西地那非治疗新生儿呼吸窘迫综合征并发持续肺动脉高压脑利钠肽的变化及意义

Changes and Clinical Significance of Serum Brain Natriuretic Peptide Level in the Treatment of Neonatal Respiratory Distress Syndrome Complicated with Persistent Pulmonary Hypertension by Sildenafil

目的:探讨西地那非治疗新生儿呼吸窘迫综合征(NRDS)并发持续肺动脉高压(PPHN)血清N末端脑利钠肽(NT-pro BNP)水平的变化及意义。方法:测定并比较治疗前后NRDS并发PPHN患儿12例(NRDS+PPHN组)、单纯NRDS 24例(单纯NRDS组)及对照组30例新生儿的血清NT-pro BNP、肺泡-动脉氧分压差(A-a DO2)、氧合指数(OI)、肺动脉压力(PAP)等指标,采用单因素方差分析、SNK-q检验、Pearson相关分析比较其差异。结果:治疗前,单纯NRDS组与NRDS+PPHN组A-a DO2、OI、血清NT-pro BNP水平显高于对照组(P<0.05),且NRDS+PPHN组的A-a DO2、OI、血清NT-pro BNP水平高于单纯NRDS组(P<0.05);NRDS+PPHN组的血清NT-pro BNP水平与PAP呈正相关(r=0.796,P<0.05)。单纯NRDS组治疗72 h后,治疗有效的20例患儿A-a DO2、OI、血清NT-pro BNP水平较治疗前降低(P<0.05);治疗无效的4例患儿A-a DO2、OI、血清NT-pro BNP水平较治疗前稍升高,与治疗前比较差异无统计学意义(P>0.05)。NRDS+PPHN组治疗72 h后,治疗有效的7例患儿A-a DO2、OI、血清NT-pro BNP、PAP水平较治疗前降低(P<0.05);治疗无效的5例患儿A-a DO2、OI、PAP水平较治疗前稍升高,与治疗前比较差异无统计学意义(P>0.05),但血清NT-pro BNP水平较治疗前增高(P<0.05)。结论:NRDS合并PPHN患儿存在NT-pro BNP分泌的增加,血清NT-pro BNP水平结合A-a DO2、OI、PAP可反映NRDS合并PPHN的严重程度,亦可评价治疗效果。

Objective： To investigate the changes and clinical significance of serum brain natriuretic peptide （NT-proBNP） level in the treatment of neonatal respiratory distress syndrome complicated with persistent pulmonary hypertension by sildenafil. Methods： Measured and compared the serum NT-proBNP, alveolar arterial oxygen difference （ A-aDO2 ）, oxygen index （ OI）, pulmonary artery pressure （PAP） among the neonatal respiratory distress syndrome complicated with persistent pulmonary hypertension of twelve cases （NRDS with PPHN group）, single neonatal respiratory distress syndrome group of twenty-four cases （ single NRDS group） and the control group of thirty cases. One way anova, SNK-q test, Pearson correlation analysis were performed for statistical analysis. Results： Before treatment, the A-aDO2, OI, NT-proBNP of single NRDS group and NRDS with PPHN group were significantly higher than those in control group （ P〈0. 05 ）, and the A-aDO2, OI, NT-proBNP of NRDS with PPHN were significantly higher than those in the single NRDS group （ P〈 0.05） ; In NRDS with PPHN group, the NT-proBNP level was positively correlated with PAP （r=0. 796, P〈0.05）. After 72 hours＇ treatment, twenty infants with successful treatment of single NRDS group, A-aDO2, OI and NT-proBNP levels decreased markedly, respectively compared with those before treatment （ P〈0. 05 ）. For the four infants failed to treatment, A-aDO2, OI, NT-proBNP levels were slightly higher compared with those before treatment （ P〉0.05 ）. After 72 hours＇ treatment, seven infants with successful treatment of NRDS with PPHN group, A-aDO2 , OI, PAP and NT-proBNP levels decreased markedly, respectively compared with those before treatment （P〈0. 05 ）. For the five infants failed to treatment, A-aDO2, OI, PAP were slightly higher compared with those before treatment （ P〉0.05 ）, hut the levels of NT-proBNP were significantly increased （ P〈0. 05 ）. Conclusion ： NRDS complicated with PPHN can cause the increased secretion of NT-proBNP. The level of serum NT-proBNP in combination with A-aDO2 , OI and PAP can reflect the severity of NRDS with PPHN and evaluate the effect of the treatment.