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目的观察西地那非对先天性心脏病合并重度肺动脉高压患儿的临床疗效。方法收集我科2009年1月至2010年11月收治的先天性心脏病合并重度肺动脉高压患儿70例,均为左向右分流型先天性心脏病。将患儿以简单随机化法分为西地那非组(n=37)和对照组(n=33),2组患儿年龄、肺动脉压无显著性差异。均在强心、利尿基础上,西地那非组给予口服西地那非(每次0.5 mg/kg,每4小时1次);对照组给予外周静脉前列腺素E_1维持[5 ng/(kg.min),6～8 h/d]。2组均用药7～10 d,比较用药前后肺动脉收缩压(PASP)、血压(BP)、动脉氧分压[p(O2)]、血氧饱和度(SaO2)等指标的变化。结果西地那非组患儿治疗7～10 d后肺动脉压降低[(74.6±9.8)mmHg vs(58.3±7.7)mmHg,P<0.05]、动脉氧分压升高[(76.6±7.6)mmHg vs(88.3±5.8)mmHg,P<0.05]、血氧饱和度增加[(89.3±2.4)%vs(94.6±3.4)%,P<0.05],而对体循环血压无明显影响[(92.8±12.3)%vs(93.3±15.6)%,P>0.05],治疗后西地那非组与治疗前相比肺循环改善,而且治疗效果与对照组无显著性差异。结论西地那非能有效减轻先天性心脏病合并重度肺动脉高压患儿的肺动脉压力,增加手术矫正心脏畸形的安全性,且给药方便、价格便宜,利于临床推广。
Objective To observe the clinical efficacy of sildenafil in children with congenital heart disease complicated by severe pulmonary hypertension. Methods Seventy patients with congenital heart disease complicated with severe pulmonary hypertension who were admitted to our department from January 2009 to November 2010 were collected, all of whom were left-right shunt congenital heart disease. The children were divided into sildenafil group (n = 37) and control group (n = 33) by simple randomization method. There was no significant difference in age and pulmonary arterial pressure between the two groups. All patients were given sildenafil orally (0.5 mg / kg once every 4 hours) on the basis of cardioplegic and diuretic effects. The control group was given peripheral blood prostaglandin E 1 [5 ng / (kg .min), 6 ~ 8 h / d]. The changes of pulmonary arterial systolic pressure (PASP), blood pressure (BP), arterial oxygen partial pressure [p (O2)] and blood oxygen saturation (SaO2) were compared between the two groups before and after treatment for 7-10 days. Results Pulmonary arterial pressure was significantly lower in patients with sildenafil after 7-10 days of treatment (74.6 ± 9.8 mmHg vs 58.3 ± 7.7 mmHg, P <0.05) (89.3 ± 2.4)% vs (94.6 ± 3.4)%, P <0.05], but had no significant effect on systemic blood pressure [(92.8 ± 12.3) vs (88.3 ± 5.8) mmHg, P < )% vs (93.3 ± 15.6)%, P> 0.05]. After treatment, the pulmonary circulation was improved in the sildenafil group compared with that before treatment, and the treatment effect was not significantly different from that in the control group. Conclusion Sildenafil can effectively reduce the pulmonary artery pressure in children with congenital heart disease complicated by severe pulmonary hypertension, increase the safety of surgical correction of cardiac malformations, and the administration is convenient, cheap, and conducive to clinical promotion.