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[目的]探讨西地那非对小儿先天性心脏手术后重度肺动脉高压的影响。[方法]总结2005年11月～2008年11月间应用西地那非治疗小儿先天性心脏手术后重度肺动脉高压共16例。所有病例均在术前行超声心动图检查确诊为重度肺动脉高压。16例先天性心脏病患儿术前均给予5～7d的间断吸氧,口服卡托普利以及应用强心利尿。术前1d停用洋地黄类药物,行心内畸形矫治术。所有病例术后均给予持续镇静和镇痛,保持适度的过度通气,维持轻度呼碱状态,同时积极纠正各种水、电解质紊乱及代谢性酸中毒。给予多巴胺,米力农,强心治疗,前列腺素E1维持肺血管扩张。经上述处理无效者,给予高浓度吸氧,增加前列腺素E1用量,肺动脉压仍无明显下降,肺氧合功能无进一步改善,即给予口服西地那非,每6h1次。观察患者肺动脉压、动脉血压、血氧饱和度、动脉氧分压、动脉二氧化碳分压、吸氧浓度的变化。[结果]服用西地那非1h以后,16例患者血氧饱和度、血氧分压渐上升,肺动脉压开始下降,体循环血压稳定或稍增高。1～2d后,吸氧浓度渐降低,肺动脉压基本稳定,无进一步上升,肺氧合功能改善,并顺利撤离呼吸机。16例患者顺利出院。[结论]西地那非用于治疗先天性心脏病手术后严重肺动脉高压具有应用方便、疗效可靠等优点。
[Objective] To investigate the effect of sildenafil on severe pulmonary hypertension after congenital heart surgery in children. [Methods] From November 2005 to November 2008, application of sildenafil in treating 16 cases of severe pulmonary hypertension after congenital heart surgery in children. All cases were diagnosed with severe pulmonary hypertension by echocardiography preoperatively. Sixteen patients with congenital heart disease were given preoperative 5 ~ 7d intermittent oxygen, oral captopril and the application of cardiac diuretic. 1d before surgery to disable digitalis, line deformity correction surgery. All cases were given continuous sedation and analgesia after surgery to maintain moderate hyperventilation, maintain a mild state of exhaled alkali, and actively correct various water and electrolyte disorders and metabolic acidosis. Given dopamine, milrinone, cardiac therapy, prostaglandin E1 to maintain pulmonary vasodilation. After the above treatment ineffective, giving high concentration of oxygen, increasing the amount of prostaglandin E1, pulmonary arterial pressure was still no significant decline in pulmonary oxygenation without further improvement, that is, giving oral sildenafil every 6h1 times. Pulmonary arterial pressure, arterial blood pressure, oxygen saturation, arterial oxygen pressure, arterial carbon dioxide partial pressure, oxygen concentration changes were observed. [Results] After taking sildenafil for 1 hour, oxygen saturation and oxygen partial pressure gradually increased in 16 patients, pulmonary arterial pressure began to decrease, and blood pressure in the systemic circulation was stable or slightly increased. After 1 ~ 2 days, the oxygen concentration gradually decreased, pulmonary arterial pressure was basically stable, without further increase, pulmonary oxygen function improved, and the successful withdrawal of ventilator. 16 patients were discharged successfully. [Conclusion] Sildenafil has the advantages of convenient application and reliable curative effect for the treatment of severe pulmonary hypertension after operation of congenital heart disease.