硝普钠雾化治疗CHD合并肺动脉高压疗效观察

Curative effect of aerosol inhalation of sodium nitroprusside on congenital heart disease complicated with pulmonary arterial hypertension

目的探讨硝普钠（SNP）雾化吸入治疗小儿先天性心脏病（CHD）合并肺动脉高压（PH）的疗效。方法对36例CHD合并PH患儿在常规治疗基础上加用SNP5mg／次＋生理盐水2mL，2～3次／d，雾化吸入治疗。比较患儿治疗前后临床症状和体征评分；动态监测患儿血压、心率（HR），运用超声心动图于吸入SNP前、吸入后10min、30min及3d测量左室射血分数（EF）和短轴缩短率（FS）、右室射血前期（RPER）、加速时间（AT）、肺动脉平均压（PAMP）、肺动脉收缩压（PASP）和肺动脉峰值血流速度（PA）的变化。结果患儿呼吸困难评分、喘息评分及肺内罗音评分治疗前后差异均有统计学意义（t值分别为6．16、8．34、7．69，均P〈0．05）。患儿吸入SNP后，血压、HR、EF及FS与吸入前比较差异均无统计学意义（F值分别为1．89、0．59、0．21、0．09，均P〉0．05）。吸入后10min、30min患儿的RPER／AT、PAMP、PASP及PA与吸入前比较差异均无统计学意义（F值分别为1．58、0．49、0．36、0．29，均P〉0．05）；患儿RPEP／AT、PAMP、PASP及PA吸入SNP后3d与治疗前比较差异均有统计学意义（t值分别为4．98、5．76、6．25、7．38，均P〈0．05）。结论SNP雾化吸入治疗CHD合并PH具有缓解病情，降低肺动脉压的作用。

Objective To explore the curative effect of aerosol inhalation of sodium nitroprusside （SNP） on congenital heart disease （CHD） complicated with pulmonary hypertension （PH）. Methods On the basis of conventional treatment, 36 children with CHD and PH were treated with aerosol inhalation therapy of 5mg SNP and 2mL normal saline （2-3 times a day）. The clinical symptoms and sign score of the sick children were compared before treatment and after treatment. Heart rate （HR） and blood pressure were monitored continuously. Before the treatment and 10min, 30min and 3d after the treatment, echocardiography was used to measure ejection fraction （EF）, fraction shortening （FS） , right pre-ejection period （RPEP） and acceleration time （ AT）, pulmonary artery mean pressure （PAMP） , pulmonary artery systolic pressure （PASP） and PA. Results There were significant differences in children＇ s dyspnea score, wheezing score and pulmonary tales score before and after treatment （t value was 6.16, 8.34 and 7.69, respectively, all P 〈 0.05 ）. After SNP treatment, children＇ s blood pressure, HR, ET and FS were not statistically significant （ F value was 1.89, 0.59, 0.21 and 0.09, respectively, all P 〉 0.05）. After 10min and 30rain, RPEP/AT, PAMP, PASP and PA were not significantly different from those before treatment （F value was 1.58, 0.49, 0.36 and 0.29, respectively, all P 〉 0.05）, but those 3 days after treatment were significantly different compared with those before treatment （t value was 4.98, 5.76, 6.25 and 7.38, respectively, all P 〈 0.05 ）. Conclusion The aerosol inhalation of SNP can relieve condition and reduce pulmonary arterial pressure in treating CHD complicated with PH.