不同剂量西地那非联合肺泡表面活性物质治疗新生儿持续性肺动脉高压的临床疗效观察
摘要
目的探讨不同剂量西地那非(SIL)联合肺泡表面活性物质(PS)治疗新生儿持续性肺动脉高压(PPHN)的临床疗效。方法选取2015年6月-2017年11月在乌鲁木齐市妇幼保健院新生儿科确诊为PPHN并住院治疗的80例患儿并按照随机数字表和治疗方法分为A组(SIL 0. 5 mg+PS)、B组(SIL 1 mg+PS)、C组(SIL 2 mg+PS)和D组(PS),每组20例患儿。4组患儿均给予HFOV。比较4组患儿的性别、出生时间、体质量、肺动脉压力(PAP)及动脉血气分析指标。结果 4组患儿的性别、出生时间、体质量比较差异均无统计学意义(均P>0. 05)。治疗前,4组患儿的动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧饱和度(Sa O_2)及PAP比较差异均无统计学意义(P>0. 05)。治疗后,A、B、C组PaO_2均高于D组(P<0. 05),PAP、PaCO_2低于D组(P<0. 05); B、C组Sa O_2均高于D组(P<0. 05)。结论 SIL联合PS治疗新生儿PPHN能快速缓解病情,有利于患儿预后。当SIL剂量到达一定量时,可能存在平台效应,单纯增大SIL剂量不一定能改善临床效果,反而可能增加SIL不良反应发生率。
引文
[1]中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿肺动脉高压诊治专家共识[J].中华儿科杂志,2017,55(3):163-168.
[2] Nair J, Lakshminrusimha S. Update on PPHN:mechanisms and treatment[J]. Semin Perinatol,2014,38(2):78-91.
[3]顾虹.新生儿持续肺动脉高压诊疗新进展[J].心肺血管病杂志,2015,34(11):836-838.
[4]中华医学会儿科学分会新生儿学组,中华儿科杂志编委会新生儿学组,杜立中,等.新生儿持续肺动脉高压诊疗常规(草案)[J].中华围产医学杂志,2003,6(1):61-62.
[5] Sanchez Luna M,Franco ML,Bernardo B. Therapeutic strategies in pulmonary hypertension of the newborn:where are we now?[J].Curr Med Chem,2012,19(27):4640-4653.
[6] O'Rourke PP,Crone RK,Vacanti JP,et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn:a prospective randomized study[J]. Pediatrics,1989,84(6):957-963.
[7] Juliana AE,Abbad FC. Severe persistent pulmonary hypertension of the newborn in a setting where limited resources exclude the use of inhaled nitric oxide:successful treatment with sildenafil[J]. Eur J Pediatr,2005,164(10):626-629.
[8]孙眉月.新生儿呼吸衰竭治疗的新进展[J].中华急诊医学杂志,2004,13(6):368-369.
[9] Steinhorn RH. Diagnosis and treatment of pulmonary hypertension in infancy[J]. Early Hum Dev,2013,89(11):865-874.
[10]陈蓓,钟丹妮.西地那非联合高频振荡通气治疗新生儿肺动脉高压的安全性及疗效的对比性研究[J].中国妇幼保健,2015,30(36):6637-6641.
[11] Simonca L,Tulloh R. Sildenafil in infants and children[J]. Children(Basel),2017,4(7):E60.
[12] Engelbrecht AL. Sildenafil in the management of neonates with PPHN:a rural regional hospital experience[J]. SAJCH,2008,2(4):166-169.
[13] Dhariwal AK,Bavdekar SB. Sildenafil in pediatric pulmonary arterial hypertension[J]. J Postgrad Med,2015,61(3):181-192.
[14] Marsh CS,Marden B,Newsom R. Severe retinopathy of prematurity(ROP)in a premature baby treated with sildenafil acetate(Viagra)for pulmonary hypertension[J]. Br J Ophthalmol, 2004, 88(2):306-307.
[15] Samiee-Zafarghandy S,van den Anker JN, Laughon MM, et al. Sildenafil and retinopathy of prematurity risk in very low birth weight infants[J]. J Perinatol,2016,36(2):137-140.
[2] Nair J, Lakshminrusimha S. Update on PPHN:mechanisms and treatment[J]. Semin Perinatol,2014,38(2):78-91.
[3]顾虹.新生儿持续肺动脉高压诊疗新进展[J].心肺血管病杂志,2015,34(11):836-838.
[4]中华医学会儿科学分会新生儿学组,中华儿科杂志编委会新生儿学组,杜立中,等.新生儿持续肺动脉高压诊疗常规(草案)[J].中华围产医学杂志,2003,6(1):61-62.
[5] Sanchez Luna M,Franco ML,Bernardo B. Therapeutic strategies in pulmonary hypertension of the newborn:where are we now?[J].Curr Med Chem,2012,19(27):4640-4653.
[6] O'Rourke PP,Crone RK,Vacanti JP,et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn:a prospective randomized study[J]. Pediatrics,1989,84(6):957-963.
[7] Juliana AE,Abbad FC. Severe persistent pulmonary hypertension of the newborn in a setting where limited resources exclude the use of inhaled nitric oxide:successful treatment with sildenafil[J]. Eur J Pediatr,2005,164(10):626-629.
[8]孙眉月.新生儿呼吸衰竭治疗的新进展[J].中华急诊医学杂志,2004,13(6):368-369.
[9] Steinhorn RH. Diagnosis and treatment of pulmonary hypertension in infancy[J]. Early Hum Dev,2013,89(11):865-874.
[10]陈蓓,钟丹妮.西地那非联合高频振荡通气治疗新生儿肺动脉高压的安全性及疗效的对比性研究[J].中国妇幼保健,2015,30(36):6637-6641.
[11] Simonca L,Tulloh R. Sildenafil in infants and children[J]. Children(Basel),2017,4(7):E60.
[12] Engelbrecht AL. Sildenafil in the management of neonates with PPHN:a rural regional hospital experience[J]. SAJCH,2008,2(4):166-169.
[13] Dhariwal AK,Bavdekar SB. Sildenafil in pediatric pulmonary arterial hypertension[J]. J Postgrad Med,2015,61(3):181-192.
[14] Marsh CS,Marden B,Newsom R. Severe retinopathy of prematurity(ROP)in a premature baby treated with sildenafil acetate(Viagra)for pulmonary hypertension[J]. Br J Ophthalmol, 2004, 88(2):306-307.
[15] Samiee-Zafarghandy S,van den Anker JN, Laughon MM, et al. Sildenafil and retinopathy of prematurity risk in very low birth weight infants[J]. J Perinatol,2016,36(2):137-140.