西地那非联合肺表面活性物质治疗胎粪吸入综合征合并肺动脉高压患儿的效果及护理

Effect and nursing of sildenafil combined with pulmonary surfactant on the treatment of newborn meconium aspiration syndrome children with persistence pulmonary hypertension

目的：探讨西地那非联合肺表面活性物质（ PS）对新生儿胎粪吸入综合征（ NMAS）合并肺动脉高压（ PPH）患儿治疗效果，并总结护理经验。方法将60例NMAS合并PPH患儿按随机数字表法分为对照组和观察组各30例。两组均采用高频振荡辅助通气、合适补液、抗生素等进行常规治疗，对照组患儿接受气管内滴入PS，观察组在对照组的基础上加用西地那非；比较两组患者治疗前后的氧合指数与肺泡动脉氧分压差值及治疗后肺动脉压（ PAP）。结果治疗后4，12 h两组患者氧合指数（ OI）及肺泡动脉氧分压差（ A-aDO2）比较差异均有统计学意义（ P＜0．01）；治疗36 h后，观察组患儿 OI 为（11．7±177;2．8），对照组为（19．1±177;3．4），两组比较差异有统计学意义（t＝9．202，P＜0．01）；观察组A-aDO2为（12．1±177;3．2）mmHg，对照组为（27．6±177;5．5）mmHg，两组比较差异有统计学意义（t＝13．342，P＜0．01）。治疗24～36 h后，观察组与对照组PAP分别为（40．4±177;10．7） mmHg和（49．3±177;13．4） mmHg，两组比较差异具有统计学意义（t＝2．843，P＜0．01）。两组均无不良并发症发生。结论西地那非联合PS，同时做好呼吸道护理及高频振荡辅助通气时气道护理，能进一步提高对NMAS伴PPH的治疗效果。

Objective To explore the treatment effect of sildenafil combined with pulmonary surfactant （PS） on newborn meconium aspiration syndrome （ NMAS） children with persistence pulmonary hypertension （ PPH） , and to summarize the nursing experience .Methods Sixty NMAS children with PPH were chosen and randomly divided into the control group and the observation group according to the random number table , each with 30 cases. All children received the routine treatment including high frequency oscillation assisted ventilation , proper rehydration , antibiotics and so on , and the control group received the intratracheal instillation of PS, and the observation group received the sildenafil on the basis of PS .The oxygenation index （ OI ） , alveolar-arterial oxygen difference （ A-aDO2 ） and pulmonary artery pressure （ PAP） were compared between two groups before and after the treatment .Results The differences were found in the OI and A-aDO2 4 and 12 h after the treatment between two groups （P＆lt;0.01）; The OI was （11.7 ±177;2.8） in the observation group 36 h after the treatment, and was （19.1 ±177;3.4） in the control group, and the difference was statistically significant （t=9.202, P＆lt;0.01）; the A-aDO2 was （12.1 ±177;3.2）mmHg in the observation group, and was （27.6 ±177; 5.5）mmHg in the control group, and the difference was statistically significant （t=13.342, P＆lt;0.01）.The PAP was （40.4 ±177;10.7） mmHg in the observation group 24 ~36 h after the treatment, and was （49.3 ±177; 13.4）mmHg in the control group, and the difference was statistically significant （t=2.843, P＆lt;0.01）.No serious complications were found in two groups .Conclusions The sildenafil combined with PS , meanwhile, the respiratory tract nursing and the high frequency oscillation assisted ventilation airway nursing were well , can further enhance the treatment effect of NMAS combined with PPH .