A New Global Definition of Acute Respiratory Distress Syndrome
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.
The Protective Effects of Sivelestat Sodium on the Basis of Corticosteroid Therapy in Patients With Moderate-to-Severe Acute Respiratory Distress Syndrome
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.
西维来司他钠治疗ARDS患者的效果及其应用价值
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。
Effect and safety of sivelestat on acute severe pancreatitis with systemic inflammatory response syndrome: a retrospective study
文章来源：PubMed
摘要信息：研究旨在探讨西维来司他钠（SV）治疗严重急性胰腺炎（SAP）伴全身炎症反应综合征（SIRS）疗效和安全性。选取2021年1月至2024年8月在郑州大学第一附属医院急诊重症监护室诊断和治疗的102例SAP患者。比较两组疾病结局、住院时间和死亡率的变化。根据是否应用SV，共有102例患者被招募到对照组（n=56）或SV组（n=46）。两组入院时的基线数据无显著差异。治疗1周后，两组各项指标均有所改善。SV组呼吸机使用时间（p=0.0400）和ICU住院时间（p=0.0495）短于对照组，但两组死亡率差异无统计学意义。尽管SV没有降低SAP患者死亡率，但它缩短了呼吸机使用时间和ICU住院时间。
有创-无创序贯通气疗法联合美罗培南、西维来司他钠治疗急性呼吸窘迫综合征的效果及对炎性因子水平的影响
文章来源：中国知网
摘要信息：目的 探究有创-无创序贯通气疗法联合美罗培南、西维来司他钠治疗急性呼吸窘迫综合征的效果。方法 选择2019年2月至2023年1月我院收治的120例急性呼吸窘迫综合征患者为研究对象，以入院时间将其分为对照组和观察组，各60例。对照组接受有创机械通气联合美罗培南、西维来司他钠治疗，观察组接受有创-无创序贯通气疗法联合美罗培南、西维来司他钠治疗。比较两组的治疗效果。结果 治疗后，观察组的C-反应蛋白（CRP）、白细胞介素-18(IL-18)、白细胞计数（WBC）及核因子-κB(NF-κB)水平低于对照组（P<0.05）。治疗后，观察组的呼吸系统阻力（Rrs）低于对照组，肺动态顺应性（Crs）、第1秒用力呼吸容积/用力肺活量（FEV1/FVC）高于对照组（P<0.05）。治疗后，观察组的动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）高于对照组，动脉血二氧化碳分压（PaCO2）低于对照组（P<0.05）。结论 有创-无创序贯通气疗法联合美罗培南、西维来司他钠治疗急性呼吸窘迫综合征患者的效果显著，可调节炎性因子水平，改善肺功能及血氧状态指标。
西维来司他钠在ICU不同疾病合并ARDS患者中的应用效果
文章来源：中国知网
摘要信息：目的 观察西维来司他钠在ICU不同疾病合并急性呼吸窘迫综合征(ARDS)患者中的应用效果。方法 回顾性选择2021年7月—2023年6月华侨大学附属厦门长庚医院ICU不同疾病合并ARDS患者87例，根据疾病类型不同分为肺炎组(n=37)、创伤组(n=21)和胰腺炎组(n=29)。所有患者均给予常规方法治疗，并于肺损伤发生后72 h内使用西维来司他钠治疗，3组均治疗7 d。比较3组呼吸功能、炎性指标及疾病转归情况。结果 干预7 d后，3组呼吸频率低于干预前(P<0.01);肺炎组与创伤组经皮血氧饱和度及3组氧合指数高于干预前(P<0.01),胰腺炎组经皮血氧饱和度干预前后比较无统计学差异(P>0.05);3组白细胞计数、中性粒细胞百分比、降钙素原、C反应蛋白水平低于干预前(P<0.01);肺炎组痊愈出院率为83.78%,创伤组痊愈出院率为90.48%,胰腺炎组痊愈出院率为89.66%。结论 西维来司他钠用于ICU不同疾病合并ARDS患者治疗中均可获得良好效果，可改善患者呼吸功能，降低炎性指标水平，有助于改善患者疾病转归。
西维来司他钠治疗急性呼吸窘迫综合征患者预后影响因素分析
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。