西地那非与前列地尔治疗先天性心脏病术后肺动脉高压的疗效对比

Comparison of oral Sildenafil and intravenous prostaglandin E_1 in treatment of pulmonary hypertension associated with congenital heart defects after cardiac surgery

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 effects of oral Sildenafil （SIL） and intravenous prostaglandin E1 （Alprostadil, PGE1） in treatment of postoperative pulmonary hypertension （PH） associated with congenital heart defects （CHD）. Methods Data were collected from 24 children with postoperative mPAP≥35 mmHg in our hospital between August 2004 and March 2005. These children were randomly divided into three groups： 8 children （group A） initially received SIL （0.35 mg/kg, orally by nasal gastric tube）, followed by the addition of intravenous PGE, （20 ng/kg per min） at 40 min. The second group of 8 children （group C） initially received intravenous PGE, followed by the addition of SIL at 20 min （dose as above）. And remains （group B） were placebo-controlled. The changes of hemodynamic variables, arterial blood gas, lung static compliance （C） and work of breathing （W） were measured after drugs were given. Results Compared with group B, the mPAP and mPAP/mSAP was significantly reduced （P〈0.01） in the two treatment groups, and SIL was more effective than PGE, （ P〈0.05）. After administration of SIL, the mSAP was significantly reduced （ P〈0.05）. SIL and PGE, reduced PaO2 and OI, respectively, but had no effeets on C and W. ConcIusion Both oral SIL and intravenous PGE, could alleviate PH following cardiac surgery in children with CHD. Compared with PGE, , SIL was more convenient. SIL could serve as a new choice in treatmen of PH after cardiac surgery in children.