高频振荡通气下西地那非联合米力农治疗新生儿持续肺动脉高压的疗效观察

目的探讨高频振荡通气下西地那非联合米力农对新生儿持续性肺动脉高压的疗效。方法选取2016年1月至2018年12月于本院确诊的新生儿持续性肺动脉高压患儿120例,随机分为3组,每组40例。A组采用高频振荡通气+西地那非(1 mg/kg,q6h)治疗,B组采用高频振荡通气+米力农负荷剂量50μg/kg,30 min静脉注射,维持剂量0.75μg/(kg·min)]治疗,C组采用高频振荡通气+西地那非+米力农治疗。检测患儿治疗前、治疗3 d后的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)和肺动脉压力(SPAP)的变化,观察患儿不良反应。结果 3组患儿PaCO_2、FiO_2、SaO_2、PaO_2和SPAP治疗前后比较差异具有统计学意义(P<0.05),PaCO_2、FiO_2均较治疗前均明显降低,且C组明显低于A、B组(P<0.05);SaO_2、PaO_2均明显高于治疗前,且C组PaO_2明显高于A、B组(P<0.05);治疗后,SPAP明显低于治疗前,且C组明显低于A、B组(P<0.05)。3组患儿均未发生恶性不良反应,且不良反应发生率较低,差异无统计学意义(P<0.05)。结论高频振荡通气下西地那非联合米力农治疗新生儿肺动脉高压疗效肯定,能够更好的改善患儿的缺氧状态和肺动脉压力,具有良好的临床应用价值。

Therapeutic effect of sildenafil combined with milrinone on continuous pulmonary hypertension in neonates under high frequency oscillatory ventilation

Objective To investigate the efficacy of sildenafil combined with milrinone in the treatment of neonatal persistent pulmonary hypertension under high frequency oscillatory ventilation.Methods A total of 120 children with persistent pulmonary hypertension diagnosed in our hospital from January 2016 to December 2018 were selected and randomly divided into three groups,40 cases in each group.Group A was treated by high frequency oscillatory ventilation+sildenafil(1mg/kg q6h).Group B was treater by high frequency oscillatory ventilation+milrinone(loading dose of 50μg/kg,intravenous injection for 30 minutes,maintenance dose of 0.75μg/(kg·min).Group C was treated by high frequency oscillatory ventilation+sildenafil+milrinone(using the same method as before).The arterial blood carbon dioxide partial pressure(PaCO2),inhaled oxygen concentration(FiO2),arterial oxygen saturation(SaO2),arterial oxygen partial pressure(PaO2)and pulmonary artery pressure(SPAP)were measured before treatment and 3 days after treatment.Children's adverse reactions were observed and compared.Results PaCO2,FiO2,SaO2,PaO2 and SPAP in the three groups showed statistically significant improvement compared with before and after treatment(P<0.05).Among them,PaCO2 and FiO2 were significantly lower than before treatment,and group C was significantly lower than group A and B(P<0.05).SaO2 and PaO2 were significantly higher than before treatment,and the improvement of PaO2 in Group C was significantly better than the other two groups(P<0.05).SPAP was significantly lower than before treatment,and the improvement of Group C was significantly better than the other two groups(P<0.05).No malignant adverse reactions occurred in the three groups,and the incidence of adverse reactions were low,and there was no statistically significant difference(P<0.05).Conclusion Sildenafil combined with milrinone in the treatment of neonatal pulmonary hypertension under high frequency oscillatory ventilation is was effective,it could improve the hypoxic state and pulmonary artery pressure of children,and has good clinical application value.