Togo Shinji, Matsuo Kenichi, Ishibe Atsushi, Nagano Yasuhiko, Takahashi Masazumi, Mochizuki Hirohiko, Osada Shunichi, Kameda Kunio, Shimada Hiroshi
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):967-73.
BACKGROUND/AIMS: The usefulness of a neutrophil elastase inhibitor (sivelestat) was evaluated for treating septic acute respiratory distress syndrome (ARDS) after gastrointestinal surgery.
The subjects were 36 patients with septic ARDS after gastrointestinal surgery. ARDS was defined as acute lung injury associated with systemic inflammatory response syndrome. Sivelestat was intravenously administered at a dose of 0.2 mg/kg/hr continuously for 3 days or more. The effectiveness of sivelestat was evaluated based on the lung injury score, P/F ratio, and ventilator free days (VFD).
Marked responses were observed in 12 patients (33.3%), responses in 17 (47.2%), and no response in 7 (19.4%). In the patients with marked responses or responses (responders), the P/F ratio was significantly improved on day 3 of drug administration and at the end of administration compared with the pre-administration ratio. Comparison between the responders and non-responders showed significant differences on day 3 and at the end of drug administration. VFD significantly differed between the responders (18.8 days) and the non-responders (11.0 days).
In conclusion, sivelestat may be effective against septic ARDS. The effectiveness of the drug could be determined based on improvement in oxygenation ability on day 3 of drug administration.
背景/目的：评估中性粒细胞弹性蛋白酶抑制剂（西维来司他）对胃肠道手术后脓毒症急性呼吸窘迫综合征（ARDS）的治疗效果。
研究对象为36例胃肠道手术后发生脓毒症ARDS的患者。ARDS定义为与全身炎症反应综合征相关的急性肺损伤。西维来司他以0.2mg/kg/小时的剂量持续静脉给药3天或更长时间。根据肺损伤评分、P/F比值和无呼吸机天数（VFD）评估西维来司他的疗效。
12例患者（33.3%）有显著反应，17例（47.2%）有反应，7例（19.4%）无反应。在有显著反应或有反应的患者（反应者）中，给药第3天和给药结束时的P/F比值与给药前相比显著改善。反应者与无反应者在给药第3天和给药结束时比较有显著差异。反应者（18.8天）和无反应者（11.0天）的VFD有显著差异。
总之，西维来司他可能对脓毒症ARDS有效。可根据给药第3天氧合能力的改善来确定该药的疗效。
