Influence of sivelestat sodium on prognosis of patients with severe acute respiratory distress syndrome

Zhao Shasha; Liu Miaomiao; Wang Pengwei; Deng Zhijian; Feng Xianjun

doi:10.3969/j.issn.1672-8157.2025.03.004

Abstract：Objective To observe the influence of sivelestat sodium combined with small tidal volume protective lung venti-lation(PLV)on inflammatory reactions and prognosis of patients with trauma-induced severe acute respiratory distress syndrome(ARDS).Methods The clinical data were collected from 98 patients with trauma-induced severe ARDS who were admitted to the First Affiliated Hospital of Xinxiang Medical College from June 2022 to October 2024 and were retrospectively reviewed.According to the treatment plan,the patients were divided into the sivelestat sodium group(45 cases)and the PLV group(53 cases).The PLV group was treated with conventional supportive therapy and small tidal volume PLV,while the sivelestat sodium group was treated with sivelestat sodium on the basis of the PLV group.Both groups were observed until discharge or death.The blood gas indexes,inflammatory response,hemodynamic indexes and prognosis were compared between the two groups before treatment and 72 hours after treatment.Results The oxygenation index and arterial partial oxygen pressure(PaO2)of the two groups were higher after the treatment for 72 hours than before the treatment;the above indexes of the sivelestat sodium group were respectively(176.31±18.79)mm Hg(1 mm Hg≈0.133 kPa)and(82.35±4.61)mm Hg,higher than(158.73±17.88)mm Hg and(73.02±5.56)mm Hg of the PLV group,and there were significant differences(t=4.418,8.360,both P<0.05).The level of arterial partial pressure of carbon dioxide(PaCO2)of the two groups was lower after the treatment for 72 hours than before the treatment;the level of the index of the sivelestat sodium group was(41.87±3.62)mm Hg,lower than(44.29±3.57)mm Hg of the PLV group,and there was signifi-cant difference(t=3.099,P<0.05).The levels of serum procalcitonin(PCT),soluble myeloid cell trigger receptor 1(sTREM-1)and C-reactive protein(CRP)of the two groups were lower after the treatment for 72 hours than before the treatment;the levels of the above indexes of the sivelestat sodium group were respectively(0.45±0.11)ng·mL-1,(3.70±0.81)ng·mL-1 and(14.75±2.20)mg·L-1,lower than(0.66±0.15)ng·mL-1,(4.53±0.73)ng·mL-1 and(19.43±3.21)mg·L-1 of the PLV group,and there was significant difference(t=7.282,4.969,7.743,all P<0.05).The mean arterial pressure(MAP)and central venous pressure(CVP)levels of the two groups were higher after the treatment for 72 hours than before the treatment;the levels of the above indexes of the sivelestat sodium group were respectively(85.29±3.18)mm Hg and(9.01±0.78)cm H2O(1 cm H2O≈0.098 kPa),higher than(80.32±3.29)mm Hg and(8.28±0.81)cm H2O of the PLV group,and there were significant differences(t=7.062,4.220,both P<0.05).The heart rate(HR)in the two groups decreased,and the HR in the silvelestat sodium group was(100.35±10.19)times·min-1,which was lower than(112.77±11.38)times·min-1,in the PLV group with significant difference(t=5.274,P<0.05).Mechanical ventilation,intensive care unit hospi-talization and length of stay((9.13±1.08)d,(10.26±1.21)d,(17.83±2.82)d,respectively)in the silvelestat sodium group were shorter than those in the PLV group((10.67±1.26)d,(11.92±1.22)d,(21.18±3.04)d,respectively),with significant difference(t=6.012,6.286,5.246,all P<0.05).The case fatality rate was 40.00%(18/45)in the silvelestat sodium group and 43.40%(23/53)in the PLV group,and there was no significant difference between the two groups(χ2=0.115,P>0.05).Conclusion Silvelestat sodium combined with small tidal volume PLV can inhibit the inflammatory response of patients with severe ARDS caused by trauma,improve blood gas indexes and hemodynamic indexes,and promote the recovery of patients.