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目的:探讨枸橼酸西地那非片(万艾可)联合多巴胺治疗新生儿持续肺动脉高压(PPHN)的疗效及对血清炎性因子水平的影响。方法:选取2012年至2014年我院收治的110例PPHN患儿,按随机数字表法分为观察组和对照组各55例,两组患儿均给予呼吸支持治疗,对照组在常规治疗基础上给予多巴胺,观察组在对照组治疗基础上加用枸橼酸西地那非,对比分析两组血氧饱和度、肺动脉收缩压、血流动力学、治疗前后C反应蛋白(CRP)及脑钠肽(BNP)水平。结果:两组患儿治疗后心功能等级较治疗前均下降(U=13.562,P<0.05),而观察组治疗后Ⅲ~Ⅳ级所占比例低于对照组(P<0.05)。观察组治疗后血氧饱和度为88.92%±7.62%、氧分压为(89.63±5.82)mm Hg、左心室射血分数为0.89%±0.21%,显著高于对照组的82.24%±6.37%、(84.87±6.23)mm Hg和0.76%±0.36%(P<0.05);观察组肺动脉收缩压为(60.23±5.44)mm Hg,低于对照组的(65.07±3.84)mm Hg(P<0.05)。观察组治疗后血清CRP(2.89±0.78)mg/L、BNP(6.12±3.48)μg/L显著低于对照组的(5.98±0.88)mg/L、(18.98±2.69)μg/L(P<0.05)。结论:枸橼酸西地那非片联合多巴胺治疗PPHN能有效改善患儿心功能及肺功能,这可能与其能降低血清炎症因子水平,减轻炎症因子对靶器官损伤作用有关。
Objective: To investigate the effect of sildenafil citrate combined with dopamine in the treatment of neonatal persistent pulmonary hypertension (PPHN) and its effect on the levels of serum inflammatory cytokines. Methods: A total of 110 children with PPHN admitted to our hospital from 2012 to 2014 were randomly divided into observation group (55 cases) and control group (55 cases). Respiratory support was given to both groups and the control group was treated on the basis of routine treatment On the basis of the control group plus sildenafil citrate, comparative analysis of two groups of oxygen saturation, pulmonary artery systolic blood pressure, hemodynamics, C-reactive protein (CRP) and brain before and after treatment Natriuretic peptide (BNP) levels. Results: The levels of cardiac function in both groups decreased after treatment (U = 13.562, P <0.05), while those in the observation group were lower than those in the control group (P <0.05). The oxygen saturation of the observation group after treatment was 88.92% ± 7.62%, the oxygen partial pressure was (89.63 ± 5.82) mm Hg, the left ventricular ejection fraction was 0.89% ± 0.21%, which was significantly higher than that of the control group (82.24% ± 6.37% , (84.87 ± 6.23) mm Hg and 0.76% ± 0.36% respectively (P <0.05). The pulmonary artery systolic pressure in the observation group was (60.23 ± 5.44) mm Hg, lower than that in the control group (65.07 ± 3.84 mm Hg) ). The levels of serum CRP (2.89 ± 0.78) mg / L and BNP (6.12 ± 3.48) μg / L in the observation group were significantly lower than those in the control group (5.98 ± 0.88 mg / L and 18.98 ± 2.69 μg / L, P < 0.05). CONCLUSION: The treatment of PPHN with sildenafil citrate combined with dopamine can effectively improve the cardiac function and pulmonary function in children, which may be related to its ability to reduce serum levels of inflammatory cytokines and reduce the effects of inflammatory cytokines on target organs.