目的 探討波生坦聯(lián)合伐地那非治療先天性心臟病術(shù)后肺動脈高壓的臨床療效。方法 選取2013年1月-2015年1月在聊城市第二人民醫(yī)院心胸外科接受治療的先天性心臟病術(shù)后肺動脈高壓患者76例,隨機(jī)分為對照組和治療組,每組各38例。對照組口服鹽酸伐地那非片,20 mg/次,1次/d。治療組在對照組的基礎(chǔ)上口服波生坦片,根據(jù)患者體質(zhì)量給藥,體質(zhì)量<10 kg:15.625 mg/次;體質(zhì)量10~20 kg:31.25 mg/次;體質(zhì)量21~40 kg:62.5 mg/次,1次/d。兩組患兒均治療6個月。觀察兩組的臨床療效,同時比較治療前后兩組呼吸困難評分(Borg評分)、腦鈉尿肽(BNP)、心臟功能分級(NYHAFC)、血氧飽和度(SpO₂)、6 min步行實(shí)驗(yàn)距離(6 MWTD)及右心導(dǎo)管檢查結(jié)果變化情況。結(jié)果 治療后,對照組和治療組的總有效率分別為73.68%、92.11%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者Borg評分、BNP及NYHAFC均明顯降低,同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的下降幅度優(yōu)于對照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者肺動脈收縮壓(sPAP)、肺動脈平均壓(mPAP)、肺動脈收縮壓/體循環(huán)動脈收縮壓(Pp/Ps)均明顯降低,而肺循環(huán)血流量/體循環(huán)血流量(Qp/Qs)明顯增高,同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后,兩組患者SpO₂和6 MWTD均明顯增加,同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些觀察指標(biāo)的改善程度優(yōu)于對照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 波生坦聯(lián)合伐地那非治療先天性心臟病術(shù)后肺動脈高壓具有較好的臨床療效,可提高患者的運(yùn)動能力,改善患者的心臟功能,緩解呼吸困難癥狀,具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical effect of bosentan combined with vardenafil in treatment of pulmonary arterial hypertension after congenital heart disease operation. Methods Patients (76 cases) with pulmonary arterial hypertension after congenital heart disease operation in Department of Cardiothoracic Surgery, the Second People's Hospital of Liaocheng from January 2013 to January 2015 were randomly divided into the control and treatment groups, and each group had 38 cases. Patients in the control group were po administered with Vardenafil Hydrochloride Tablets, 20 mg/time, once daily. Patients in the treatment group were po Bosentan Tablets on the basis of the control group, body weight < 10 kg: 15.625 mg/time, body weight 10 - 20 kg: 31.25 mg/time, body weight 21 - 40 kg: 62.5 mg/time, once daily. Patients in two groups were treated for 6 months. After treatment, the efficacy was evaluated, and the changes of Borg scores, BNP, NYHAFC, SpO₂, 6 MWTD, and right heart catheterization results in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were73.68% and 92.11%, respectively, and there was difference between two groups (P < 0.05). After treatment, Borg scores, BNP, and NYHAFC in two groups were significantly decreased, and the differences were statistically significant in the same group (P <0.05). After treatment, the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, sPAP, mPAP, and Pp/Ps in two groups were significantly decreased, but Qp/Qs in two groups were obviously increased, and the differences were statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, SpO₂ and 6 MWTD in two groups were significantly increased, and the differences were statistically significant in the same group (P < 0.05). After treatment, the observational indexes were significantly better than those in the control group (P < 0.05). Conclusion Bosentan combined with vardenafil has clinical curative effect in treatment of pulmonary arterial hypertension after congenital heart disease operation, and can improve exercise capacity , and heart function of patients, and relieve dyspnea of patients, which has a certain clinical application value.