Effect of combined therapy with silverestana, methylprednisolone sodium succinate, and airway pressure release ventilation on lung function in acute respiratory distress syndrome caused by sepsis

doi:10.3877/cma.j.issn.1674-6902.2025.05.023

Abstract

Abstract:

Objective

To analyze the impact of silverestana combined with methylprednisolone sodium succinate and airway pressure release ventilation (APRV) on lung function in patients with acute respiratory distress syndrome (ARDS) caused by sepsis.

Methods

A total of 54 patients with ARDS due to sepsis admitted to our hospital from January 2020 to December 2024 were selected. They were divided into a control group of 31 patients and an observation group of 23 patients based on the treatment method. Both groups received conventional treatment and respiratory management. The control group was treated with APRV and intravenous infusion of 40 mg of methylprednisolone sodium succinate daily. The observation group received an additional 4.8 mg/kg of silverestana intravenously via a pump on top of the control group′s treatment regimen. The medications were administered continuously for 7 days. Hematological indicators, lung function, lung CT imaging results, acute physiology and chronic health evaluation Ⅱ (APACHE-Ⅱ) scores, murray lung injury scores (MLIS), sequential organ failure assessment (SOFA) scores, prognosis, and adverse reactions were compared between the two groups.

Results

After treatment, the observation group exhibited lower levels of interleukin-6 (IL-6) (0.47±0.06) ng/L, procalcitonin (PCT) (0.43±0.07) ng/ml, C-reactive protein (CRP) (12.38±3.17) mg/L, and extravascular lung water index (ELWI) (8.34±1.39) ml/kg, APACHE-Ⅱ (13.19±2.12) points, MLIS (2.26±0.34) points, and SOFA (6.32±1.17) points compared to the control group, which had values of (0.52±0.09) ng/L, (0.48±0.09) ng/ml, (14.35±3.62) mg/L, (9.23±1.75) ml/kg, (14.65±2.68) points, (2.54±0.35) points, and (7.14±1.48) points, respectively. The observation group showed higher dynamic lung compliance (Cdyn) values (18.28±3.45) ml/cm and a higher survival rate of 18 cases compared to the control group, which had values of (16.47±3.06) ml/cm and 16 cases, respectively (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05).

Conclusion

The combination of silverestana with methylprednisolone sodium succinate and APRV has clinical significance in improving blood gas indicators and lung function, reducing inflammation levels, and improving the prognosis of ARDS patients.

Key words: Acute respiratory distress syndrome, Silverestana, Methylprednisolone sodium succinate, Airway pressure release ventilation, Sepsis

Xinghua Li, Guixian Li, Ying Liu, Hongyu Geng, Ying Gu, Congcong Han. Effect of combined therapy with silverestana, methylprednisolone sodium succinate, and airway pressure release ventilation on lung function in acute respiratory distress syndrome caused by sepsis[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 789-795.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2025.05.023

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2025/V18/I05/789

Figures/Tables 6

References 31

1	魏丁，乔艳艳，顾兴，等. 体外膜肺氧合救治急性呼吸窘迫综合征不良预后危险因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(3): 363-367.
2	李玉娟，贾元萍，张誉腾，等. 基于文献的中医药治疗急性肺损伤、急性呼吸窘迫综合征用药规律研究[J]. 世界中医药，2020, 15(12): 1756-1761.
3	魏丁，乔艳艳，顾兴，等. 体外膜肺氧合救治急性呼吸窘迫综合征不良预后危险因素分析[J/OL]. 中华肺部疾病杂志，2024, 17(3): 363-367.
4	王敏，孙雯雯，汪东亮，等. 老年脓毒症合并急性呼吸窘迫综合征患者血清铁蛋白、内毒素、肺表面活性蛋白A、TLR4水平变化及意义[J]. 中国老年学杂志，2024, 44(24): 5918-5922.
5	王熊，李欣坪，徐晓微，等. 西维来司他钠治疗儿童脓毒症和急性呼吸窘迫综合征病例分析与文献回顾[J]. 实用药物与临床，2025, 28(1): 21-25.
6	许晓函，胡威龙，王润珠，等. 西维来司他钠治疗时机对脓毒症急性呼吸窘迫综合征患者的影响[J]. 实用心脑肺血管病杂志，2025, 33(1): 94-97.
7	李瀛，罗蔚锋，卫红齐，等. 甲泼尼龙琥珀酸钠联合高压氧治疗神经性耳聋患者的临床研究[J]. 中国临床药理学杂志，2024, 40(3): 345-349.
8	王维娟，李娜，王璐，等. 西维来司他钠联合APRV治疗小儿重度ARDS的前瞻性随机对照研究[J]. 中国医院用药评价与分析，2024, 24(11): 1329-1332.
9	Russell J, Slutsky A, Lemaire F, et al. Ventilator-associated lung injury in ARDS: american thoracic society (ATS), european society of intensive care medicine (ESICM) Société de réanimation de langue française (SRLF)[J]. Reanimation Urgences, 2013, 9(1): 53-61.
10	曹钰，柴艳芬，邓颖，等．中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学，2018, 38(9): 741-756.
11	Redfern OC, Smith GB, Prytherch DR, et al. A comparison of the quick sequential (sepsis-related) organ failure assessment score and the national early warning score in non-ICU patients with/without infection[J]. Critical Care Medicine, 2018, 46(12): 1923-1933.
12	黄祺，孙宇，罗莉，等. ICU创伤患者并发脓毒症预警评分系统的建立[J]. 中华危重病急救医学，2019, 31(4): 422-427.
13	朱建凤，王红娟. 盐酸氨溴索联合纤维支气管镜肺泡灌洗在老年重症肺炎患者中的应用效果[J]. 实用临床医药杂志，2020, 24(1): 82-87.
14	刘甜，杜玉明，孙建浩，等. 食管压指导呼气末正压滴定对急性呼吸窘迫综合征患者早期预后影响的Meta分析[J]. 中国全科医学，2021, 24(20): 2573-2579.
15	丁伟超，陈娟，叶英，等. 血必净注射液治疗脓毒症相关急性呼吸窘迫综合征肺热血瘀证患者的临床疗效[J]. 中草药，2024, 55(19): 6645-6654.
16	周峰，尹其翔，魏法星，等. 血清水通道蛋白1水平联合血管外肺水指数对脓毒症致急性呼吸窘迫综合征的价值[J]. 实用医学杂志，2024, 40(17): 2483-2488.
17	黎玉霜，田继先. 中性粒细胞弹性蛋白酶及其抑制剂在脓毒症相关ARDS中作用的研究进展[J]. 国际检验医学杂志，2024, 45(14): 1761-1766.
18	王瑾，周冠华，王助衡. 西维来司他钠联合乌司他丁对ARDS患者炎性反应、血气水平的影响[J]. 河北医药，2024, 46(12): 1810-1813.
19	张春，吕桂芳，郭登方，等. 糖皮质激素对重症急性胰腺炎大鼠急性肺损伤的保护作用机制研究[J]. 中国临床药理学杂志，2020, 36(24): 4006-4009.
20	岳伟岗，向飞，张莹，等. 急性呼吸窘迫综合征患者早期应用气道压力释放通气的疗效[J/OL]. 中华危重症医学杂志(电子版), 2020, 13(2): 93-99.
21	梁旭，李国旗，库尔班江·吐尔逊，等. 脓毒症患者系统免疫炎症指数、D-二聚体水平与SOFA评分的变化及其对预后的评估价值[J]. 暨南大学学报(自然科学与医学版), 2024, 45(6): 622-630.
22	孟祥艳，赵艳梅，路倩颖，等. 肺康复在急性呼吸窘迫综合征治疗中的应用进展[J]. 中国康复医学杂志，2022, 37(6): 845-849.
23	李晓东，李甜，邸兴伟. 基于肺动脉压力导向的最佳呼气末正压对ARDS患者氧合指数及血流动力学的影响研究[J]. 中国急救医学，2020, 40(7): 619-623.
24	董晓玉，马晴晴，殷俊，等. 血清IL-6与中性粒细胞表型及吞噬力关系在脓毒症分期中的诊断价值[J]. 安徽医科大学学报，2020, 55(8): 1265-1270.
25	李南，钟昌宝，张娇珍，等. 脓毒症并发ARDS患者血清miR-98-5p、ESM-1、sTM、VE-Cad水平及其与预后的关系[J]. 中华医院感染学杂志，2023, 33(15): 2241-2245.
26	乔智灏，张梦雅，游凯斌，等. 脓毒症致ARDS患者死亡的影响因素及炎症因子水平对预后评估的价值[J]. 中国病原生物学杂志，2021, 16(11): 1334-1337.
27	陈玲，胡荆江，覃军. 低剂量甲泼尼龙琥珀酸钠对重症支原体肺炎患儿T淋巴细胞亚群及炎症因子水平的影响[J]. 中国现代医学杂志，2023, 33(5): 63-67.
28	杨波，金肇权. 西维来司他钠联合乌司他丁治疗脓毒症所致急性呼吸窘迫综合征的临床疗效[J]. 实用医学杂志，2024, 40(5): 621-626.
29	孙伟，王晶. 非重型肺源性急性呼吸窘迫综合征患者的预后影响因素分析[J]. 解放军医学杂志，2022, 47(8): 795-801.
30	汤赐俊，唐瑾，张素冕，等. 相对血糖比值对脓毒症相关ARDS患者关系的研究[J]. 南京医科大学学报(自然科学版), 2024, 44(11): 1573-1580.
31	罗敏，胡鸿彬，孙烨，等. 西维来司他钠治疗COVID-19相关急性呼吸窘迫综合征重症患者的疗效：一项回顾性、单中心、队列研究[J].南方医科大学学报，2023, 43(8): 1259-1267.

组　别	例数	PaO₂(mmHg)		PaCO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	23	70.92±16.57	109.65±23.72^a	45.85±8.65	35.77±7.24^a	88.06±19.26	241.35±40.24^a
对照组	31	72.86±19.81	102.83±21.25^a	43.27±7.17	38.29±8.71^a	95.38±17.39	221.84±36.18^a
t值		0.381	1.110	1.197	1.128	1.461	1.868
P值		0.705	0.272	0.237	0.265	0.150	0.067

组　别	例数	PaO₂(mmHg)		PaCO₂(mmHg)		PaO₂/FiO₂
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	23	70.92±16.57	109.65±23.72^a	45.85±8.65	35.77±7.24^a	88.06±19.26	241.35±40.24^a
对照组	31	72.86±19.81	102.83±21.25^a	43.27±7.17	38.29±8.71^a	95.38±17.39	221.84±36.18^a
t值		0.381	1.110	1.197	1.128	1.461	1.868
P值		0.705	0.272	0.237	0.265	0.150	0.067

组　别	例数	NEUT(%)		IL-6(ng/L)		ESM-1(ng/ml)		PCT(ng/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	23	87.35±16.75	62.26±10.84^a	0.92±0.15	0.47±0.06^a	3.57±0.61	1.62±0.24^a	0.91±0.17	0.43±0.07^a
对照组	31	90.86±17.24	68.29±12.58^a	0.88±0.13	0.52±0.09^a	3.49±0.53	1.74±0.28^a	0.88±0.14	0.48±0.09^a
t值		0.749	1.845	1.047	2.308	0.514	1.653	0.711	2.212
P值		0.457	0.071	0.300	0.025	0.609	0.104	0.481	0.031

组　别	例数	NEUT(%)		IL-6(ng/L)		ESM-1(ng/ml)		PCT(ng/ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	23	87.35±16.75	62.26±10.84^a	0.92±0.15	0.47±0.06^a	3.57±0.61	1.62±0.24^a	0.91±0.17	0.43±0.07^a
对照组	31	90.86±17.24	68.29±12.58^a	0.88±0.13	0.52±0.09^a	3.49±0.53	1.74±0.28^a	0.88±0.14	0.48±0.09^a
t值		0.749	1.845	1.047	2.308	0.514	1.653	0.711	2.212
P值		0.457	0.071	0.300	0.025	0.609	0.104	0.481	0.031

组　别	例数	AST(IU/L)		肌酐(μmol/L)		CRP(mg/L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	23	47.35±7.51	30.28±5.54^a	175.34±29.29	131.84±22.32^a	37.25±6.35	12.38±3.17^a
对照组	31	49.34±6.42	33.12±5.73^a	170.32±28.56	142.53±20.15^a	39.34±5.78	14.35±3.62^a
t值		1.048	1.826	0.632	1.841	1.260	2.083
P值		0.300	0.074	0.530	0.071	0.213	0.042

Please choose a citation manager

Content to export