小剂量西地那非联合常规综合治疗对持续性肺动脉高压新生儿血气指标和体循环收缩压的影响

The Effects of Low-dose Sildenafil Combined with Conventional Comprehensive Therapy on Blood Gas Indexes and Systemic Circulation Systolic Blood Pressure in Persistent Pulmonary Hypertension of the Newborn

目的探讨小剂量西地那非联合常规综合治疗对持续性肺动脉高压(PPHN)新生儿血气指标和体循环收缩压的影响。方法选取82例PPHN新生患婴随机分为对照组和观察组,每组41例,对照组给予常规综合治疗,观察组在对照组的治疗基础上给予小剂量[1.0mg/(kg·次)]西地那非治疗,观察两组治疗前及治疗后(治疗3d后)的血气指标、体循环收缩压、肺动脉收缩压、临床有效率和治疗前后的血清生化指标。结果治疗后,两组患婴动脉血氧分压(PaO2)显著升高(P<0.05),二氧化碳分压(PaCO2)和肺动脉收缩压(SPAP)显著降低(P<0.05),观察组变化幅度显著大于对照组(P<0.05),组间及组内治疗前后的体循环收缩压(SBP)对比,差异无统计学意义(P>0.05);观察组的临床总有效率(90.24%)显著高于对照组(73.17%)(P<0.05);治疗后,两组血清缺氧诱导因子(HIF-1α)、内皮素(ET-1)、促红细胞生成素(EPO)、N-末端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)及基质金属蛋白酶-9(MMP-9)水平显著降低(P<0.05),观察组变化幅度显著大于对照组(P<0.05)。结论小剂量西地那非联合常规综合治疗PPHN新生患婴疗效显著,可有效改善患婴缺氧状态和肺动脉压,同时不影响其循环稳定,利于患婴心功能改善和炎症水平降低,适于推广于临床。

Objective To explore the effects of low-dose sildenafil combined with conventional comprehensive therapy on blood gas indexes and systemic circulation systolic blood pressure in persistent pulmonary hypertension of the newborn(PPHN).Methods 82 cases of infant patients with PPHN were randomly divided into the control group and the observation group,with 41 cases in each group.The control group was given routine comprehensive treatment,and the observation group was given low-dose [1.0mg/(kg·time)] sildenafil in addition.The blood gas indexes,systemic circulation systolic pressure,pulmonary systolic pressure and clinical effective rate and serum biochemical indicators were observed in the two groups before and after the treatment(3 d after the treatment).Results After the treatment,the arterial partial pressure of oxygen(PaO 2 )was significantly increased in both groups( P <0.05),while the partial pressure of carbon dioxide(PaCO 2 )and pulmonary systolic pressure(SPAP)were significantly decreased( P <0.05),and the changes in the observation group were significantly greater than those in the control group( P <0.05).There was no significant difference in the systemic circulation systolic blood pressure(SBP)between groups and within groups before and after the treatment( P >0.05).The total clinical effective rate in the observation group was significantly higher than that in the control group(90.24% vs 73.17%)( P <0.05).After the treatment,the levels of serum hypoxia-inducible factor(HIF-1 α),endothelin(ET-1),erythropoietin(EPO),N-terminal pro-brain natriuretic peptide(NT-pro BNP),C-reactive protein(CRP)and matrix metalloproteinase-9(MMP-9)were all significantly decreased in both groups( P <0.05),and the changes in the observation group were significantly higher than those in the control group( P <0.05).Conclusion Low-dose sildenafil combined with conventional comprehensive therapy for infant patients with PPHN has a significant efficacy,and it can effectively improve the hypoxic state and pulmonary artery pressure,and does not affect the stability of circulation,suggesting the beneficial role to the improvement of heart function and the reduction of inflammation levels.Our results showed that this approach is suitable for the clinical promotion.