前列地尔联合一氧化氮治疗先天性心脏病合并肺动脉高压患儿的临床研究

Clinical Study of Alprostadil Combined with Nitric Oxide in the Treatment of Congenital Heart Disease Complicated with Pulmonary Hypertension

目的:观察前列地尔联合一氧化氮对先天性心脏病合并肺动脉高压患儿的临床效果及免疫功能的影响。方法:采用回顾性研究方法,选取2009年8月-2015年2月我院胸心血管外科收治的40例先天性心脏病合并肺动脉高压患儿,依据治疗方式不同分为一氧化氮组(单独组)和前列地尔+一氧化氮组(联合组),各20例。两组患儿均给予先天性心脏病合并肺动脉高压的常规手术治疗;单独组患儿术后予以外源性吸入一氧化氮(体积分数为20×10-6),联合组患儿在此基础上联合静脉泵入前列地尔5 ng/(kg·min),持续72 h。比较两组患儿治疗前后的心率、左室射血分数、平均动脉压、肺动脉压、T淋巴细胞和免疫球蛋白(Ig)的变化,以及不良反应发生情况。结果:治疗前,两组患儿上述各项指标比较,差异均无统计学意义(P>0.05)。治疗后,两组患儿的心率、左室射血分数、平均动脉压、CD3^+、Ig A、Ig M和Ig G水平无明显变化,但CD4^+、CD4^+/CD8^+、Treg/CD4^+均较治疗前显著升高,肺动脉压、CD8^+、Th1、Th2、Th1/Th2、Th17/CD4^+、补体C3和补体C4水平均较治疗前显著下降,且联合组上述指标均显著优于单独组,差异均有统计学意义(P<0.05)。两组患儿均未见明显不良反应发生。结论:前列地尔联合一氧化氮可显著降低先天性心脏病合并肺动脉高压患儿的肺动脉压,改善T淋巴细胞表达情况,降低补体C3和C4水平,且安全性较高。

OBJECTIVE:To observe clinical effects of alprostadil combined with nitric oxide in the treatment of congenitalheart disease complicated with pulmonary hypertension and its effects on immune function.METHODS:In retrospective study,40cases of congenital heart disease complicated with pulmonary hypertension in thoracic and cardiovascular surgery department of ourhospital during Aug.2009to Feb.2015were selected and divided into nitric oxide group(single group)and alprostadil+nitric oxidegroup(combination group)according to therapy method,with20cases in each group.Both groups received conventional surgery.Single group was given extrinsic inhalation of nitric oxide(volume fraction of20×10-6)after surgery;combination group was additionallygiven intravenous pump of alprostadil5ng/(kg·min)for consecutive72h,on the basis of combination group.The heartrate,left ventricular ejection fraction(LVEF),mean arterial pressure,pulmonary arterial pressure,T lymphocyte and immunoglobulin(Ig)of children before and after treatment,and the occurrence of ADR were compared between2groups.RESULTS:Beforetreatment,there was no statistical significance in above indexes between2groups(P>0.05).After treatment,heart rate,LVEF,mean arterial pressure,the levels of CD3+,IgA,IgM and IgG in2groups had no significant change,but CD4+,CD4+/CD8+,Treg/CD4+were increased significantly;pulmonary arterial pressure,the levels of CD8+,Th1,Th2,Th1/Th2and Th17/CD4+,supplementC3and supplement C4were decreased significantly,compared to before treatment.Above indexes in the combination groupwas significantly better than the single group,with statistical significance(P<0.05).No obvious ADR was found in2groups.CONCLUSIONS:Alprostadil combined with nitric oxide could significantly reduce the pulmonary hypertension in children withcongenital heart disease complicated with pulmonary hypertension,improve the level of T lymphocytes,and decrease the levels ofsupplement C3and supplement C4with good safety.