西维来司他钠治疗急性呼吸窘迫综合征患者预后影响因素分析

Influencing factors on prognosis of patients with acute respiratory distress syndrome treated with sivele-stat sodium

目的探讨西维来司他钠治疗急性呼吸窘迫综合征(ARDS)的效果及其预后影响因素。方法选择2020年4月至2022年3月北京市大兴区人民医院ARDS患者160例,根据治疗方案不同分2组,各80例。对照组接受常规治疗,观察组在对照组基础上加用西维来司他钠。比较2组动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))及血清C反应蛋白(CRP)、降钙素原(PCT)水平变化。多因素Logistic回归分析影响西维来司他钠治疗ARDS预后的因素。结果治疗后观察组PaCO_(2)及血清CRP、PCT水平较对照组低,PaO_(2)、PaO_(2)/FiO_(2)较对照组高(P<0.05);观察组死亡患者年龄>60岁比例、基线急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)高于存活患者,发病距入院时间长于存活患者,红细胞体积分布宽度(RDW)大于存活患者(P<0.05);多因素Logistic回归分析,年龄、呼气终末正压(PEEP)水平、基线APACHEⅡ评分、发病距入院时间、RDW水平与西维来司他钠治疗ARDS预后有关(P<0.05)。结论西维来司他钠治疗ARDS能有效减轻炎症,改善血气指标,但仍具有较高预后不良风险,其影响因素包括年龄、发病距入院时间、基线APACHEⅡ评分、RDW水平等,积极监测上述指标对提高ARDS救治成功率及预后改善有重要意义。

Objective To investigate the efficacy and prognostic factors of sivelestat sodium in the treat-ment of acute respiratory distress syndrome(ARDS).Methods A total of 160 ARDS patients admitted to Daxing District People′s Hospital in Beijing from April 2020 to March 2022 were divided into a control group and an ob-servation group based on different treatment plans,with 80 cases in each group.The control group received con-ventional treatment,while the observation group received sivelestat sodium in addition to the same treatment as the control group.The changes in arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2)),and serum levels of C-reactive protein(CRP)and procalcitonin(PCT)were com-pared between the two groups.The factors affecting the prognosis of ARDS treated with sivelestat sodium were an-alyzed using Logistic regression.Results After treatment,the levels of PaCO_(2),CRP and PCT in the observation group were significantly lower than those in the control group,while PaO_(2) and PaO_(2)/FiO_(2) were significantly higher than those in the control group(P<0.05).The proportion of dead patients aged>60 years old and baseline A-PACHEⅡscore in observation group were higher than those in survival patients,the time between onset and ad-mission was longer than that in survival patients,and the volume distribution width of red blood cells(RDW)was larger than that in survival patients(P<0.05).Logistic regression analysis showed that age,PEEP level,baseline APACHEⅡscore,onset time to hospital admission and RDW level were correlated with the prognosis of ARDS treated with cilvelestat sodium(P<0.05).Conclusion Sivelestat sodium can effectively reduce inflammation and improve blood gas indicators in the treatment of ARDS,but still has a high risk of poor prognosis.Its influencing factors include age,time from onset to admission,baseline APACHEⅡscore,RDW level,etc.Actively monitoring these indica-tors has important guiding value for improving the success rate of ARDS treatment and prognosis improvement.