摘要信息：The objective of the study was to evaluate the efficacy of sivelestat, a selective neutrophil elastase inhibitor, on body fluid balance after transthoracic esophagectomy. Esophagectomy with elective lymphadenectomy may induce excessive release of neutrophil elastase, which then promotes vascular permeability and an excessive water shift from the intravascular space to the peripheral compartment. Body fluid imbalance after esophagectomy often leads to circular instability, a decrease of urine output, and a delay in the shift to a diuretic state. The study was designed as a case-control study with a historical control group. A retrospective analysis was performed to examine our hypothesis that sivelestat improves abnormal body fluid retention and prevents subsequent pulmonary complications. To reveal the direct influence of sivelestat on the postoperative course, we avoided using steroids or other diuretic agents. Eighty-eight patients who underwent thoracic esophagectomy with extended lymphadenectomy from 2000 to 2008 were divided into two groups: those treated from 2003 to 2008, who all received postoperative administration of sivelestat (n=60); and those treated from 2000 to 2002, who did not receive sivelestat and were used as the control group (n=28). Both groups received fluid management using the same protocol. The time to reach a diuretic state, time until extubation of the tracheal tube, and development of delayed respiratory dysfunction were compared between the groups using univariate and multivariate analysis. The time until a shift to a diuretic state was significantly shorter after treatment with sivelestat (p<0.0001) and with a shorter operation time (p<0.0001). The tracheal tube was extubated significantly earlier in the sivelestat group (p<0.0001) and the incidence of delayed respiratory dysfunction was also significantly lower (p=0.0028) in this group. Multivariate logistic regression analysis showed that a delay in a shift to a diuretic state was a strong independent risk factor for the time to tracheal extubation (odds ratio 2.539, p=0.0056) and occurrence of delayed respiratory dysfunction (odds ratio 1.989, p=0.0104). Sivelestat treatment was not independently associated with reduced pulmonary complications, but the diuretic state was strongly regulated by sivelestat treatment (odds ratio 0.044, p=0.0003). Thus, administration of sivelestat has a beneficial influence on recovery from body water imbalance through a more rapid return to a diuretic state after esophagectomy, which contributes to prevention of subsequent pulmonary complications.

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：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：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。

摘要信息：Inhalation of acid fumes and aspiration of liquid substances or gastric contents may not initiate dyspnea within several hours after exposure but may result in delayed onset of alveolar edema. The present report presents three cases of inhalation or aspiration of chemical substances that resulted in acute respiratory distress syndrome (ARDS). Due to different underlying reasons, three patients developed ARDS resulting from chemical pneumonitis and pulmonary infection. From patients with dyspnea, dry rales could be heard in both lungs, with <92% percutaneous oxygen saturation at room air. All patients were treated using a high-flow nasal cannula and sivelestat sodium. Oxygenation gradually improved and the patients were discharged without adverse events. These cases suggest that early treatment with sivelestat sodium may improve the clinical outcomes of patients with ARDS.

摘要信息：【摘 要】 目的 观察西维来司他钠联合气道压力释放通气(APRV)在创伤所致重度急性呼吸窘迫综合征(ARDS)治疗中的应用效果。方法选取2021年1月一2022年12月厦门市海沧医院收治的创伤所致重度 ARDS 患者 80 例,采用随机数字表法分为观察组和对照组,各 40 例。在常规对症处理基础上,对照组予 APRV 治疗,观察组在对照组基础上加用注射用西维来司他钠治疗,2组均持续治疗1周。比较2组患者预后情况(机械通气时间、ICU 住院时间和病死率),治疗前后炎性因子[白介素-6(1L-6)、降钙素原(PCT)、C 反应蛋白(CRP)]、血气指标[二氧化碳分压(PaC0,)、动脉血氧分压(Pa0,)、Pa0,/Fi0,]和肺功能[第1秒用力呼气容积(FEV,)、用力肺活量(FVC)、FEV,FVC]。结果 观察组病死率为2.50%,低于对照组的22.50%( =7.314,P=0.007);观察组机械通气时间与 ICU住院时间均短于对照组(P 均<0.01);治疗1周后,2 组 Ⅱ-6、PCT、CRP、PaC0,水平均较治疗前降低,Pa0,、Pa0,FiO,、FEV,、FVC、FEV,/FVC 均较治疗前升高,且观察组降低或升高的程度大于对照组(P均<0.01)。结论 西维来司他钠联合 APRV 在创伤所致重度 ARDS 治疗中应用效果较好,能改善患者血气指标,减轻炎性反应,提升肺功能,进而促进其快速康复,利于改善疾病预后。

摘要信息：Background:Acryloyl chloride is a highly toxic volatile liquid that can cause pulmonary edema. However, no sufficient treatment reports have been published to date. Here, we report a case of acute respiratory distress syndrome (ARDS) caused by acryloyl chloride inhalation. Case presentation:The patient was a 36-year-old man with accidental exposure to acryloyl chloride. The patient had dyspnea and wet cough, with approximately 88% percutaneous oxygen saturation at room air. He was diagnosed with ARDS and admitted to the intensive care unit. Initially, he was treated with a high-flow nasal cannula and sivelestat sodium. However, due to the possibility of delayed exacerbation, the patient was switched to methylprednisolone. Oxygenation gradually improved, and the patient was discharged on the day 8 of hospitalization. Conclusion:We report the case of a patient who developed ARDS with delayed exacerbation after the inhalation of acryloyl chloride, which was treated without endotracheal intubation.

摘要信息：硝酸和氢氟酸等强酸性物质具有很强的氧化性,被广泛应用于工业生产中,强酸吸入引起化学性肺炎偶见报道。严重的化学性肺炎会引起急性肺水肿，出现危及生命的急性呼吸窘迫综合征(acuterespiratory distress syndrome,ARDS)。目前针对化学性肺炎的治疗不仅缺乏统一标准，而且强烈依赖于激素、抗感染等传统治疗方案。西维来司他钠为新型 ARDS 治疗药物,其面世弥补了 ARDS 临床治疗手段的匮乏。本文报道了1例早期应用西维来司他钠成功治疗硝酸氢氟酸混合物吸入致ARDS 的病例，以分享救治体会。

摘要信息：【摘 要】 目的 观察西维来司他钠联合气道压力释放通气(APRV)治疗创伤所致重度急性呼吸窘迫综合征(ARDS)的疗效及对血气指标、炎性因子和预后的影响。方法选取2020年4月一2021年4月徐州仁慈医院重症医学科收治创伤所致重度 ARDS 患者 80 例,随机数字表法分为观察组(40 例)和对照组(40 例)。2 组均予基础治疗,对照组加用 APRV 治疗,观察组加用 APRV 治疗和西维来司他钠治疗。比较2组治疗期间血清炎性因子、血气和血流动力学指标、急性生理和慢性健康状况(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分变化,以及机械通气时间.ICU 住院时间、病死率差异。结果 2组治疗7d后血清 PCT、IL6、CRP水平、APACHEⅡ评分、SOFA 评分较治疗前降低(P<0.05),且观察组血清 PCT、IL6、CRP水平低于对照组(t/P =9.309/0.000、12.221/0.000、5.471/0.000)。2 组患者治疗期间 Pa0,、Pa0,/ Fi0,增高,PaC0,降低(P<0.05),HR、CVP、MAP 下降后又回升(P<0.05),观察组患者治疗24 h、72h时 PaO,、PaO, /FO,、HR、CVP、MAP 高于对照组,PaC0,低于对照组(治疗24 h:t/P=2.092/0.0405.931/0.000、2.854/0.006、3.683/0.002、3.978/0.000、2.063/0.042;治疗72 h: t/P = 2.202/0.031、3. 177/0.0025.380/0.000、10.125/0.000、5.993/0.000、4.314/0.000)。2 组患者机械通气时间、ICU 住院时间、病死率比较差异均无统计学意义(P均>0.05)。结论 西维来司他钠联合 APRV 可降低血清炎性因子水平,提高氧合指数,但不能缩短机械通气时间和住院时间、降低病死率。