一氧化氮联合西地那非治疗新生儿肺动脉高压疗效及对血管内皮及细胞因子影响

Effect of nitric oxide inhalation combined with sildenafil for treating neonates with pulmonary hypertension, and its influence on vascular endothelium and cytokines

目的:探讨一氧化氮(NO)联合西地那非治疗新生儿肺动脉高压疗效及对患儿血管内皮功能、细胞因子的影响。方法:选取68例肺动脉高压新生儿,随机分为观察组和对照组各34例。对照组采用NO吸入治疗,观察组采用NO联合西地那非治疗。对比两组临床疗效及治疗前后氧分压(PaO 2)、二氧化碳分压(PaCO 2)、血氧饱和度(SaO 2)、肺动脉收缩压(PASP)、N末端脑钠肽前体(NT proBNP)、肿瘤坏死因子α(TNFα)、白细胞介素8(IL 8)、缺血诱导因子(HIF 1α)、内皮素1(ET 1)、NO水平。结果:观察组总有效率(94.1%)高于对照组(70.6%)(P<0.05),治疗后PaO 2(82.71±10.35mmHg)、SaO 2、(96.57±3.36%)均高于对照组,而PaCO 2(35.05±8.19mmHg)、PASP(25.39±6.34 mmHg)均低于对照组(均P<0.05);NT proBNP(341.65±118.68ng/ml)、TNFα(4.59±0.81ng/ml)、IL 8(2.96±0.52 ng/ml)、HIF 1α(304.51±45.29pg/ml)、ET 1(46.21±25.27pg/ml)均低于对照组,而NO(27.03±11.79μmol/L)高于对照组(均P<0.05)。结论:NO联合西地那非可显著改善肺动脉高压新生儿的血管内皮功能,调节炎症因子等细胞因子的表达,提高新生儿肺动脉高压临床治疗效果。

Objective:To investigate the effect of nitric oxide(NO)inhalation combined with sildenafil for treating neonates with pulmonary hypertension,and to study the influence of NO inhalation combined with sildenafil on vascular endothelium and cytokines of neonates.Methods:68 neonates with pulmonary hypertension were randomly divided into the observation group and the control group(34 cases in each group).Neonates in the control group were treated by NO inhalation,and neonates in the observation group were treated by NO inhalation combined with sildenafil.The clinical efficacy,the values of oxygen partial pressure(PaO 2)before and after treatment,carbon dioxide partial pressure(PaCO 2),blood oxygen saturation(SaO 2)and pulmonary systolic pressure(PASP),and the levels of N terminal pro brain natriuretic peptide(NT proBNP),tumor necrosis factorα(TNFα),interleukin 8(IL 8),ischemia inducing factor(HIF 1α),endothelin 1(ET 1)and NO of neonates were compared between the two groups.Results:The total effective rate of neonates in the observation group was 94.1%,which was significant higher than that(70.6%)of neonates in the control group(P<0.05).After treatment,the values of PaO 2 before treatment(82.71±10.35mmHg)and SaO 2 after treatment(96.57±3.36%)of neonates in the observation group were significant higher than those of neonates in the control group,but the values of PaCO 2(35.05±8.19mmHg)and PASP(25.39±6.34mmHg)of neonates in the observation group were significant lower(P<0.05).The levels of NT proBNP(341.65±118.68 ng/ml),TNFα(4.59±0.81 ng/ml),IL 8(2.96±0.52 ng/ml),HIF 1α(304.51±45.29 pg/ml),and ET 1(46.21±25.27pg/ml)of neonates in the observation group were significant lower than those of neonates in the control group,while level of NO(27.03±11.79μmol/L)of neonates in the observation group was significant higher(P<0.05).Conclusion:NO inhalation combined with sildenafil can significantly improve the vascular endothelial function of neonates with pulmonary hypertension,regulate the expression of cytokines such as inflammatory factors,and improve the clinical therapeutic effect of neonatal pulmonary hypertension.