Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan.
Shock. 2010 Jan;33(1):14-8. doi: 10.1097/SHK.0b013e3181aa95c4.
Neutrophil elastase plays an important role in the development of acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) in sepsis. Sivelestat is a selective neutrophil elastase inhibitor. It is possible that sivelestat improves the outcome of septic patients associated with ARDS and DIC. A retrospective data analysis of septic patients associated with ARDS and DIC was conducted to investigate the effects of sivelestat. Observational period was 5 days after admission to intensive care unit (ICU). The study included 167 septic patients associated with ARDS and DIC. Control group included 133 patients without sivelestat, and sivelestat group included 34 patients started to deadministered sivelestat on the admission to ICU. The lung injury scores and Pa(O2)/Fl(O2) ratio of the sivelestat group were significantly more severe than those of the control group from days 1 to 4. On day 5, the lung injury score and Pa(O2)/Fl(O2) ratio of the sivelestat group improved to the same levels of those of the control group. The DIC score of sivelestat group improved on day 3 in comparison to day 1, and those of control group remained unchanged until day 4. The length of ICU stay of the sivelestat group was significantly shorter than that of the control group. A stepwise multiple logistic-regression analysis showed the sivelestat administration to be an independent predictor of survival of the septic patients associated with both ARDS and DIC. The length of ICU stay of the sivelestat group was significantly shorter than that of the control group. In addition, sivelestat administration was found to be an independent predictor of survival of those patients.
中性粒细胞弹性蛋白酶在脓毒症并发急性呼吸窘迫综合征（ARDS）和弥散性血管内凝血（DIC）的发展中起重要作用。西维来司他是一种选择性中性粒细胞弹性蛋白酶抑制剂。西维来司他可能改善与 ARDS 和 DIC 相关的脓毒症患者的预后。对与 ARDS 和 DIC 相关的脓毒症患者进行了回顾性数据分析，以研究西维来司他的作用。观察期为入住重症监护病房（ICU）后 5 天。该研究包括 167 例与 ARDS 和 DIC 相关的脓毒症患者。对照组包括 133 例未使用西维来司他的患者，西维来司他组包括 34 例在入住 ICU 时开始使用西维来司他的患者。西维来司他组的肺损伤评分和 Pa(O2)/Fl(O2) 比值从第 1 天到第 4 天明显比对照组更严重。第 5 天，西维来司他组的肺损伤评分和 Pa(O2)/Fl(O2) 比值改善至与对照组相同水平。与第 1 天相比，西维来司他组的 DIC 评分在第 3 天有所改善，而对照组的 DIC 评分直到第 4 天仍未改变。西维来司他组的 ICU 住院时间明显短于对照组。逐步多因素逻辑回归分析表明，西维来司他的使用是与 ARDS 和 DIC 相关的脓毒症患者存活的独立预测因子。西维来司他组的 ICU 住院时间明显短于对照组。此外，西维来司他的使用被发现是这些患者存活的独立预测因子。
