Morimoto Keisuke, Nishimura Kengo, Miyasaka Shigeto, Maeta Hiroyuki, Taniguchi Iwao
Department of Thoracic and Cardiovascular Surgery, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(4):369-75. doi: 10.5761/atcs.oa.10.01555.
Patients who undergo thoracic aortic surgery with deep hypothermia frequently have postoperative respiratory failure as a complication. Severe lung injury in these patients results in a fatal outcome. A specific neutrophil elastase inhibitor, sivelestat sodium hydrate, is an innovative therapeutic drug for acute lung injury. We evaluated the protective effects of sivelestat sodium hydrate on severe lung injury after thoracic aortic surgery with deep hypothermia. From January 2002 to July 2007, 71 consecutive patients underwent thoracic aortic surgery with deep hypothermia. Of these patients, 22 had postoperative respiratory failure with PaO₂/FiO₂ ratios of less than 150. They were randomly assigned to one of two groups. The first group (Group S, n = 10) was administered sivelestat sodium hydrate continuously at 0.2 mg/kg/h until weaning from mechanical ventilation; the second group (Group C, n = 12) was not administered sivelestat sodium hydrate. The groups were comparable with respect to clinical data. There were no significant differences between the two groups in age, operation duration, total cardiopulmonary bypass time, circulatory ischemia time, cardiac arrest time, intraoperative blood loss, and total transfusion volume. The improvement of pulmonary function was observed in the both groups, but more marked in Group S by statistical analysis using analysis of variance for repeated measurements. Especially, in the early phase, pulmonary function improvement was more marked in Group S. The duration of mechanical ventilation, the length of stay in the intensive care unit, and the length of hospital stay were shorter in Group S, but not significantly. Sivelestat sodium hydrate is a specific neutrophil elastase inhibitor that improves pulmonary function in patients with severe postoperative respiratory failure following thoracic aortic surgery with deep hypothermia. The drug may shorten the duration of postoperative ventilation, intensive care unit stay, and hospital stay.
接受深低温胸主动脉手术的患者术后常并发呼吸衰竭。这些患者的严重肺损伤会导致致命后果。一种特异性中性粒细胞弹性蛋白酶抑制剂——水合西维来司他钠，是治疗急性肺损伤的创新型治疗药物。我们评估了水合西维来司他钠对深低温胸主动脉手术后严重肺损伤的保护作用。2002年1月至2007年7月，71例连续接受深低温胸主动脉手术的患者。其中，22例术后出现呼吸衰竭，动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）低于150。他们被随机分为两组。第一组（S组，n = 10）以0.2 mg/kg/h的速度持续给予水合西维来司他钠，直至脱机；第二组（C组，n = 12）未给予水合西维来司他钠。两组临床资料具有可比性。两组在年龄、手术时间、体外循环总时间、循环缺血时间、心脏停搏时间、术中失血量和总输血量方面无显著差异。两组肺功能均有改善，但通过重复测量方差分析进行统计分析发现，S组更明显。特别是在早期，S组肺功能改善更明显。S组机械通气时间、重症监护病房住院时间和住院时间较短，但差异无统计学意义。水合西维来司他钠是一种特异性中性粒细胞弹性蛋白酶抑制剂，可改善深低温胸主动脉手术后严重术后呼吸衰竭患者的肺功能。该药物可能会缩短术后通气时间、重症监护病房住院时间和住院时间。
