西维来司对中重度急性呼吸窘迫综合征患者肺血管内皮多糖蛋白复合物层作用的临床研究  

A clinical study of the effect of sivelestat on the lung endothelial glycacalyx layer of moderate severe ARDS patients

作　　者：王宇辉[1] 叶八宁[1] 施贤清[1] 

机构地区：[1]贵州省人民医院重症医学科,贵阳550002

出　　处：《重庆医学》2015年第20期2793-2795,共3页Chongqing medicine

摘　　要：目的探讨西维来司对中重度急性呼吸窘迫综合征(ARDS)患者肺血管内皮多糖蛋白复合物层(EGL)的作用,以及对ARDS患者的临床治疗效果。方法纳入2012年6月至2014年6月入住该院重症监护室(ICU)的需机械通气的中重度ARDS患者共80例,采用随机、双盲分为治疗组(给予西维来司0.2mg·h-1·kg-1静脉持续泵入,连续使用72h)与对照组(同时间给予等量生理盐水泵入),在入住ICU时,24、72h检测血气分析、心排指数(CI)、血管外肺水指数(EVLWI)、肺血管通透性指数(PVPI)及弹性蛋白酶(NE)、硫酸乙酰肝素(HS)、黏结蛋白聚糖-1(Syndecan-1),取肺泡灌洗液(Balf)检测Balf-NE及清蛋白(Balf-ALB)。记录患者机械通气时间,入住ICU时间,住院时间及90d病死率。结果两组患者入ICU时各项指标差异均无统计学意义(P>0.05)。在24h时与对照组比较,治疗组氧合指数显著增加(P<0.05),EVLWI、PVPI、血浆NE、HS、Syndecan-1及Balf-NE水平显著降低(P<0.05)。在72h与对照组比较,治疗组动脉血氧分压(PO2)、肺泡动脉氧分压差[P(A-a)DO2]、氧合指数显著增加(P<0.05),EVLWI、PVPI,血浆NE、HS、Syndecan-1及Balf-NE、Balf-ALB水平显著降低(P<0.05)。治疗组机械通气时间、住ICU时间、住院时间及90d病死率均显著低于对照组(P<0.05)。结论 NE抑制剂西维来司可以显著改善中重度ARDS患者氧合水平,降低患者机械通气时间、入住ICU时间、住院时间及90d病死率。Objective To investigate the effect of sivelestat on the lung endothelial glycocalyx layer of patients with moderate or severe ARDS and its clinical outcome. Methods This was a randomized,placebo controlled,double blind trial that involved a to- tal of 80 individuals,who were admitted to the ICU of Guizhou provicial hospital during the time period from June 2012 to June 2014 and,as patients with modest or severe ARDS, required mechanical ventilation. The individuals were divided into two same sized groups. One group were the treatment group who were treated with Sivelestat by 0.2 mg · h^-1 · kg^-1 intravenous infusion consecu- tively for 72 hours. The other group was the control group whose members underwent saline intravenous infusion simultaneously with the treatment group. Their cardiac indexes （CI）, extravascular lung water indexes （EVLWI）, pulmonary vascular permeability indexes （PVPI）,and blood gas analyses, serum elastase （NE）, heparan sulfate （HS）, Syndecan-1 were obtained when they at ad- mission, the 24th as well as the 72nd hour. The duration of the mechanical ventilation, ICU stays, hospital stays and mortality within 90 days were recorded, Results There was no statistical significance in the differences between all the indicators of the two groups at admission（P〉0.05）. By the 24th hour, the oxygenation index of the treatment group was found to have increased significantly （P〈0.05） after the Sivelestat treatment compared to those of the control group while the EVLWI, PVPI, serum NE, H S,Synde- can-1 and Balf-NE of the treatment group had become significantly lower（P〈0.05）. By the 72nd hour,the PO2 ,P （A-a） DO2 and oxygenation index of the treatment group, compared to those of the control group, had increased significantly （P〈0.05） while the levels of EVLWI, PVPI, serum NE, HS, Syndecan-1, Balf-NE, Balf-ALB had decreased significantly （ P 〈 0.05 ）. The duration of mechanical ventilation,ICU stays,hospital stays and mortality of 90 days were decrea

关 键 词：呼吸窘迫综合征 成人 西维来司 弹性蛋白酶抑制剂 肺血管内皮多糖蛋白复合物层 

分 类 号：R563.8[医药卫生—呼吸系统]