高频振荡通气联合不同剂量西地那非治疗PPHN临床疗效的对比研究

Comparative study of high frequency oscillatory ventilation combined with different doses of Sildenafil in the treatment of persistent pulmonary hypertension of the newborn

目的对比研究高频振荡通气(HFOV)联合不同剂量的西地那非(SIL)治疗新生儿持续肺动脉高(PPHN)的临床疗效,探讨HFOV联合SIL治疗PPHN的可行性。方法选取2015年1月-2018年5月在乌鲁木齐市妇幼保健院新生儿科收治确诊为PPHN患儿60例,根据用药治疗方法不同分为SIL 0.5 mg/kg组(A组)、SIL 1 mg/kg组(B组)、SIL 2 mg/kg组(C组)和对照组(仅使用HFOV,D组),每组各15例,所有组均使用高频振荡机械通气。对比各组患儿心脏彩超中的肺动脉压力(PAP)和动脉血气分析中的动脉血氧分压(PO2)、动脉血氧饱和度(SaO2)动脉血二氧化碳分压(PaCO2)。结果治疗前各组患儿临床资料和监测指标比较的差异无统计学意义(P>0.05);治疗后使用SIL的三组中PAP(A组:31.7±3.3 mmHg,B组:28.9±3.9 mmHg,C组:28.1±3.6 mmHg)低于不使用SIL的D组(34.6±4.1 mmHg);PaO2(A组:74.8±5.0 mmHg,B组:77.7±4.7 mmHg,C组:78.7±5.4 mmHg)高于D组(71.0±5.2 mmHg);B组及C组的SaO2(96.0±1.5%及96.4±1.5%)高于对照组(93.3±1.8%);PaCO2(A组:39.2±2.5 mmHg,B组:38.1±2.2 mmHg,C组:37.2±1.8 mmHg)低于对照组(41.1±2.8 mmHg);B组、C组的临床效果优于A组,以上差异有统计学意义(P<0.05),但B组、C组之间无明显差异(P>0.05)。使用SIL的三组患儿均未发生严重不良反应。结论高频振荡通气下使用SIL联合治疗新生儿PPHN有助于缓解病情,有利于患儿预后。增大SIL剂量能改善临床治疗效果,但当使用SIL增大到一定剂量时,即使再增加使用剂量也不一定能进一步改善临床效果,反而可能增加SIL副反应发生的概率,提示SIL用量可能存在平台效应。

Objective To compare the effect of high frequency oscillatory ventilation(HFOV)combined with different doses of Sildenafil(SIL)in the treatment of persistent pulmonary hypertension of the newborn(PPHN).Methods 60 neonates with PPHN were admitted in Maternity and Children Healthcare Hospital of Urumqi from January 2015 toMay 2018 were selected.The neonates were all treated with HFOV and randomly divided into four groups.Group A were treated with 0.5 mg/kg Sildenafil.Group B were given 1.0mg/kg Sildenafil,Group C were received 2.0 mg/kg Sildenafil and Group D was control group being treated with HFOV only.There were 15 cases in each group.The clinical effect of four groups were compared through monitoring indexes(PAP and Blood gas).Results There was no significant differences of monitoring indexes and general clinical data among four groups before treatment(P>0.05).At 72h after treating with HFOV and SIL,PAP in group A,B,C(Group A was 31.7±3.3mmHg.Group B was 28.9±3.9mmHg.Group C was 28.1±3.6mm mmHg)were significantly lower than that in group D(34.6±4.1mmHg)(P<0.05);PaO2 in groupA,B,C(Group A was 74.8±5.0mmHg,Group B was 77.7±4.7mmHg,Group C was 78.7±5.4mmHg)were significantly higher than that of group D(71.0±5.2 mmHg)(P<0.05);SaO2 in group B and C(96.0±1.5%and 96.4±1.5%)were significantly higher than that of group D(93.3±1.8%);and PaCO2 in group A,B,C(group A:39.2±2.5mmHg,group B:38.1±2.2mmHg,group C:37.2±1.8mmHg)were lower than that of control group(41.1±2.8mmHg)(P<0.05).The clinical effect of Group B and C were better than that of group A(P<0.05);However,there was no significant difference between group B and C(P>0.05).No side effects occurred in all patients treated by HFOV combined with SIL.Conclusion Treating PPHN through HFOV combined with SIL is helpful to relieve the condition and conducive to the prognosis of PPHN.Increasing the dose of SIL can improve clinical curative effect.But there may be a platform effect,Even if the dose increases more,better clinical effect can’t be got,and may increase the occurring probability of SIL side effects.