西地那非联合高频振荡通气治疗足月新生儿肺动脉高压的效果观察

目的 观察西地那非联合高频振荡通气(HFOV)治疗足月新生儿肺动脉高压(PPHN)的临床效果.方法 回顾性分析2008年1月至2014年12月本院新生儿重症监护病房收治的PPHN患儿临床资料,根据不同时间段治疗措施不同分为HFOV组、常频机械通气(CMV)+西地那非组、HFOV+西地那非组.分析各组患儿治疗前、治疗3、6、12 h后的P/F比值、氧合指数(OI)、肺动脉压力,以及机械通气时间、氧疗时间、住院时间、转归.结果 治疗3、6、12 h后HFOV+西地那非组P/F、OI、肺动脉压力均优于CMV+西地那非组和HFOV组,CMV+西地那非组优于HFOV组,差异有统计学意义(P＜0.05).HFOV+西地那非组机械通气时间、氧疗时间、住院时间均短于CMV+西地那非组和HFOV组,CMV+西地那非组短于HFOV组,差异有统计学意义(P＜0.05);各组患儿病死率比较差异无统计学意义(P＞0.05).结论 早期西地那非联合HFOV治疗PPHN疗效显著,能迅速改善肺动脉高压患儿的氧合情况,显著缩短患儿的上机时间、氧疗时间及住院时间,但对患儿病死率没有影响.

The efficacy of sildenafil combined with high frequency oscillatory ventilation for persistent pulmonary hypertension of the full-term newborn

Objective To observe the clinical effect of sildenafil combined with high frequency oscillatory ventilation (HFOV) for persistent pulmonary hypertension of the newborn (PPHN) in full-term infants.Methods Clinical data of PPHN in NICU of our hospital from January 2008 to December 2014 was retrospectively studied.These infants were divided into three groups according to different therapeutic strategies:HFOV group,conventional mechanical ventilation (CMV) + sildenafil group,and HFOV + sildenafil group.Their P/F,oxygenation index (OI),and pulmonary artery pressure (PAP) before and 3,6,12 h after treatment,the duration of mechanical ventilation,the duration of oxygen therapy,hospital stay,and clinical outcomes were compared.Results 3,6,12 h after treatment,P/F,OI,and PAP in HFOV + sildenafil group were better than those in CMV + sildenafil group and HFOV group,and those in CMV + sildenafil group were better than those in HFOV group (P＜0.05).The duration of mechanical ventilation,the duration of oxygen therapy,hospital stay of HFOV + sildenafil group were shorter than those of CMV + sildenafil group and HFOV group,and those in CMV + sildenafil group were shorter than those in HFOV group (P＜0.05).There was no statistically significant difference in the mortality rate among three groups (P＞0.05).Conclusions Sildenafil combined with HFOV is effective for PPHN.The combination therapy can rapidly and effectively improve oxygenation in children with pulmonary hypertension,and shorten mechanical ventilation time,oxygen exposure time,and hospital stay.