西地那非治疗肺动脉高压的前瞻性研究  

Prospective Study of Sildenafil in the Treatment of Pulmonary Hypertension

作　　者：严晓娟[1] 马可忠[2] 刘海[2] 汤永谦[2] 朱锐[2] 李彬[2] 赵玉勤[2] 刘文卫[2] 

机构地区：[1]襄阳市中心医院呼吸内科,湖北襄阳441021 [2]襄阳市中心医院心内科,湖北襄阳441021

出　　处：《中国药房》2012年第30期2855-2857,共3页China Pharmacy

摘　　要：目的:研究西地那非对肺动脉高压的疗效及安全性。方法:筛选2008年6月-2010年6月我院诊治的肺动脉高压患者,对符合入组标准的35例患者,在抗凝、利尿、地高辛和吸氧等常规治疗的基础上给予口服西地那非治疗3个月,比较治疗前、后患者血常规、肝肾功能、世界卫生组织(WHO)肺动脉高压功能分级、6min步行距离、Borg呼吸困难积分、动脉血气分析和血流动力学指标的差异。结果:35例肺动脉高压患者治疗前WHO肺动脉高压功能分级分别为Ⅱ级19例、Ⅲ级12例、Ⅳ级4例,治疗后分别为Ⅰ级9例、Ⅱ级20例、Ⅲ级5例和Ⅳ级1例,治疗后患者肺功能分级显著优于治疗前(P<0.05)。治疗后肺动脉高压患者6min步行距离、心输出量、心指数和动脉血氧分压显著增加(P<0.05),心率、Borg呼吸困难积分、右室收缩压、平均肺动脉压、肺血管阻力和三尖瓣反流速率均显著降低(P<0.05)。治疗后的红细胞(RBC)、血红蛋白(Hbg)、白细胞(WBC)、血小板(PLT)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)和血肌酐(Cr)较治疗前降低,尿素氮(BUN)升高,其中在RBC、Hbg、WBC和PLT方面的差异有统计学意义(P<0.05)。服药期间未发生血常规和肝肾功能、电解质等异常,不良反应包括头痛5例(14.3%)、面部潮红3例(8.6%)、腹泻2例(5.7%)、头昏2例(5.7%)和耳鸣1例(2.9%)。结论:西地那非可显著改善肺动脉高压患者心功能,是安全、有效的治疗方法。OBJECTIVE：To study the curative effect and safety of sildenafil in the treatment of pulmonary hypertension.METHODS：35 cases of pulmonary hypertension collected from our hospital between Jun.2008 and Jun.2010 were administrated with sildenafil for 3 months on the basis of conventional treatment of anticoagulant,diuresis,digoxin and oxgen uptake.Blood routine,hepatic and renal function,WHO functional classification of pulmonary hypertension,6 min walking distance,Borg respiration difficulty score,arterial blood gas analysis and hemodynamics index were compared before and after therapy.RESULTS：WHO functional classification of 35 cases of pulmonary hypertension before therapy were 19 cases of class Ⅱ,12 cases of class Ⅲ and 4 cases of class Ⅳ,while 9 cases of classⅠ,20 cases of class Ⅱ,5 cases of class Ⅲ and 1 case of class Ⅳ after therapy.Pulmonary functional classification score of patients before therapy was superior to that after therapy significantly（P0.05）.6 min walking distance,cardiac output,cardiac index and arterial partial pressure were increased significantly after therapy（P0.05）,while heart rate,Borg respiration difficulty score,right ventricular systolic pressure,average pulmonary arterial pressure,pulmonary vascular resistance and velocity of tricuspid regurgitation were decreased significantly（P0.05）.The RBC,Hbg,WBC,PLT,ALT,TBIL and Cr were significantly decreased（P0.05）,while BUN increased.There were statistical significance in RBC,Hbg,WBC and PLT（P0.05）.No abnormal blood routine,hepatic and renal function or electrolyte were observed.Adverse drug reactions were 5 cases of encephalalgia（14.3%）,3 cases of facial flush（8.6%）,2 cases of diarrhea（5.7%）,2 cases of dizziness（5.7%） and 1 case of tinnitus（2.9%）.CONCLUSION：Sildenafil could significantly promote cardiac function in patients with pulmonary hypertension,which is an effective and safe therapeutic method.

关 键 词：肺动脉高压 西地那非 疗效 不良反应 

分 类 号：R969.4[医药卫生—药理学] R541.5[医药卫生—药学]