatory response syndrome. The aim of this study is to examine the mechanisms by which SV can reduce the severity of ALI resulting from sepsis. Methods:Cecum ligation and puncture (CLP) was employed for creating an animal model of ALI caused by sepsis. Primary human pulmonary microvascular endothelial cells (HPMECs) were treated with lipopolysaccharide (LPS) to develop an in vitro model of infection-induced ALI. Lung tissue damage was assessed by employing hematoxylin-eosin (H&E) and Masson staining. Lung edema was determined by calculating the lung wet-to-dry weight ratio. Lung tissue and cell samples were analyzed using Enzyme-linked immunosorbent assay (ELISA) to detect levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6. The 5-ethynyl-2'-deoxyuridine (EdU) and wound-healing assay were used to determine the cell proliferation and migration, while flow cytometry was used for detecting cell apoptosis. The association between microRNA (miR)-744 and transforming growth factor (TGF)-β1 was discovered and confirmed through the utilization of bioinformatics analyses and dual-luciferase gene reporter assay. The analysis of TGF-β1, p-Smad3, and Smad3 was carried out through western blotting and immunohistochemistry in both in vitro and in vivo scenarios. Results:In both in vivo and in vitro settings of ALI models of sepsis, there was a significant decrease in the level of miR-744-5p, a significant elevation in the expression of inflammatory factors, and a significant intensification of lung tissue damage. Administration of SV resulted in a significant increase in the level of miR-744-5p, suppressed the inflammatory response, and ultimately improved lung injury. Cell proliferation was significantly enhanced by SV and cell apoptosis was inhibited. The protection of SV was significantly reversed by inhibiting the effect of miR-744-5p. The double-luciferase reporter gene assay revealed substantial interactions occurring between miR-744-5p and TGF-β1. The TGF-β/Smad signaling pathway was significantly inhibited by SV, however, the inhibitory effect can be counteracted by utilizing the miR-744-5p inhibitor. Conclusions:The upregulation of miR-744-5p by SV inhibits the TGF-β/Smad signaling pathway, thereby reducing sepsis-induced ALI.

摘要信息：摘要:目的:探究西维来司他钠联合血必净治疗重症肺炎对血气分析、血清炎性因子的影响。方法:回顾性选取商丘市中心医院2021年6月至2023 年6月收治的60 例重症肺炎患者病历资料,根据治疗方案不同分为两组,各30例。两组均给予常规治疗,基于此参照组给予西维来司他钠治疗,联合组予以血必净+西维来司他钠治疗。对比两组肺功能[呼气流量峰值(PEF)、第1秒用力呼气末容积(FEV1)、FEV1/用力肺活量(FVC)1、血气分析指标[动脉血氧分压(Pa0,)、二氧化碳分压(PaCO,)、氧合指数(0I)]、炎性因子水平[4 羟基壬烯醛(4-HNE)、活化蛋白(APC)、C 反应蛋白(CRP)]、T细胞亚群CD4*、CD3*、CD4*/CD8*1、用药安全性。结果:治疗7d、14d后,联合组 FEV1、PEF、FEVI/FVC、Pa0,、0I高于参照组.PaC0,低于参照组(P<0.05):治疗7d14d后,联合组APC、CD4*、CD4*/CD8*CD3*高于参照组,4-HNE、CRP 低于参照组(P<0.05)。结论:西维来司他钠联合血必净治疗重症肺炎可改善肺功能、血气分析指标,调节T细胞亚群,抑制炎性反应,利于病情转归,安全性较高。

摘要信息：Background:Sivelestat, a neutrophil elastase inhibitor, is postulated to mitigate acute lung injury in patients following emergency surgery. However, its efficacy in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) induced by coronavirus disease 2019 (COVID-19) remains uncertain. This study aims to evaluate the pulmonary protective effects of sivelestat in COVID-19 patients with ALI/ARDS. Methods:A retrospective study was conducted involving 2454 COVID-19 patients between October 5, 2022, and February 1, 2023. Of these, 102 patients received sivelestat (0.2 mg/kg/h), while 2352 age- and sex-matched controls were identified. Propensity score matching (PSM) analysis was used to match sivelestat and non-sivelestat subgroups in ratios of 1:1 and 1:3 for sensitivity analysis. The primary outcome was a composite of effective outcomes, including 30-day mortality. Secondary outcomes included changes in partial pressure of arterial oxygen (PaO2), the ratio of PaO2to the fraction of inspired oxygen (PaO2/FiO2), and various cytokine levels. Safety evaluations included assessments of liver function, kidney function, and leukopenia. Results:In the propensity score-matched analysis, the sivelestat group had a higher proportion of severe/critical patients (87.26 % vs. 51.02 %, P < 0.001), more ARDS patients (4.9 % vs. 0.43 %, P < 0.001), and more patients with interstitial lung disease (4.9 % vs. 1.49 %, P = 0.023), but fewer patients with stroke (17.65 % vs. 19.86 %, P < 0.001). Oxygen therapy rates were similar between the groups (79.41 % vs. 80.95 %, P = 0.9). The relative risk reduction in 30-day mortality was 88.45 % (95 % confidence interval [CI] 81.23%-93.21 %) for severe/critical COVID-19 patients treated with sivelestat. Sivelestat significantly decreased cytokine levels of interferon alpha (IFNα), interleukin-1 beta (IL-1β), and interleukin-2 (IL-2).In the sivelestat group, the mortality rate was significantly reduced with standard oxygenation and HFNC therapy(P < 0.05). The treatment with sivelestat did not increase side effects. Conclusion:The administration of the neutrophil elastase inhibitor sivelestat may improve clinical outcomes in COVID-19 patients with ALI/ARDS. These findings suggest that sivelestat could be considered an effective treatment option to alleviate pulmonary inflammatory injury caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

文章来源：中国知网

摘要信息：目的：探讨创伤所致重度急性呼吸窘迫综合征（ARDS）行气道压力释放通气联合西维来司他钠治疗的 效果和对患者炎症因子的影响。方法：回顾性选取 2022 年 1 月至 2024 年 2 月湛江中心人民医院重症医学科收治的创 伤所致重度 ARDS 患者 98 例，依据治疗方法的不同分为通气治疗组（气道压力释放通气治疗）、联合药物组（气道 压力释放通气联合西维来司他钠治疗），各 49 例。比较两组患者临床疗效、炎症因子水平、血流动力学指标、临床 指标、不良反应发生情况。结果：联合药物组患者临床总有效率高于通气治疗组，差异具有统计学意义（P ＜ 0.05）。 治疗后，联合药物组患者血清肿瘤坏死因子 –α（TNF–α）、C 反应蛋白（CRP）、白细胞介素（IL）–6、IL–10 水平 低于通气治疗组，差异具有统计学意义（P ＜ 0.05）。治疗后各时间点，两组患者心率（HR）、中心静脉压（CVP）、 平均动脉压（MAP）比较，差异无统计学意义（P ＞ 0.05）。联合药物组患者氧疗时间、通气时间和住院时间短于通 气治疗组，差异具有统计学意义（P ＜ 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P ＞ 0.05）。结论： 创伤所致重度 ARDS 气道压力释放通气联合西维来司他钠治疗的疗效较单独气道压力释放通气治疗显著，更能降低 患者的炎症因子水平。

摘要信息：目的 本研究旨在探讨中性粒细胞弹性蛋白酶抑制剂(NEI)在治疗艾滋病合并急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)中的效果。方法 本研究采用回顾性病例对照研究设计,选取昆明市第三人民医院2022年1月1日至2023年12月31日期间收治的艾滋病合并ALIARDS患者83例为研究对象,采用SPSS 26.0软件进行:检验Y检验,使用Pearson相关系数分析观察指标之间的相关性。结果 共选取83例患者依据有无使用NEI进行分组,仅接受常规治疗(常规组)60例,在常规治疗基础上加用NEI(NEI组)23例,两组病例基线资料比较差异无统计学意义(P>0.05);治疗后观察指标对比分析,NEI组氧合指数(Pa02/F02)[(185.8+34.7)mmHg]、11-10[(28.7+7.5)pg/mL.]高于常规组[(167.3+31.2)mmHg、(14.9+3.5)pg/mL];NEI组白细胞计数[(9.2+2.2)x10"Л]、C反应蛋白[(9.7±3.5)mg]、IL-6[(32.5+9.8)pe/ml]、L-8[(29.0+7.1)pg/m[]低于常规组[(10.5+2.3)x10%L、(13.2+4.1)mgL、(45.6+12.3)pgm.(35.3+8.4)pg/ml];治疗预后影响对比分析,NEI组患者平均非机械通气天数(10.8±3.1)d,高于常规组(8.7±2.8)d(P<0.01):NE组28 d病死率 13.0%低于常规组21.7%(P=0.03):Pearson相关系数分析,白细胞计数、反应蛋白,Ⅱ-6和1L-10与28 d病死率均呈正相关,其中Ⅱ-10与28 d病死率的相关系数为0.24。结论NEI能有效改善艾滋病合并ALIARDS患者的氧合情况、降低炎症指标,并提高抗炎因子水平,增加非机械通气天数及降低28 d病死率。

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。