多巴胺联合西地那非治疗新生儿肺动脉高压的临床研究

Clinical study on dopamine combined with sildenafil in treatment of neonates with pulmonary arterial hypertension

目的探讨多巴胺联合西地那非治疗新生儿肺动脉高压的临床疗效。方法选取2011年6月—2014年11月天津市西青医院收治的肺动脉高压患儿90例,随机分为对照组和治疗组,每组45例。对照组患儿口服或鼻饲枸橼酸西地那非片0.5~1.0 mg/（kg·次）,1次/6 h。治疗组患儿在对照组治疗的基础上,静脉滴注盐酸多巴胺注射液5μg/（kg·min）,输液泵持续静脉滴入。两组均连续治疗3 d。观察两组患者的临床疗效,同时比较两组治疗前后动脉血氧分压（Pa O2）、动脉血二氧化碳分压（Pa CO2）、肺动脉压（PAP）、动脉血氧饱和度（Sa O2）、血清内皮素（ET-1）、缺氧诱导因子（HIF-1α）、一氧化氮（NO）、促红细胞生成素（EPO）、Ca2＋的变化。结果治疗后,对照组和治疗组总有效率分别为82.22%、95.56%,两组总有效率比较差异具有统计学意义（P〈0.05）。两组Pa O2、Sa O2、NO均较治疗前显著升高,Pa CO2、PAP、EPO、HIF-1、ET-1较治疗前显著降低,同组治疗前后差异有统计学意义（P〈0.01）;治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义（P〈0.05）。两组Ca2＋均较治疗前显著升高（P〈0.05）,但两组比较差异无统计学意义。结论多巴胺联合西地那非治疗新生儿肺动脉高压具有较好的临床疗效,可显著调节缺氧相关因子水平,值得临床推广应用。

Objective To investigate the effect ofdopamine combined with sildenafil in treatment of neonates with pulmonary arterial hypertension. Methods Patients （90 cases） with pulmonary arterial hypertension in Tianjin Xiqing Hospital from June 2011 to November 2014 were randomly divided into control and treatment groups, and each group had 45 cases. The patients in the control group werepo or nasal feeding administered with Sildenafil Citrate Tablets, 0.5~ 1.0 mg/（kg＇time）, one time/6 h. The patients in the treatment group were iv administered with Dopamine Hydrochloride Injection on the basis of control group, 5 gg/（kg.min）, continuous intravenous drip infusion pump. Two groups were treated for 3 d. After treatment, the efficacy was evaluated, and the changes ofPaO2, PaCO2, PAP, SaO2, ET-1, HIF-lct, NO, EPO, and Ca2~ in two groups were compared. Results The efficacies in the control and treatment groups were 82.22% and 95.56%, respectively, and there were differences between two groups （P 〈 0.05）. After treatment, PaO2, SaO2, and NO in two groups were significantly increased, while PaCO2, PAP, EPO, HIF-1, and ET-1 were significantly reduced, and the difference was statistically significant in the same group （P 〈 0.01）. And these indicators in treatment group improved better than those in the control group, with significant difference between two groups （P 〈 0.05）. Ca2~ in two groups were significantly increased （P 〈 0.05）, and there was no statistically significant difference between two groups. Conclusion Dopamine combined with sildenafil has the good clinical effect in treatment of neonates with pulmonary arterial hypertension, and can adjust hypoxia correlated factors levels, which is worth clinical promotion