Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary Bypass: A Prospective Randomized Study
Effect of the Neutrophil Elastase Inhibitor Sivelestat on Perioperative Inflammatory Response After Pediatric Heart Surgery With Cardiopulmonary Bypass: A Prospective Randomized Study
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DOI：
10.1111/aor.12103
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发表时间：
2013-12-01
影响因子：
2.4
通讯作者：
Miyaji, Kagami
中科院分区：
文献类型：
--
作者：
Kohira, Satoshi;Oka, Norihiko;Miyaji, Kagami
体外循环(CPB)会引起全身炎症反应。已知中性粒细胞弹性蛋白酶抑制剂西维来司他能抑制这种全身性炎症反应，最终可导致急性器官衰竭。西维来特对急性肺损伤的预防作用，特别是在儿童心脏手术中的作用尚不清楚。这项前瞻性、双盲、随机研究评价了在体外循环下接受择期心内直视手术的患儿围手术期应用西维来司他的预防效果。连续30例体外循环心脏直视手术患者，体重5~10 kg，随机分为西维来司组(n=15)和对照组(n=15)。从体外循环开始至术后24小时，西维来司组给予西维来司0.2 mg/kg/h持续静脉滴注，对照组给予等量生理盐水。测定白细胞(IL)-6、IL-8、肿瘤坏死因子-α、多形核弹力酶(PMN-E)、C反应蛋白(CRP)、白细胞(WBC)、血小板、中性粒细胞计数(NC)。根据重复双向方差分析，西维来司组PMN-E水平、IL-8水平、WBC计数、NC和CRP水平显著低于对照组，而血小板计数显著高于对照组。西维来司组活化凝血时间明显缩短，失血量也明显减少。综上所述，西维来司可减轻体外循环下小儿心脏手术患者围手术期的炎症反应和临床结局。
Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response. The neutrophil elastase inhibitor sivelestat is known to suppress this systemic inflammatory response, which can eventually result in acute organ failure. The prophylactic effect of sivelestat on acute lung injury, especially in pediatric cardiac surgery, remains unclear. This prospective double-blind, randomized study evaluated the perioperative prophylactic effect of sivelestat in patients undergoing elective pediatric open heart surgery with CPB. Thirty consecutive patients, weighing 5-10kg and undergoing open heart surgery with CPB, were assigned to sivelestat (n=15) or control (n=15) groups. From CPB initiation to 24h after surgery, patients in the sivelestat group received a continuous intravenous infusion of 0.2mg/kg/h sivelestat, whereas patients in the control group received the same volume of 0.9% saline. Blood samples were collected, and levels of interleukin (IL)-6, IL-8, tumor necrosis factor alpha, polymorphonuclear elastase (PMN-E), C-reactive protein (CRP), as well as the white blood cell (WBC) count, platelet count, and neutrophil count (NC) were measured. PMN-E levels, IL-8 levels, WBC count, NC, and CRP levels were significantly lower, and platelet count was significantly higher in the sivelestat group, according to repeated two-way analysis of variance. The activated coagulation time was significantly shorter in the sivelestat group, similarly, blood loss was significantly less in the sivelestat group. In conclusion, Sivelestat attenuates perioperative inflammatory response and clinical outcomes in patients undergoing pediatric heart surgery with CPB.