曲前列尼尔联合西地那非在室间隔缺损合并肺动脉高压围术期的应用

目的 探讨围术期采用曲前列尼尔联合西地那非治疗先天性心脏病室间隔缺损(VSD)合并肺动脉高压(PAH)患儿的疗效和预后.方法 回顾性分析2018年1月至2019年1月在本院诊断VSD合并PAH,择期行开胸心脏手术患儿,根据围术期除曲前列尼尔基础上是否联用西地那非治疗,分为单药治疗组及联用治疗组.结果 共纳入患儿48例,...

The treatment of treprostinil combined with sildenafil on perioperative patients of ventricular septal defects with pulmonary arterial hypertension

Objective To investigate the effects and prognosis of treprostinil combined with sildenafil treatment on perioperative patients of ventricular septal defects(VSD)with pulmonary arterial hypertension(PAH).Methods From January 2018 to Janunary 2019,48 patients of VSD concomitant with PAH underwent elective cardiac surgery were selected and analyzed retrospectively.Patients were divided into mono-therapy group(n=29)and concomitant-therapy group(n=19)according to whether sildenafil was combined with treprostanil or not.Results There was no significant difference in the general clinical data,preoperative pulmonary arterial pressure(PAP),left ventricular ejection fraction(LVEF),transcutaneous oxygen saturation,type B natriuretic peptide(BNP),creatine kinase MB(CKMB),Troponin I(cTnI),and C-reactive protein(CRP)between the two groups(P>0.05).There was also no significant difference in the aortic cross-clamp time between two groups(P>0.05).Whereas,cardiopulmonary bypass time was significantly decreased in the concomitant-therapy group(P<0.05).Postoperative PAP and transcutaneous oxygen saturation were significantly ameliorated compared with those before operation(P<0.05),however,no statistic difference was observed between the two groups postoperatively(P>0.05)between the two groups.No significance was found in LVEF as well between the two groups(P>0.05).Compared with mono-therapy group,the mechanical ventilation and ICU stay time were significantly decreased in concomitant-therapy group(P<0.01).The BNP,CKMB,and cTnI were obviously decreased in the concomitant-therapy group postoperatively(P<0.05).No significant difference was detected in CRP(P>0.05).No patients experienced pulmonary hypertensive crisis.Conclusion Congenital disease with PAH severely affected the prognosis of the patients.Perioperative treatment of treprostinil combined with sildenafil could significantly improve the short-term outcomes of pediatric patients.