目的 探討西地那非治療高海拔地區(qū)兒童先天性心臟病并發(fā)重度肺動(dòng)脈高壓的臨床療效.方法 選擇2012 年1 月-2014 年12 月阿壩藏族羌族自治州人民醫(yī)院兒科收治的先天性心臟病合并重度肺動(dòng)脈高壓患兒150 例,隨機(jī)分為對(duì)照組和治療組,每組各75 例.對(duì)照組采用常規(guī)方法治療,治療組在常規(guī)治療基礎(chǔ)上口服枸櫞酸西地那非片,0.3 mg/kg,3 次/d.兩組均連續(xù)治療7 d.觀察兩組的臨床療效,同時(shí)比較兩組治療前后N 末端腦鈉肽(NT-proBNP)、C 反應(yīng)蛋白(CRP)、肺循環(huán)阻力指數(shù)(PVRI)、每分心輸出量(CO)、氧合指數(shù)(OI)、肺動(dòng)脈收縮壓(PASP)、平均肺動(dòng)脈壓(mPAP)、血氧分壓(PaO₂)、心指數(shù)(CI)、呼吸困難評(píng)分的變化.結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為69.3%、92.0%,兩組總有效率比較差異有統(tǒng)計(jì)學(xué)意義(P< 0.05).治療后,兩組患者呼吸困難評(píng)分、NT-ProBNP、CRP、mPAP、PASP 均顯著降低,PaO₂、OI、CI、PVRI、CO 顯著升高,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P< 0.05);且治療組這些觀察指標(biāo)的觀察程度優(yōu)于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P< 0.05).結(jié)論 西地那非治療高海拔地區(qū)兒童先天性心臟病合并重度肺動(dòng)脈高壓臨床療效較好,可降低肺動(dòng)脈阻力,改善肺循環(huán)血流動(dòng)力學(xué)指標(biāo),具有較高的安全性和可靠性,值得在臨床推廣應(yīng)用.

objective To investigate the efficacy of sildenafil in treatment of high altitude congenital heart disease in children complicated with severe pulmonary hypertension. Methods Patients (150 cases) with congenital heart disease in children complicated with severe pulmonary hypertension in Department of Pediatrics of People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture from January 2012 to December 2014 were randomly divided into control and treatment groups. Each group had 75 cases. Patients in control group were given conventional treatment. Patients in treatment group were po administered with Sildenafil Citrate Tablets on the basis of the control group, 0.3 mg/kg, three times daily. Two groups were treated for 7 d. After treatment, the efficacy was evaluated, and the changes of NT-proBNP, CRP, PVRI, CO, OI, PASP, mPAP, PaO₂, CI, and dyspnea score in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 69.3% and 92.0%, respectively, and there were differences between two groups (P < 0.05). After treatment, dyspnea score, NT-ProBNP, CRP, mPAP, and PASP in two groups were significantly reduced, while PaO₂, OI, CI, PVRI, and CO in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). Conclusion Sildenafil has clinical curative effect in treatment of high altitude congenital heart disease in children complicated with severe pulmonary hypertension, can reduce pulmonary artery resistance, and can significantly improve the hemodynamic parameters about pulmonary circulation with high safety and reliability, which is worth popularizing in clinical application.