目的 探討多巴胺聯(lián)合西地那非治療新生兒肺動脈高壓的臨床療效。方法 選取2011年6月—2014年11月天津市西青醫(yī)院收治的肺動脈高壓患兒90例,隨機分為對照組和治療組,每組45例。對照組患兒口服或鼻飼枸櫞酸西地那非片0.5～1.0 mg/(kg·次),1次/6 h。治療組患兒在對照組治療的基礎(chǔ)上,靜脈滴注鹽酸多巴胺注射液5 μg/(kg·min),輸液泵持續(xù)靜脈滴入。兩組均連續(xù)治療3 d。觀察兩組患者的臨床療效,同時比較兩組治療前后動脈血氧分壓(PaO₂)、動脈血二氧化碳分壓(PaCO₂)、肺動脈壓(PAP)、動脈血氧飽和度(SaO₂)、血清內(nèi)皮素(ET-1)、缺氧誘導(dǎo)因子(HIF-1α)、一氧化氮(NO)、促紅細胞生成素(EPO)、Ca²⁺的變化。結(jié)果 治療后,對照組和治療組總有效率分別為82.22%、95.56%,兩組總有效率比較差異具有統(tǒng)計學(xué)意義(P < 0.05)。兩組PaO₂、SaO₂、NO均較治療前顯著升高,PaCO₂、PAP、EPO、HIF-1、ET-1較治療前顯著降低,同組治療前后差異有統(tǒng)計學(xué)意義(P < 0.01);治療組這些觀察指標的改善程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P < 0.05)。兩組Ca²⁺均較治療前顯著升高(P < 0.05),但兩組比較差異無統(tǒng)計學(xué)意義。結(jié)論 多巴胺聯(lián)合西地那非治療新生兒肺動脈高壓具有較好的臨床療效,可顯著調(diào)節(jié)缺氧相關(guān)因子水平,值得臨床推廣應(yīng)用。

Objective To investigate the effect of dopamine combined with sildenafil in treatment of neonates with pulmonary arterial hypertension. Methods Patients (90 cases) with pulmonary arterial hypertension in Tianjin Xiqing Hospital from June 2011 to November 2014 were randomly divided into control and treatment groups, and each group had 45 cases. The patients in the control group were po or nasal feeding administered with Sildenafil Citrate Tablets, 0.5～1.0 mg/(kg·time), one time/6 h. The patients in the treatment group were iv administered with Dopamine Hydrochloride Injection on the basis of control group, 5 μg/(kg·min), continuous intravenous drip infusion pump. Two groups were treated for 3 d. After treatment, the efficacy was evaluated, and the changes of PaO₂, PaCO₂, PAP, SaO₂, ET-1, HIF-1α, NO, EPO, and Ca²⁺ in two groups were compared. Results The efficacies in the control and treatment groups were 82.22% and 95.56%, respectively, and there were differences between two groups (P < 0.05). After treatment, PaO₂, SaO₂, and NO in two groups were significantly increased, while PaCO₂, PAP, EPO, HIF-1, and ET-1 were significantly reduced, and the difference was statistically significant in the same group (P < 0.01). And these indicators in treatment group improved better than those in the control group, with significant difference between two groups (P < 0.05). Ca²⁺ in two groups were significantly increased (P < 0.05), and there was no statistically significant difference between two groups. Conclusion Dopamine combined with sildenafil has the good clinical effect in treatment of neonates with pulmonary arterial hypertension, and can adjust hypoxia correlated factors levels, which is worth clinical promotion