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目的比较口服西地那非(SIL)与静脉应用前列地尔(PGE1)治疗先天性心脏病(先心病)术后肺动脉高压(PH)的早期疗效。方法24例患者随机分为A、B、C三组:A组先鼻饲SIL0·35mg/kg,后静脉应用PGE120ng/(kg·min);C组顺序相反;B组为对照组。检测用药前后患者血流动力学参数、动脉血气、氧合指标及肺力学参数。结果与B组比较,两组在降低平均肺动脉压(mPAP)、mPAP/有创桡动脉压(mSAP)方面差异均具有统计学意义(P<0·01),SIL较PGE1作用更明显(P<0·05)。SIL可造成患者mSAP下降(P<0·01),但不需干预治疗;PGE1可抑制患者PaO2下降(P<0·05);两组对肺顺应性、呼吸功均无影响。结论两药均能有效降低此类患者肺动脉压力,而SIL口服使用更方便。因此,SIL可作为先心病术后治疗PH的新选择。
Objective To compare the early effects of oral administration of sildenafil (SIL) and intravenous prostaglandin (PGE1) on pulmonary hypertension (PH) after congenital heart disease (CHD). Methods Twenty-four patients were randomly divided into three groups: A, group A, nasal feeding of SIL0 35 mg / kg, and post-vein application of PGE1 20 ng / (kg · min). The order of the group C was opposite. The group B was the control group. The hemodynamic parameters, arterial blood gas, oxygenation index and pulmonary mechanics parameters were measured before and after treatment. Results Compared with group B, the differences in mean pulmonary arterial pressure (mPAP), mPAP / invasive radial arterial pressure (mSAP) in both groups were statistically significant (P <0.01) and SIL was more significant than PGE1 <0 · 05). SIL could cause the decline of mSAP in patients (P <0.01), but no intervention was needed; PGE1 could inhibit the decrease of PaO2 in patients (P <0.05); There was no effect on lung compliance and respiration in both groups. Conclusion Both drugs can effectively reduce pulmonary artery pressure in these patients, and oral administration of SIL is more convenient. Therefore, SIL can be used as a new choice for the treatment of congenital heart disease PH.