西维来司他钠联合血必净治疗对重症肺炎患者血气分析指标及血清APC、4-HNE水平的影响-周岩
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。
中性粒细胞弹性蛋白酶抑制剂(西维来司他钠)治疗COVID-19 ALI-ARDS患者的临床应用
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).
气道压力释放通气联合西维来司他钠治疗创伤所致重度ARDS的疗效
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。