风湿性心脏病合并肺动脉高压体外循环中西地那非降肺动脉压及心肌保护作用

目的:探讨风湿性心脏病(RHD)合并肺动脉高压(PH)患者在行瓣膜置换术中,西地那非(SIL)降低肺动脉压及心肌保护作用.方法:本院2007年6月至11月RHD合并PH行瓣膜置换术、术中经Swan-Ganz漂浮导管测定平均肺动脉压(mPAP)I30 mmH9的患者纳入研究.符合上述条件28例患者分为2组:实验组(SIL治疗组)14例,对照组l4例.实验组于麻醉诱导、SwanGanz漂浮导管置入后,经鼻饲SILl00mg;对照组l4例,同法用牛理盐水对照.连续记录2组给药前(T0)及给药后20min(T1)、40min(T2)、60min(T3)的血流动力学变化.并分别于转流前、主动脉开放后2、6、16h采集患者桡动脉血.测血清CK-MB、cTn-T,观测术后机械通气时间及术后正性肌力药物的应用情况.结果:与对照组比较,实验组在降低平均肺动脉压(mPAP),mPAP/有创平均桡动脉压(mAP)方面差异均具有统计学意义(P<0.01).实验组主动脉开放后2h的cK-MB及开放后16h的cTn-T均较对照组降低(P<0.05).结论:CPB心脏手术中,西地那非能高选择降低此类患者肺动脉压力.并有显著心肌保护作用.

Effect of oral sildenafil citrate on pulmonary vasodilatory and myocardial protection in rhe-umatic heart disease patients with pulmonary hypertension in cardiopulmulnary bypass

Objective:To evaluated the effects of sildenafil on hemodynamics and cardioprotection in rheumatic heart disease patients with pulmonary hypertension undergoing valvular heart surgery during cardiopulmonary bypass(CPB). Methods:After pulmonary arterial catheter insertion,patients with mean pulmonary arterial pressures(MPAP) greater than 30 mmHg were eventually included in this study. Twenty-eight cases were randomly divided into the control group(n = 14),and the experimental group(n = 14). Each patient in the experimental group was given 100 mg SIL(orally by nasal gastric tube) after induction of anesthesia. In control group,patients were placebo-controlled. Hemodynamic variables were measured after induction of anesthesia,at 0,20,40,and 60 minutes after medication. Blood samples were taken to determine the serum concentrations of CK-MB and cTn-T before cardiopulmonary bypass,at 2,6 and 16 h after aortic open-clamp. Results:Compared with the control group,the mPAP and mPAP/PmSAP was significantly reduced(P < 0.01) in the experimental group. And the levels of CK-MB at 2h after aortic open-clamp and cTn-T at 16 h after aortic open-clamp in the experimental group were significantly lower than those in control group(P < 0.05). Conclusion:Sildenafil produced significant pulmonary vasodilatory effect in cardiac surgical patients with pulmonary hypertension and beneficial effects such as myocardial protection.