曲前列尼尔治疗Fontan术后早期失代偿患儿的临床疗效及安全性  

Clinical efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure

作　　者：刘学兰 华影 吴开元 胡曼曼 李斌 黄晓婧 Liu Xuelan;Hua Ying;Wu Kaiyuan;Hu Manman;Li Bin;Huang Xiaojing(Intensive Care Unit of Children Heart Center,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450000,China;Department of Pharmacy,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省人民医院,郑州大学人民医院,阜外华中心血管病医院儿童心脏中心重症监护室,郑州450000 [2]河南省人民医院,郑州大学人民医院,阜外华中心血管病医院药学部,郑州450000

出　　处：《中华实用儿科临床杂志》2022年第1期41-44,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：河南省医学科技攻关计划(LHGJ20210089)。

摘　　要：目的探讨曲前列尼尔治疗Fontan术后早期失代偿患儿的临床疗效及安全性。方法回顾性分析2017年12月至2020年6月阜外华中心血管病医院使用曲前列尼尔注射液治疗的16例Fontan术后早期失代偿患儿的临床资料,16例患儿中男5例(31.2%),女11例(68.8%);年龄(4.6±1.2)岁,体质量(16.0±2.1)kg。记录治疗前、治疗3 h、24 h、48 h及72 h中心静脉压(CVP)、心率(HR)、收缩压(SBP)、中心静脉血氧饱和度(ScvO_(2))、乳酸(Lac)、氧合指数、B型利钠肽(BNP)变化;观察曲前列尼尔治疗Fontan术后早期失代偿患儿的近期疗效[病死率、机械通气时间、重症监护室(ICU)时间]。采用配对t检验比较不同时间点上述指标。记录用药过程中的不良反应。结果16例患儿机械通气中位时间9(5,22)h,ICU滞留中位时间2(1,12)d。用药72 h后,患儿CVP、Lac、BNP、HR下降,CVP从(16±5)mmHg(1 mmHg=0.133 kPa)降至(11±2)mmHg(P<0.001),Lac从(6.8±3.2)mmol/L降至(3.2±1.2)mmol/L(P=0.002),BNP从(980±223)ng/L降至(250±120)ng/L(P<0.001),HR从(150±20)次/min降至(125±16)次/min(P=0.002);SBP、ScvO_(2)、氧合指数上升:SBP从(83±10)mmHg升至(98±12)mmHg(P<0.001),ScvO_(2)从0.53±0.13升至0.65±0.11(P=0.003),氧合指数从(200±72)mmHg升至(298±13)mmHg(P<0.001),差异均有统计学意义(均P<0.05)。死亡1例(6.3%),2例(12.5%)早期有一过性血压下降,1例(6.3%)出现恶心、呕吐,无其他不良反应。结论对于Fontan术后早期失代偿患儿,静脉应用曲前列尼尔能快速降低肺动脉压,有效改善循环状态及氧合,最终改善患儿预后。Objective To investigate the efficacy and safety of Treprostinil in the treatment of children with early decompensation after the Fontan procedure.Methods A retrospectively analysis was performed on the clinical data of 16 children with early decompensation after the Fontan procedure treated with Treprostinil injection from December 2017 to June 2020 at Fuwai Central China Cardiovascular Hospital.A total of 16 patients were included,including 5 boys(31.2%)and 11 girls(68.8%).The age was(4.6±1.2)years,the weight was(16.0±2.1)kg.The changes of central venous pressure(CVP),heart rate(HR),systolic blood pressure(SBP),central venous oxygen saturation(ScvO_(2)),lactic acid(Lac),oxygenation index and B-type natriuretic peptide(BNP)were recorded at the infusion of Treprostinil and 3 hours,24 hours,48 hours and 72 hours after the infusion.The short-term efficacy of Treprostinil was observed[mortality,mechanical ventilation time,and length of intensive care unit(ICU)stay];paired t-test was used to analyze the above indexes at different time points.The adverse reactions during the administration were also recorded.Results Of the 16 children,the median mechanical ventilation time was 9(5,22)h,and the median ICU stay time was 2(1,12)days.After 72 hours of drug administration,CVP,Lac,BNP and HR decreased:CVP decreased from(16±5)mmHg(1 mmHg=0.133 kPa)to(11±2)mmHg(P<0.001),Lac decreased from(6.8±3.2)mmol/L to(3.2±1.2)mmol/L(P=0.002),BNP decreased from(980±223)ng/L to(250±120)ng/L(P<0.001),HR decreased from(150±20)times/min to(125±16)times/min(P=0.002);SBP,ScvO_(2) and oxygenation index increased:SBP increased from(83±10)mmHg to(98±12)mmHg(P<0.001),ScvO_(2) increased from 0.53±0.13 to 0.65±0.11(P=0.003),oxygenation index increased from(200±72)mmHg to(298±13)mmHg(P<0.001),and the differences were statistically significant(all P<0.05).One case died(6.3%),2 cases(12.5%)had transient blood pressure drop and 1 case(6.3%)had nausea and vomiting.Besides,no other treatment-related complications were observed.Conclusions A

关 键 词：肺血管阻力 FONTAN手术 曲前列尼尔 

分 类 号：R726.5[医药卫生—儿科]