高频振荡通气与西地那非联合治疗新生儿持续性肺动脉高压的临床效果
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摘要
目的探讨高频振荡通气与西地那非联合治疗方案对新生儿持续性肺动脉高压(PPHN)的影响。方法选取2014年3月～2018年3月承德医学院附属医院收治的109例PPHN患儿为研究对象。按照随机数字表法将患儿分为对照组(54例)和研究组(55例)。对照组予高频振荡通气治疗,研究组予西地那非联合治疗。比较两组患儿治疗72 h后临床疗效,比较两组患儿治疗前后动脉血二氧化碳分压(PaCO_2)、吸入氧浓度(FiO_2)、动脉血氧饱和度(SaO_2)、动脉血氧分压(PaO_2)、肺动脉压力(SPAP)、体循环血压(SBP)。观察并比较两组患儿治疗期间不良反应发生情况。结果研究组患儿治疗后总有效率显著高于对照组,差异有统计学意义(P <0.05)。两组患儿治疗后PaCO_2、FiO_2均较本组治疗前降低,且研究组低于对照组(P <0.05);两组患儿治疗后SaO_2、PaO_2均较本组治疗前升高,且研究组高于对照组(P <0.05)。研究组患儿治疗后SPAP显著低于治疗前(P <0.05),对照组患儿治疗前后SPAP差异无统计学意义(P> 0.05),治疗后研究组低于对照组(P <0.01)。两组患儿治疗前后SBP组内及组间比较,差异均无统计学意义(P> 0.05)。两组患儿治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论高频振荡通气与西地那非联合治疗新生儿PPHN,疗效较佳,可显著改善患儿临床症状以及相关临床指标,临床应用价值较高。
Objective To investigate the effect of high frequency oscillatory ventilation combined with Sildenafil in the treatment of neonatal persistent pulmonary hypertension(PPHN). Methods A total of 109 newborns with PPHN admitted to the Affiliated Hospital of Chengde Medical College from March 2014 to March 2018 were selected as subjects.Newborns were divided into control group(54 cases) and study group(55 cases) according to random number table method. The control group was treated with high frequency oscillatory ventilation, and the study group was treated with Sildenafil. The clinical effect of the two groups was compared after 72 hours′ treatment. The arterial partial pressure of carbon dioxide(PaCO_2), fraction of inspired oxygen(FiO_2), arterial oxygen saturation(SaO_2), arterial partial pressure of oxygen(PaO_2), pulmonary artery pressure(SPAP) and systemic blood pressure(SBP) were compared between the two groups before and after treatment. Adverse reactions of the two groups during treatment were observed. Results The total effective rate of the study group was significantly higher than that of the control group, and the difference was statistically significant(P < 0.05). The PaCO_2 and FiO_2 of the two groups were lower than those before treatment,and those in the study group were lower than those in the control group(P < 0.05). The SaO_2 and PaO_2 of the two groups increased after treatment, and those in the study group were higher than those in the control group(P < 0.05). The SPAP of the study group after treatment was significantly lower than that before treatment(P < 0.05),while there was no significant difference in the control group before and after treatment(P > 0.05), and that in the study group was lower than the control group(P < 0.05). There was no significant difference in SBP before and after treatment in the same group nor between the two groups(P > 0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P > 0.05). Conclusion High frequency oscillatory ventilation combined with Sildenafil in the treatment of PPHN is effective remarkbly, which can significantly improve clinical symptom and related clinical indicators, and it has high clinical application value.
Objective To investigate the effect of high frequency oscillatory ventilation combined with Sildenafil in the treatment of neonatal persistent pulmonary hypertension(PPHN). Methods A total of 109 newborns with PPHN admitted to the Affiliated Hospital of Chengde Medical College from March 2014 to March 2018 were selected as subjects.Newborns were divided into control group(54 cases) and study group(55 cases) according to random number table method. The control group was treated with high frequency oscillatory ventilation, and the study group was treated with Sildenafil. The clinical effect of the two groups was compared after 72 hours′ treatment. The arterial partial pressure of carbon dioxide(PaCO_2), fraction of inspired oxygen(FiO_2), arterial oxygen saturation(SaO_2), arterial partial pressure of oxygen(PaO_2), pulmonary artery pressure(SPAP) and systemic blood pressure(SBP) were compared between the two groups before and after treatment. Adverse reactions of the two groups during treatment were observed. Results The total effective rate of the study group was significantly higher than that of the control group, and the difference was statistically significant(P < 0.05). The PaCO_2 and FiO_2 of the two groups were lower than those before treatment,and those in the study group were lower than those in the control group(P < 0.05). The SaO_2 and PaO_2 of the two groups increased after treatment, and those in the study group were higher than those in the control group(P < 0.05). The SPAP of the study group after treatment was significantly lower than that before treatment(P < 0.05),while there was no significant difference in the control group before and after treatment(P > 0.05), and that in the study group was lower than the control group(P < 0.05). There was no significant difference in SBP before and after treatment in the same group nor between the two groups(P > 0.05). There was no significant difference in the incidence of adverse reactions between the two groups during treatment(P > 0.05). Conclusion High frequency oscillatory ventilation combined with Sildenafil in the treatment of PPHN is effective remarkbly, which can significantly improve clinical symptom and related clinical indicators, and it has high clinical application value.
引文
[1]钟美雄,张应金,黄敏宜,等.雾化吸入伊洛前列素对新生儿持续性肺动脉高压的临床疗效[J].中国临床药理学杂志,2016,32(9):783-785.
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[4]Gupta A,VanLoozen D,Polimenakos AC,et al.Restoring Fetal Circulation as a Means of Bridging Treatment Prior to Surgical Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta with Persistent Pulmonary Hypertension of the Newborn[J].Pediatr Cardiol,2018,39(4):848-851.
[5]袁文浩,曾凌空,刘晓艳,等.高频振荡通气联合多巴酚丁胺治疗新生儿持续性肺动脉高压的作用及其机制[J]山东医药,2017,57(1):83-85.
[6]陈玲,张炼,李文斌,等.不同剂量西地那非治疗新生儿肺动脉高压的疗效[J].华中科技大学学报:医学版,2012,41(2):210-213.
[7]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011.
[8]陈萍,王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823.
[9]陈冬梅,许景林,王瑞泉,等.一氧化氮吸入联合西地那非口服治疗新生儿持续性肺动脉高压的疗效观察[J].中国小儿急救医学,2015,22(7):486-490.
[10]朱兴旺,朱小冰.吸入一氧化氮治疗新生儿持续性肺动脉高压研究进展[J].中国新生儿科杂志,2015,30(3):236-240.
[11]张继英,俞建德.高频通气联合西地那非治疗新生儿持续性肺动脉高压的临床疗效[J].中国妇幼健康研究,2015,26(2):271-273.
[12]Hussain AS,Ali R,Ahmed S,et al.Oral Sildenafil Use In Neonates With Persistent Pulmonary Hypertension Of Newborn[J].J Ayub Med Coll Abbottabad,2017,29(4):677-680.
[13]蒋璐灿,全淑燕,李佳莲,等.西地那非治疗新生儿持续性肺动脉高压的系统评价[J].中国药房,2017,28(9):1211-1215.
[14]李丽霞.高频振荡通气结合西地那非治疗新生儿持续性肺动脉高压临床疗效研究[J].基层医学论坛,2016,20(7):912-913.
[15]王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823.
[16]黄琳,张树英.前列地尔联合高频通气治疗新生儿持续性肺动脉高压疗效分析[J].中国医师杂志,2015,17(3):439-441.
[17]罗芳,温晓芳,邱在军.不同剂量西地那非治疗新生儿肺动脉高压的临床分析[J].中国当代医药,2015,22(36):62-64.
[18]杨梅,朱晓静,宋万千.西地那非治疗新生儿肺动脉高压疗效与安全性分析[J].中国生育健康杂志,2013,19(1):5-7.
[19]吴晓宁,许桂凤.多巴胺联合西地那非治疗新生儿肺动脉高压的临床研究[J].现代药物与临床,2015,30(5):572-576.
[20]高淑强,巨容,胡旭红,等.高频振荡通气联合西地那非治疗新生儿持续肺动脉高压的疗效观察[J].中华实用儿科临床杂志,2015,30(2):114-117.
[2]Kibe M,Ibara S,Inagaki H,et al.Lethal persistent pulmonary hypertension of the newborn in Bohring-Opitz syndrome[J].Am J Med Genet A,2018,176(5):1245-1248
[3]钱爱民,矫凤飞.米力农治疗新生儿持续性肺动脉高压的临床观察[J].中国药房,2016,27(35):4993-4995.
[4]Gupta A,VanLoozen D,Polimenakos AC,et al.Restoring Fetal Circulation as a Means of Bridging Treatment Prior to Surgical Repair of Anomalous Origin of the Right Pulmonary Artery from the Ascending Aorta with Persistent Pulmonary Hypertension of the Newborn[J].Pediatr Cardiol,2018,39(4):848-851.
[5]袁文浩,曾凌空,刘晓艳,等.高频振荡通气联合多巴酚丁胺治疗新生儿持续性肺动脉高压的作用及其机制[J]山东医药,2017,57(1):83-85.
[6]陈玲,张炼,李文斌,等.不同剂量西地那非治疗新生儿肺动脉高压的疗效[J].华中科技大学学报:医学版,2012,41(2):210-213.
[7]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011.
[8]陈萍,王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823.
[9]陈冬梅,许景林,王瑞泉,等.一氧化氮吸入联合西地那非口服治疗新生儿持续性肺动脉高压的疗效观察[J].中国小儿急救医学,2015,22(7):486-490.
[10]朱兴旺,朱小冰.吸入一氧化氮治疗新生儿持续性肺动脉高压研究进展[J].中国新生儿科杂志,2015,30(3):236-240.
[11]张继英,俞建德.高频通气联合西地那非治疗新生儿持续性肺动脉高压的临床疗效[J].中国妇幼健康研究,2015,26(2):271-273.
[12]Hussain AS,Ali R,Ahmed S,et al.Oral Sildenafil Use In Neonates With Persistent Pulmonary Hypertension Of Newborn[J].J Ayub Med Coll Abbottabad,2017,29(4):677-680.
[13]蒋璐灿,全淑燕,李佳莲,等.西地那非治疗新生儿持续性肺动脉高压的系统评价[J].中国药房,2017,28(9):1211-1215.
[14]李丽霞.高频振荡通气结合西地那非治疗新生儿持续性肺动脉高压临床疗效研究[J].基层医学论坛,2016,20(7):912-913.
[15]王宁玲.西地那非在新生儿持续性肺动脉高压中的应用效果及安全性分析[J].重庆医学,2017,46(13):1820-1823.
[16]黄琳,张树英.前列地尔联合高频通气治疗新生儿持续性肺动脉高压疗效分析[J].中国医师杂志,2015,17(3):439-441.
[17]罗芳,温晓芳,邱在军.不同剂量西地那非治疗新生儿肺动脉高压的临床分析[J].中国当代医药,2015,22(36):62-64.
[18]杨梅,朱晓静,宋万千.西地那非治疗新生儿肺动脉高压疗效与安全性分析[J].中国生育健康杂志,2013,19(1):5-7.
[19]吴晓宁,许桂凤.多巴胺联合西地那非治疗新生儿肺动脉高压的临床研究[J].现代药物与临床,2015,30(5):572-576.
[20]高淑强,巨容,胡旭红,等.高频振荡通气联合西地那非治疗新生儿持续肺动脉高压的疗效观察[J].中华实用儿科临床杂志,2015,30(2):114-117.