目的 探究波生坦聯(lián)合伐地那非治療先天性心臟病術(shù)后肺動(dòng)脈高壓的臨床療效及對(duì)血管內(nèi)皮功能的影響。方法 2011年11月-2015年12月鄭州市第七人民醫(yī)院重癥醫(yī)學(xué)科收治的80例先天性心臟病術(shù)后肺動(dòng)脈高壓患者為研究對(duì)象。根據(jù)術(shù)后拔除氣管插管順序隨機(jī)分為觀察組（40例）和對(duì)照組（40例）。兩組患者均給予持續(xù)吸氧、利尿等常規(guī)治療。在此基礎(chǔ)上，對(duì)照組口服鹽酸伐地那非片；觀察組在對(duì)照組的基礎(chǔ)上加服波生坦，兩組均治療6個(gè)月。比較兩組患者臨床有效率、臨床癥狀緩解情況、心臟功能的情況。結(jié)果 治療后對(duì)照組的臨床總有效率為80.0%，觀察組的臨床總有效率為90.0%，觀察組的臨床總有效率顯著高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前比較，治療后兩組患者的肺動(dòng)脈收縮壓（sPAP）、肺動(dòng)脈平均壓（mPAP）均大幅下降（P<0.05），肺循環(huán)血流量/體循環(huán)血流量明顯升高（P<0.05）；且觀察組的變化較對(duì)照組更為顯著，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前比較，治療后兩組患者的呼吸困難評(píng)分（Borg）、心臟功能分級(jí)（NYHAFC）評(píng)分均大幅下降（P<0.05），且觀察組上述指標(biāo)評(píng)分顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組患者血管內(nèi)皮生長因子（VEGF）水平均治療前大幅下降（P<0.05），且觀察組下降幅度較對(duì)照組更為明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組在不良反應(yīng)方面比較，差異無統(tǒng)計(jì)學(xué)意義。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(dòng)脈高壓的臨床效果顯著，可顯著改善患者呼吸困難等臨床癥狀，改善心臟功能，值得臨床推廣。

Objective To explore the clinical effect of bosentan combined with vardenafil on postoperative pulmonary hypertension associated with congenital heart and its influence on function of vascular endothelium. Methods 80 congenital heart disease patients with postoperative pulmonary hypertension, who were treated in our hospital from November, 2011 to December, 2015 were enrolled in the present study. They were randomly divided into observation group and control group, with each group of 40 cases. Both group received conventional therapy of oxygen and dieresis. The clinical effect, clinical symptom improvement, cardiac function were compared between the two groups. Results The clinical effect of control group was 80.0% (32/40), which was significantly lower than that of observation group (90.0%, P<0.05). The sPAP, mPAP in both group were significantly decreased, and the Qp/Qs level was obviously increased (P<0.05); Borg score and NYHAFC score as well as the level of VEGF were largely decreased, and those of observation group were significantly lower than control group (P<0.05). In the terms of adverse reactions, there was no statistical difference between the two groups. Conclusion Bosentan combined with vardenafil was effective on postoperative pulmonary hypertension associated with congenital heart, which can significantly improve the clinical symptoms of patients with dyspnea, improve the cardiac function, worthy of clinical promotion.