西地那非在风湿性心脏瓣膜病体外循环术中对肺动脉高压的作用

目的研究西地那非（SIL）对风湿性心脏病（RHD）合并肺动脉高压（PH）的患者行瓣膜置换术中降低肺动脉压的作用。方法我院2007年1月至2007年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）≥30 mmHg的患者纳入研究。符合上述条件28例患者分为两组：实验组（SIL治疗组）14例,对照组14例。实验组于麻醉诱导、Swan-Ganz漂浮导管置入后,经鼻饲SIL100mg（辉瑞公司生产的万艾可）;对照组14例,生理盐水对照。连续记录两组给药前（T0）及给药后20 min（T1）、40 min（T2）、60 min（T3）的血流动力学变化。观测给药前、体外循环（extracorporeal circulation,ECC）前、ECC及手术结束时的肺顺应性（CL）及氧合指数（OI）变化,以及术后机械通气时间。结果与对照组比较,实验组在降低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）。ECC开始前及结束时,实验组肺顺应性（CL）显著高于对照组（P〈0.05）,氧合指数显著低于对照组（P〈0.05）。结论ECC瓣膜置换手术中,西地那非能高选择地降低此类患者肺动脉压力,并能改善肺功能,产生肺保护作用。

Treatment with Sildenafil Citrate in Rheumatie Heart Disease Patients with Pulmonary Hypertension in Extracorporeal Circulation

OBJECTIVE To evaluated the effects of sildenafil（SIL）on hemodynamics and lung protection in rheumatic heart disease patients with pulmonary hypertension during extracorporeal circulation（ECC）.METHODS 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 min after medication.Oxyenation index（OI） and compliance of lung（CL） were also recorded at medication,before ECC,at the end of ECC and oparetion.RESULTS Compared with the control group,the mPAP and mPAP/mAP was significantly reduced（P〈0.01） in the experimental group.And the OI was significantly lower（P〈0.05）,CL was also significantly highter in the experimental group（P〈0.05） before ECC and at the end of ECC.CONCLUSION Sildenafil can produce significant pulmonary vasodilatory effect in cardiac surgical patients with pulmonary hypertension,and other beneficial effects such as lung protection.