波生坦联合西地那非治疗先天性心脏病合并重度肺动脉高压的临床观察

Clinical observation of Bosentan combined with Sildenafil in the treatment of congenital heart disease with severe pulmonary arterial hypertension

目的探讨波生坦联合西地那非治疗先天性心脏病（CHD）合并重度肺动脉高压（PAH）的效果。方法选取2012年9月~2015年12月在我院确诊的61例CHD合并重度PAH患者作为研究对象,依据随机数字表法分为对照组（30例）和治疗组（31例）。所有入选患者均给予常规治疗,对照组在此基础上联合西地那非治疗,治疗组在对照组的基础上联合波生坦治疗。比较两组治疗前后的脑钠尿肽（BNP）水平、呼吸困难评分（Borg评分）、血氧饱和度（SpO_2）水平、心脏功能分级及右心导管检查结果的改善情况。结果治疗组治疗后的BNP水平、Borg评分、NYHAFC评分显著低于治疗前及对照组治疗后,SpO_2水平显著高于治疗前及对照组治疗后,差异有统计学意义（P〈0.05）。治疗组治疗后的Pp/Ps、s PAP、m PAP水平显著低于治疗前及对照组治疗后,Qp/Qs水平显著高于治疗前及对照组治疗后,差异有统计学意义（P〈0.05）。结论波生坦联合西地那非治疗CHD合并SPH效果显著,可更好地改善心肺功能,提高生活质量,值得临床推广应用。

Objective To explore the effect of Bosentan combined with Sildenafil in the treatment of congenital heart disease（CHD） with severe pulmonary arterial hypertension（PAH）.Methods 61 patients diagnosed with CHD with severe PAH from September 2012 to December 2015 in our hospital were selected and divided into the control group（30cases） and the treatment group（31 cases） according to the random number table method.All the patients were treated with routine treatment,the control group was treated with Sildenafil on the basis of routine treatment,the treatment group was treated with Bosentan on the basis of the control group.The level of brain natriuretic peptide（BNP）,dyspnea score（Borg score）,oxygen saturation（SpO_2） level,the grade of cardiac function classification and the improvement of right heart catheterization results before and after treatment in the two groups was compared.Results The level of brain natriuretic peptide（BNP）,Borg score,NYHAFC score after treatment in the treatment group was lower than that before treatment and the control group after treatment,the level of SpO_2 after treatment in the treatment group was higher than that before treatment and the control group after treatment,with significant difference（P〈0.05）.The level of Pp/Ps,s PAP,m PAP after treatment in the treatment group was lower than that before treatment and the control group after treatment,the level of Qp/Qs after treatment in the treatment group was higher than that before treatment and the control group after treatment,with significant difference（P〈0.05）.Conclusion The effect of Bosentan combined with Sildenafil in the treatment of CHD with SPH is significant,which can improve the cardiopulmonary function better,with higher qualified life level,it is worthy of clinical promotion and application.