不同剂量西地那非治疗新生儿肺动脉高压的疗效

目的探讨口服不同剂量的西地那非(SIL)治疗新生儿持续性肺动脉高压(PPHN)的疗效、有效剂量和不良反应。方法 48例PPHN患儿在呼吸机机械通气下口服SIL,根据用药剂量分为3组,每6h给药1次,每次剂量分别是0.3、0.5和1.0mg/kg。治疗前和治疗后3d检测动脉氧合和肺动脉压(PAP)的变化,记录心率、血压、呕吐次数等。结果口服SIL 3d后3组患儿动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)均明显提高(均P<0.01),PAP显著下降(P<0.05或P<0.01);3组患儿在提高动脉氧合指标(PaO2、SaO2)上无显著差异,而0.3mg/kg组PAP下降程度及PPHN治疗有效率小于0.5、1.0mg/kg组(均P<0.05);治疗期间所有患儿均未出现明显不良反应。结论口服SIL在新生儿持续性肺动脉高压的治疗上有显著疗效,安全性好,有效剂量为每次0.3～1.0mg/kg,6h给药1次。

Effectiveness of Different Doses of Sildenafil on Persistent Pulmonary Hypertension of Newborns

Objective To observe the effectiveness of different doses of sildenafil(SIL)on pulmonary artery pressure(PAP)and oxygenation of persistent pulmonary hypertension of newborns(PPHN).Methods Forty-eight newborns with PPHN were recruited from December 2005 to May 2011 in NICU.The patients were randomly assigned to three groups,which were given orally 0.3,0.5 and 1.0 mg/kg SIL respectively,once per 6 h for 3 days.Arterial blood gas analysis was done and PAP was measured before treatment and 3 days after treatment.HR,BP,and vomiting times were recorded.Results At 3rd day after administration of SIL,PaO2 and SaO2 were significantly increased(P<0.01)and PAP significantly reduced(P<0.05).There was no significant difference in the oxygenation indexes(PaO2,SaO2)among three groups.But the decrease of PAP in 0.3 mg/kg dose SIL group was lower than in 0.5 mg/kg and 1.0 mg/kg dose SIL groups(P<0.05).No side effects occurred in all patients treated with SIL.Conclusion SIL is an effective and safe drug to reduce PAP and improve oxygenation of PPHN.Effective doses are 0.3-1.0 mg/kg,4 times per day.