西维来司他钠对急性A型主动脉夹层术后急性呼吸功能不全及全身炎症反应的疗效观察

Effect of civelestat sodium on acute respiratory insufficiency and systemic in⁃flammatory response after acute type A aortic dissection

目的探讨西维来司他钠对主动脉夹层术后急性呼吸功能不全(ARI)及全身炎症反应的临床疗效。方法回顾2021年1月至2021年7月期间收治的A型主动脉夹层患者共90例,术后出现ARI的共86例,纳入排除标准以后共62例,其中16例为实验组,46例为对照组。对照组给予常规治疗,实验组在常规治疗基础上应用了西维来司他钠按照0.2 mg/(kg·h)剂量24 h匀速泵入,维持7 d。比较两组患者给药前(T1)、第3天(T2)、第5天(T3)、第7天(T4)氧合指数之差(△PaO_(2)/FiO_(2))、白细胞(WBC)、中性粒细胞(NEU)、淋巴细胞、C反应蛋白(CRP)、降钙素原(PCT)、白介素6(IL-6)、白介素8(IL-8)的变化,并比较两组术后呼吸机带机时间、二次插管例数、ICU停留时间、西药费及总费用。结果在T1~T4时间点,实验组的△PaO_(2)/FiO_(2)值要明显高于对照组;实验组WBC在第T2、T3、T4时间点较对照组显著降低;实验组NEU在T2、T3、T4时间点较对照组显著降低;实验组CRP、PCT、IL-6均仅在T4时间点较对照组显著降低。结论西维来司他钠可能通过减轻机体炎症反应,降低主动脉夹层术后患者血清炎性因子水平,改善氧合,使患者获益。

Objective To investigate the therapeutic effect of civelestat sodium on acute respiratory dysfunction and systemic inflammatory response after aortic dissection.Methods A total of 90 patients with type A aortic dissection from January 2021 to July 2021 were reviewed.A total of 86 patients developed acute respiratory dysfunction after surgery,and 62 patients were included in our study based on the inclusion and exclusion criteria.Among them,16 cases were treated with civelestat sodium(treated group)and 46 cases were treated with routine treatment(control group).For acute respiratory dysfunction,the control group was given routine treat⁃ment,and the experimental group was pumped with civelestat sodium at a dose of 0.2 mg/(kg·h)for 24 h and maintained for 7d.The difference of oxygenation index(△PaO_(2)/FiO_(2)),leukocyte count(WBC),neutrophil count(NEU),lymphocyte count(LYM),Creactive protein(CRP),procalcitonin(PCT),interleukin 6(IL-6)and interleukin 8(IL-8)levels on the 1st(T1),3rd(T2),5th(T3),7th(T4)day after operation were compared between the two groups.The postoperative ventilator time,the number of sec⁃ondary intubation cases,ICU stay time,western medicine cost and total cost were also compared between the two groups.Results The △PaO_(2)/FiO_(2) at T1-T4 time points in the experimental group was significantly improved compared with the control group(P<0.05);WBC and Neu in the experimental group were significantly lower than those in the control group at T2,T3,T4 time points(P<0.05);CRP,PCT and IL-6 in the experimental group were significantly lower than those in the control group only at T4 time point.Postoperative ventilator time,number of secondary intubation cases,ICU stay time,western medicine cost and total cost had no statistical signifi⁃cance between the two groups(P>0.05).Conclusion Civelestat sodium may reduce the levels of serum inflammatory factors and im⁃prove oxygenation in patients with aortic dissection by reducing the inflammatory response.