西地那非治疗婴幼儿先天性心脏病重度肺动脉高压疗效观察  

Therapeutic effect of sildenafil on severe pulmonary arterial hypertension associated with congenital heart disease in infants

作　　者：杨望[1] 廖伟[1] 赵聪敏[1] 

机构地区：[1]第三军医大学新桥医院儿科,重庆400037

出　　处：《第三军医大学学报》2011年第15期1623-1625,共3页Journal of Third Military Medical University

摘　　要：目的观察西地那非对先天性心脏病合并重度肺动脉高压患儿的临床疗效。方法收集我科2009年1月至2010年11月收治的先天性心脏病合并重度肺动脉高压患儿70例,均为左向右分流型先天性心脏病。将患儿以简单随机化法分为西地那非组(n=37)和对照组(n=33),2组患儿年龄、肺动脉压无显著性差异。均在强心、利尿基础上,西地那非组给予口服西地那非(每次0.5 mg/kg,每4小时1次);对照组给予外周静脉前列腺素E_1维持[5 ng/(kg.min),6～8 h/d]。2组均用药7～10 d,比较用药前后肺动脉收缩压(PASP)、血压(BP)、动脉氧分压[p(O2)]、血氧饱和度(SaO2)等指标的变化。结果西地那非组患儿治疗7～10 d后肺动脉压降低[(74.6±9.8)mmHg vs(58.3±7.7)mmHg,P<0.05]、动脉氧分压升高[(76.6±7.6)mmHg vs(88.3±5.8)mmHg,P<0.05]、血氧饱和度增加[(89.3±2.4)%vs(94.6±3.4)%,P<0.05],而对体循环血压无明显影响[(92.8±12.3)%vs(93.3±15.6)%,P>0.05],治疗后西地那非组与治疗前相比肺循环改善,而且治疗效果与对照组无显著性差异。结论西地那非能有效减轻先天性心脏病合并重度肺动脉高压患儿的肺动脉压力,增加手术矫正心脏畸形的安全性,且给药方便、价格便宜,利于临床推广。Objective To determine the therapeutic effect of sildenafil on severe pulmonary arterial hypertension （PAH） associated with congenital heart disease in infants. Methods Seventy infants with PAH, 38 males and 32 females, with a mean age of 13.2 ± 2.3 months, and a mean weight of 8.4 ± 1.4 kg, hospitalized in our department from January 2009 to November 2010 were enrolled. All the 70 infants were randomly divided into research group （n = 37） and control group （n = 33）. There were no significant difference in age, pulmonary artery pressure, p （ 02 ）, and SaO2 between the 2 groups. All infants were treated with diuretic digoxin. Those infants in research group were also treated with Sildenafil （0.5 mg/kg, once per 4 h） and the other of control group were treated with PGE1 [5 ng/（kg · min）]. And the c blood pressure, SaO2, and p （ 02 ） were measured after the drugs were hanges of pulmonary artery pressure, given for 7 to 10 d. Results After using Sildenafil for 7 to 10 d, pulmonary artery pressure was decreased （74.6 ±9.8 mrnHg vs 58.3 ±7.7 mmHg, P 〈 0.05 ）, and p （ 02 ） was increased significantly （76.6 ± 7.6 mmHg vs 88.3 ± 5.8 mmHg, P 〈 0.05 ）, and SaO2 was elevated（76.6±7.6 mmHg vs 88.3 ± 5.8 mmHg, P 〈 0.05）. There was no significant change on blood pressure [ （92.8 ± 12.3 ） % vs （93.3 ± 15.6） %, P 〉 0.05 ]. After 7 to 10 days＇ treatment, pulmonary artery pressure was obviously alleviated than before treatment in research group. Conclusion Sildenafil attenuates pulmonary artery pressure in infants with PAH induced by CHD, and improves the security of operations on those with severe pulmonary hypertension. And sildenafil is cheap, convenient to administration, and should be widely used in clinic.

关 键 词：西地那非 先天性心脏病 术前 重度肺动脉高压 

分 类 号：R725.411[医药卫生—儿科] R725.432[医药卫生—临床医学]