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目的:探讨西地那非治疗新生儿持续肺动脉高压(PPHN)的疗效与安全性。方法:将60例肺源性PPHN患儿随机分成硫酸镁组、米力农组、西地那非组各20例。三组患儿连续应用相应药物3 d后,应用超声心动仪检测肺动脉压力(SPAP),监测治疗前后氧合指数(OI)、体循环收缩压(SBP),并比较三组患儿疗效。结果:三组患儿OI、SPAP、SBP治疗前比较差异无统计学意义(P>0.05)。治疗后三组患儿SPAP及OI均明显下降,三组组间各时间点SPAP比较差异无统计学意义(P>0.05),但各时间点组间OI及SBP比较差异有统计学意义(P<0.05)。米力农组及西地那非组改善OI效果明显优于硫酸镁组。硫酸镁组治疗期间出现低血压,米力农组治疗后24 h出现短期低血压,与西地那非组比较差异有统计学意义(P<0.05)。治疗3 d后三组总有效率比较,西地那非组及米力农组优于硫酸镁组,差异均有统计学意义(P<0.05)。结论:治疗肺源性PPHN时应首选西地那非,与硫酸镁相比更安全有效。使用米力农时,应注意监测患儿血压变化。
Objective: To investigate the efficacy and safety of sildenafil in the treatment of neonatal persistent pulmonary hypertension (PPHN). Methods: Sixty children with pulmonary PPHN were randomly divided into two groups: magnesium sulfate group, milrinone group and sildenafil group. Three groups of children with continuous application of the corresponding drug 3 d, the application of echocardiography pulmonary artery pressure (SPAP), monitoring before and after treatment oxygenation index (OI), systolic blood pressure (SBP), and compared the efficacy of three groups of children. Results: There was no significant difference in OI, SPAP and SBP between the three groups before treatment (P> 0.05). After treatment, the SPAP and OI in three groups were significantly decreased. There was no significant difference in SPAP between the three groups at all time points (P> 0.05), but the difference of OI and SBP between the three groups was statistically significant (P <0.05). The improvement of OI in the Milrinone and Sildenafil groups was significantly better than that of the magnesium sulfate group. In the magnesium sulfate group, hypotension occurred during the treatment, short-term hypotension occurred 24 hours after treatment in the Milrinone group, which was significantly different from that in the sildenafil group (P <0.05). After 3 days of treatment, the total effective rate of three groups was significantly higher than that of sildenafil group (P <0.05). Conclusion: Sildenafil should be the first choice for the treatment of pulmonary PPHN, which is safer and more effective than magnesium sulfate. Use of rice farmers should pay attention to monitoring changes in children with blood pressure.