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目的:研究枸橼酸西地那非对先天性心脏病介入手术后重度肺动脉高压的影响。方法:20例经右心导管检查术确诊为先天性心脏病合并重度肺动脉高压的患儿介入封堵术后口服枸橼酸西地那非0.3 mg/kg,每天3次。术后30 d复查心脏彩超,测量三尖瓣返流速度,计算肺动脉收缩压及肺动脉压/体动脉压,测量左心室及右心室舒张末内径、左心房内径、右心房内径、左室射血分数、左心室短径缩短率,同时测量指端动脉血氧饱和度、体动脉收缩压。结果:用药30 d后,与用药前相比外周动脉血氧饱和度增加(0.97±0.02 vs 0.90±0.07,P<0.01),体动脉血压升高[(96.40±7.88)mm Hg vs(83.80±7.09)mmHg](P<0.01),肺动脉收缩压明显降低[(30.10±3.05)mm Hg vs(79.25±8.05)mm Hg](P<0.01),肺动脉收缩压/体动脉压下降明显(0.32±0.06 vs 0.72±0.08,P<0.01);左心室舒张末内径(47.85±9.48 vs 32.05±4.63,P<0.01),左心房内径(35.60±4.08 vs 21.75±3.46,P<0.01)和右心室舒张末内径(25.10±5.40 vs 19.25±3.79,P<0.01)均有缩短,右心房内径改变不明显(18.25±1.88 vs 18.15±1.98,P>0.05);左室射血分数降低(76.65±7.89 vs 67.70±6.96,P<0.01),左心室短径缩短率增加(33.70±4.01 vs 37.45±4.72,P<0.05)。20例患儿均未出现明显不良反应。结论:枸橼酸西地那非是一种新型、高选择性降低小儿介入心脏手术后严重肺动脉高压的药物。
Objective: To study the effect of sildenafil citrate on severe pulmonary hypertension after interventional surgery of congenital heart disease. Methods: Twenty children with congenital heart disease complicated with severe pulmonary hypertension diagnosed by right heart catheterization were given oral sildenafil citrate 0.3 mg / kg three times a day after closure. Thirty days after operation, the echocardiography was performed and the tricuspid regurgitation velocity was measured. The pulmonary artery systolic pressure and pulmonary arterial pressure / arterial pressure were calculated. The left and right atrial end diastolic diameter, left atrium diameter, right atrium diameter, left ventricular ejection Fractional shortening of left ventricular shortening, simultaneous measurement of finger arterial oxygen saturation and body artery systolic pressure. Results: After 30 days of treatment, peripheral arterial oxygen saturation increased (0.97 ± 0.02 vs 0.90 ± 0.07, P <0.01) and arterial blood pressure (96.40 ± 7.88) mm Hg vs (83.80 ± 7.09) mmHg] (P <0.01), pulmonary artery systolic pressure decreased significantly ([30.30 ± 3.05] mm Hg vs (79.25 ± 8.05) mm Hg] 0.06 vs 0.72 ± 0.08, P <0.01); left ventricular end diastolic diameter (47.85 ± 9.48 vs 32.05 ± 4.63, P <0.01), left atrial diameter (35.60 ± 4.08 vs 21.75 ± 3.46, P <0.01) The mean diameter of the right atrium (18.25 ± 1.88 vs 18.15 ± 1.98, P> 0.05) and the left ventricular ejection fraction decreased (76.65 ± 7.89 vs 67.70 ± 6.96, P <0.01). Shortening rate of shortening of left ventricle increased (33.70 ± 4.01 vs 37.45 ± 4.72, P <0.05). Twenty patients showed no obvious adverse reactions. CONCLUSIONS: Sildenafil citrate is a novel and highly selective drug that reduces severe pulmonary hypertension in pediatric cardiac surgery.