西地那非对先天性心脏病相关的阻力型肺动脉高压患者远期右心功能及活动耐量的影响

Effects of sildenafil on long-term right heart function and exercise tolerance in patients with resistance pulmonary arterial hypertension associated with congenital heart disease

目的探讨西地那非对先天性心脏病相关的阻力型肺动脉高压患者远期右心功能及活动耐量的影响。方法84例阻力型先天性心脏病相关动脉高压(PAH-CHD)患者均分为西地那非组(口服西地那非)和对照组(口服贝前列素钠),比较2组患者服药前、服药后6个月及12个月时肺动脉收缩压、三尖瓣反流速度、右室游离壁厚度、世界卫生组织(WHO)功能分级Ⅲ-Ⅳ级、脑钠肽、6 min步行距离(6MWT)及指脉氧饱和度的差异。结果服药后6个月及12个月时,与对照组比较,西地那非组肺动脉压力及三尖瓣反流速度下降差异有明显统计学意义(P<0.01);西地那非组患者服药前、服药后6个月及服药后12个月时的WHO功能分级Ⅲ-Ⅳ级患者的例数减少、BNP水平下降,6MWT逐步提升,差异有统计学意义(P<0.01)。结论西地那非可改善阻力型肺动脉高压患者远期右心功能及活动耐量。

Objective To investigate the effect of sildenafil on long-term right heart function and exercise tolerance in patients with resistant pulmonary arterial hypertension associated with congenital heart disease(PAH-CHD).Methods Eighty-four patients with PAH-CHD were randomly divided into sildenafil group(oral sildenafil alone)and control group(oral beraprost sodium alone).Pulmonary artery systolic blood pressure,tricuspid regurgitation velocity,right ventricular free wall thickness,functional classificationⅢ-Ⅳof World Health Organization(WHO),the differences in brain natriuretic peptide,6-min walking distance(6MWT)and finger pulse oxygen saturation were detected and compared before taking the medicine,6 months and 12 months after taking the medicine.Results At 6 months and 12 months after taking the medicine,pulmonary artery pressure and tricuspid regurgitation velocity were decreased in sildenafil group relative to control group(P<0.01).When compared to control group,sildenafil group had reduced number of patients with WHO functional classificationⅢ-Ⅳ,decreased BNP level,while 6MWT gradually were increased(P<0.01).Conclusion Sildenafil can improve long-term right heart function and exercise tolerance in patients with resistant pulmonary hypertension.