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目的:评价西地那非辅助治疗新生儿持续肺动脉高压(PPHN)的有效性和安全性,为临床应用提供指导。方法:将2008年1月～2011年5月确诊的40例PPHN患儿随机分为治疗组22例和对照组18例,对照组给予保暖、碳酸氢钠碱化血液、积极治疗原发病、常规给氧及呼吸机辅助通气等常规治疗,治疗组在常规治疗的基础上给予枸橼酸西地那非片鼻饲0.6～2.0 mg/(kg.次),每6 h 1次,疗程到停用机械通气,比较两组治疗前后PaCO2、PaO2、肺动脉压力(PAP)、氧合指数(OI)、肺泡气-动脉血氧分压差。结果:西地那非组血气指标明显改善,肺动脉压下降,治疗组PAP和肺动脉/体循环收缩压(PAP/SBP)在治疗后各时点逐步下降,与治疗前比较均明显下降,差异有统计学意义(P<0.05),两组PaO2和OI在治疗后均明显上升,并随着治疗时间延长逐步上升,与治疗前比较差异有统计学意义(P<0.05)。结论:西地那非治疗新生儿PPHN能更好改善患儿的氧合指数、氧饱和度,降低肺动脉压力,其疗效肯定。
Objective: To evaluate the efficacy and safety of sildenafil adjuvant treatment of neonatal persistent pulmonary hypertension (PPHN), and provide guidance for clinical application. Methods: Forty patients with PPHN diagnosed from January 2008 to May 2011 were randomly divided into treatment group (n = 22) and control group (n = 18). The control group was given warm, sodium bicarbonate and alkalinized blood, the active treatment of the primary disease, Conventional oxygen therapy and ventilator assisted ventilation and other conventional treatment, the treatment group given routine treatment of sildenafil citrate tablets 0.6 to 2.0 mg / (kg), once every 6 h, treatment to stop The mechanical ventilation was used to compare PaCO2, PaO2, PAP, OI and alveolar-arterial oxygen pressure difference before and after treatment. Results: The blood gas index of sildenafil group was significantly improved and the pulmonary arterial pressure was decreased. PAP and PAP / SBP of the treatment group were gradually decreased at various time points after treatment, which were significantly lower than those before treatment, with statistical differences (P <0.05). PaO2 and OI in both groups increased significantly after treatment, and gradually increased with the prolongation of treatment time. The difference was statistically significant (P <0.05). Conclusion: Sildenafil treatment of neonatal PPHN can better improve children’s oxygenation index, oxygen saturation, reduce pulmonary artery pressure, its efficacy is sure.