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目的探讨西地那非和高频振荡通气(HFO)治疗新生儿呼吸衰竭并肺动脉高压的疗效。方法选择2012年12月至2015年1月我院NICU收治的急性呼吸衰竭合并肺动脉高压的新生儿,分别采用口服西地那非联合HFO治疗(观察组)或单独HFO治疗(对照组),观察两纽患儿血气分析、体循环收缩压(SBP)、肺动脉收缩压(SPAP),评价氧合情况及疗效,比较两组患儿机械通气天数、用氧天数、治愈率、病死率。结果观察组43例,对照组29例,两组患儿治疗前各指标差异无统计学意义(P>0.05)。治疗6 h后,观察组SPAP、动脉血氧分压/肺泡氧分压[a/AP(O_2)]及肺氧合指数(OI)明显改善,治疗12 h后对照组各指标明显改善,观察组各时间点(6 h、12 h、24 h、72 h)SPAP、OI低于对照组,a/AP(O_2)高于对照组[6 h:SPAP(47.3±8.4)比(58.7±3.9)mmHg,a/AP(O_2)(0.19±0.11)比(0.14±0.08),OI(16.1±6.2)比(20.2±7.3)mmHg;12 h:SPAP(42.7±4.5)比(50.1±7.4)mmHg,a/AP(O_2)(0.24±0.10)比(0.18±O.13),OI(13.8±3.8)比(17.3±5.9)mmHg;24 h:SPAP(39.1±3.3)比(47.5±7.3)mmHg,a/AP(O_2)(0.28±0.12)比(0.21±0.13),OI(11.9±3.0)比(14.2±4.4)mmHg;72 h:SPAP(30.2±5.7)比(35.6±3.2)mmHg,a/AP(O_2)(0.32±0.11)比(0.27±0.14),OI(9.7±1.9)比(11.5±3.5)mmHg],差异有统计学意义(P<0.05)。观察组用氧天数、机械通气天数、肺部并发症发生率和病死率均少于对照组,治愈率明显高于对照组,差异有统计学意义(P<0.05)。结论西地那非和HFO联合治疗能迅速改善新生儿呼吸衰竭并肺动脉高压患儿的氧合功能,缩短用氧时间和机械通气时间,提高治愈率,降低病死率。
Objective To investigate the efficacy of sildenafil and high frequency oscillatory ventilation (HFO) in the treatment of neonatal respiratory failure and pulmonary hypertension. Methods Neonates with acute respiratory failure and pulmonary hypertension undergoing NICU in our hospital from December 2012 to January 2015 were selected and treated with oral sildenafil combined with HFO (observation group) or HFO alone (control group), respectively Two New Zealand children with blood gas analysis, systolic blood pressure (SBP), pulmonary artery systolic blood pressure (SPAP), evaluation of oxygenation and efficacy, compared the two groups of children with mechanical ventilation days, oxygen days, cure rate, mortality. Results The observation group of 43 cases, the control group of 29 cases, two groups of children before treatment there was no significant difference in each index (P> 0.05). After 6 hours of treatment, the indexes of SPAP, arterial partial pressure of oxygen, alveolar partial pressure [a / AP (O 2)] and oxygenation index (OI) in observation group were significantly improved. Compared with the control group, the SPAP and OI of the group at each time point (6 h, 12 h, 24 h, 72 h) were lower than that of the control group, and the ratio of a / AP (O 2) was higher than that of the control group [6 h: 47.3 ± 8.4 vs 58.7 ± 3.9 ) mmHg, the ratio of a / AP (O_2) (0.19 ± 0.11) and (0.14 ± 0.08) and OI (16.1 ± 6.2) and (20.2 ± 7.3) mmHg, a / AP (O_2) (0.24 ± 0.10) vs (0.18 ± 0.13), OI (13.8 ± 3.8) vs (17.3 ± 5.9) mmHg; ) mmHg, the ratio of a / AP (O_2) (0.28 ± 0.12) (0.21 ± 0.13) and OI (11.9 ± 3.0) vs (14.2 ± 4.4) mmHg; mmHg, a / AP (O_2) (0.32 ± 0.11) vs (0.27 ± 0.14) and OI (9.7 ± 1.9) vs (11.5 ± 3.5) mmHg, respectively. The difference was statistically significant (P <0.05). The observation group with oxygen days, mechanical ventilation days, the incidence of pulmonary complications and mortality were less than the control group, the cure rate was significantly higher than the control group, the difference was statistically significant (P <0.05). Conclusion The combination therapy of sildenafil and HFO can rapidly improve the oxygenation function of neonates with respiratory failure and pulmonary hypertension, shorten the time of using oxygen and mechanical ventilation, improve the cure rate and reduce the mortality rate.