西地那非在治疗儿童肺血减少型先天性心脏病术后低氧血症中的作用

Effect of Sildenafil in the treatment of hypoxemia after operation of cyanotic congenital heart disease

目的探讨西地那非在治疗儿童肺血减少型先天性心脏病术后低氧血症中的作用。方法选择2009年1月至2015年1月肺血减少型先天性心脏病术后出现低氧血症的患者34例，按照0．3～0．5mg／kg，每6h鼻饲西地那非片1次。观察服药前、服药后1h、服药后1d和脱呼吸机辅助4个时间点患者心率、桡动脉收缩压、中心静脉压、肺动脉压、动脉血氧分压、动脉血二氧化碳分压、氧合指数、呼吸道峰压、正性肌力药物评分和肝下界等指标变化，总结探讨西地那非的治疗作用。结果34例患者均治愈出院。服用西地那非1h后肺动脉压和中心静脉压则下降，动脉血氧分压和氧合指数明显升高，呼吸道峰压下降，与服药前相比差异有统计学意义（P〈0．05）。服药后1d桡动脉收缩压升高并相对平稳，肺动脉压和中心静脉压继续降低，正性肌力药物评分显著降低，肝下界明显缩小，与服药前和服药后1h相比差异有统计学意义（P〈0．05）。至脱呼吸机辅助时动脉血氧分压达到（144．12±26．25）mmHg（1mmHg=0．133kPa），低氧血症得到纠正，肺动脉压降至（37．47±3．77）mmHg，正性肌力药物评分下降至（17．56±1．94）分，心力衰竭症状基本缓解，与前3个时间点相比差异有统计学意义（P〈0．05）。结论西地那非能高选择性地降低肺血管阻力，可明显促进肺血减少型先天性心脏病术后低氧血症的纠正。

Objective To study the effect of Sildenafil in the treatment of hypoxemia after operation of cyanotic congenital heart disease. Methods A total of 34 cases with hypoxemia after operation of cyanotic congenital heart disease were collected between January 2009 to January 2015. They took Sildenafil with the dosage of O. 3 -0.5 mg/kg every 6 hour. The change of heart rate （HR）, systolic blood pressure （SBP）, central venous pressure （CVP）, pulmona- ry artery pressure （PAP） , arterial partial pressure of oxygen [ Pa （O2 ） ] , arterial partial pressure of carbon dioxide [ pa （ CO2 ） ], oxygenation index [ P a （O2 ）/FiO2 ], peak airway pressure （ Ppeak ）, positive inotropic drug score （ PIDS ） and the lower bound of liver were observed at 4 time points,including before taking the medicine, after taking the medi- cine for 1 hour, after taking the medicine 1 day and after the ventilator was removed. Based on the data, the therapeutic effects of Sildenafil were studied. Results All 34 cases were cured. At the time point of 1 hour after taking Sildenafil, PAP, CVP and Ppeak decreased significantly, but pa （O2） and Pa （O2）/FiO2 increased significantly （ P 〈 0.05 ）. At the time point of 1 day after taking Sildinafil, SBP increased steadily, but PAP and CVP continued to get lower, and PIDS decreased significantly ,while the liver lower bound was significantly reduced（ P 〈0. 05 ）. At the time point of removing the ventilator,pa （O2 ） reached to （ 144.12 ± 26.25） mmHg, and hypoxemia was corrected, but PAP was reduced to （ 37.47 ± 3.77） mmHg, PIDS decreased to （ 17.56 ± 1.94） scores, and heart failure was corrected. Compared with the previous 3 time points, there were statistically significant differences （ P 〈 0.05 ）. Conclusion Sildenafil can highly se- lectively decrease pulmonary vascular resistance and obviously promote the correction of hypoxemia after operation of cyanotic congenital heart disease.