Imokawa Shiro, Sano Takehisa, Todate Akihito, Uchiyama Hiroshi, Yasuda Kazumasa, Nagayama Masaharu, Enomoto Noriyuki, Suda Takafumi, Chida Kingo
Department of Respiratory Medicine, Iwata City Hospital.
Nihon Kokyuki Gakkai Zasshi. 2006 Jan;44(1):27-33.
We encountered two patients with clinically diagnosed idiopathic interstitial pneumonia with acute respiratory distress syndrome (ARDS). Both patients required mechanical ventilation within 24 hours after admission. We managed these patients using lower tidal volume ventilation (tidal volume: 5-6 ml/kg), antibiotics, sivelestat sodium hydrate and steroid pulse therapy followed by oral prednisolone therapy. Respiratory failure was relieved within 2 weeks following treatment There was no four-fold rise in screen viral titers and screening investigations of autoantibodies were negative. Based on these findings, we diagnosed these cases as having acute interstitial pneumonia (AIP). AIP represents a small subset of patients with ARDS without any associated or predisposing factor. Sivelestat sodium hydrate is an anti-neutrophil elastase inhibitor and is used for the treatment of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). Therefore, sivelestat sodium hydrate may be one of the treatment options for acute respiratory failure due to idiopathic interstitial pneumonia.
我们遇到了两名临床诊断为特发性间质性肺炎合并急性呼吸窘迫综合征（ARDS）的患者。两名患者在入院后24小时内均需要机械通气。我们采用低潮气量通气（潮气量：5 - 6 ml/kg）、抗生素、注射用西维来司他钠和类固醇冲击疗法，随后进行口服泼尼松龙治疗来处理这些患者。治疗后2周内呼吸衰竭得到缓解。筛查病毒滴度没有出现四倍升高，自身抗体筛查检查结果为阴性。基于这些发现，我们将这些病例诊断为急性间质性肺炎（AIP）。AIP是ARDS患者中一小部分没有任何相关或诱发因素的病例。注射用西维来司他钠是一种抗中性粒细胞弹性蛋白酶抑制剂，用于治疗急性肺损伤（ALI）/急性呼吸窘迫综合征（ARDS）。因此，注射用西维来司他钠可能是特发性间质性肺炎所致急性呼吸衰竭的治疗选择之一。
