前列地尔联合波生坦治疗先天性心脏病术后肺动脉高压疗效及对血流动力学影响

Effect of alprostadil combined with bosentan on pulmonary arterial hypertension after congenital heart disease and its effect on hemodynamics

目的探讨前列地尔联合波生坦治疗先天性心脏病术后肺动脉高压的疗效及对血流动力学的影响。方法选取自2014年10月至2018年10月收治的先天性心脏病术后肺动脉高压患儿300例,采用随机数字表法分为A组(n=150)与B组(n=150)。A组给予波生坦治疗,B组给予前列地尔联合波生坦治疗,两组患儿均连续治疗3个月。治疗后,观察两组患儿临床疗效及不良反应发生情况。记录并比较患儿治疗前后肺动脉高压情况、血氧饱和度、6 min步行实验距离、脑钠尿肽水平、血管内皮因子水平、心功能分级、Borg评分以及血流动力学参数。结果治疗后,B组患儿总有效率显著高于A组,差异有统计学意义(P<0.05)。在治疗过程中,两组患儿均未发生严重不良反应。治疗后,两组组患儿肺动脉收缩压、肺动脉平均压、肺动脉收缩压/体循环动脉收缩压水平均较治疗前显著降低,且B组低于A组;肺循环血流量/体循环血流量水平较治疗前显著升高,且B组高于A组,差异均有统计学意义(P<0.05)。治疗后,两组患儿血氧饱和度、6 min步行实验距离均较治疗前显著升高,且B组高于A组,差异均有统计学意义(P<0.05)。治疗后,两组患儿脑钠尿肽、血管内皮因子水平均较治疗前显著降低,且B组低于A组,差异均有统计学意义(P<0.05)。治疗后,两组患儿心功能分级、Borg评分均较治疗前显著降低,且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组患儿体血管阻力、肺血管阻力、肺动脉压力均较治疗前显著降低,且B组低于A组,差异有统计学意义(P<0.05)。结论前列地尔联合波生坦治疗先天性心脏病术后肺动脉高压临床疗效较好,能改善肺循环血流动力学参数,降低肺动脉阻力。

Objective To investigate the effect of alprostadil combined with bosentan on pulmonary arterial hypertension after congenital heart disease and its effect on hemodynamics.Methods A retrospective study was performed on 300 cases of children with pulmonary arterial hypertension after congenital heart disease surgery who were admitted from October 2014 to October 2018.Patients were randomly divided into the Group A(n=150)and Group B(n=150).Patients in Group A were treated with bosentan,and patients in Group B were treated with alprostadil combined with bosentam.Both groups of patients received continuous treatment for 3 months.After treatment,the clinical efficacy and adverse reactions of the two groups were observed.Pulmonary arterial hypertension index,oxygen saturation,6-minute walking distance,brain natriuretic peptide level,vascular endothelial factor level,cardiac function grade,Borg score and hemodynamic parameters were recorded and compared before and after treatment.Results After treatment,the total effective rate of Group B was significantly higher than that of Group A(P<0.05).During the treatment,no serious adverse reactions occurred in the two groups.After treatment,pulmonary systolic blood pressure,average pulmonary artery pressure and Pp/Ps level in both groups were significantly lower than that before treatment,and Group B was lower than Group A.Qp/Qs level was significantly higher than that before treatment,and Group B was higher than Group A(P<0.05).After treatment,the blood oxygen saturation and 6-minutes walking distance in both groups were significantly higher than that before treatment,and the difference between Group B and Group A was statistically significant(P<0.05).After treatment,the levels of cerebral natriuretic peptide and vascular endothelial factor in both groups were significantly lower than that before treatment,and the levels in Group B were lower than those in Group A(P<0.05).After treatment,the cardiac function grade and Borg score of the two groups were significantly lower than that before treatment(P<0.05).After treatment,the body vascular resistance,pulmonary vascular resistance and pulmonary artery pressure in both groups were significantly lower than before treatment,and the difference in Group B was lower than that in Group A(P<0.05).Conclusion Alprostadil combined with bosentan is effective in treating pulmonary arterial hypertension after congenital heart disease,which can improve pulmonary circulation hemodynamic parameters and reduce pulmonary artery resistance.