目的：探讨西地那非联合硫酸镁治疗新生儿持续性肺动脉高压的疗效和安全性。方法：2011年1月—2015年12月本院新生儿重症监护病房收治新生儿肺动脉高压患儿共81例，随机分为三组：A组(硫酸镁组)、B组(西地那非组)及C组(西地那非联合硫酸镁组)，三组患儿的胎龄、日龄、出生体重等无显著性差异(P>0.05)。所有病例均积极治疗原发病，机械辅助通气并纠正酸中毒等，利用多普勒超声心动图检测肺动脉压力，一经确诊新生儿持续性肺动脉高压(Persistent pulmonary hypertension of the newborn，PPHN)并除外气胸、先天性心脏病后即开始进入治疗。结果：81例患儿中，治愈50例，好转19例，无效12例，总有效率85.2%。硫酸镁组有效率为76%，西地那非组有效率为85.2%，西地那非联合硫酸镁组有效率为93.1%。结论：西地那非联合硫酸镁两者联合应用治疗新生儿肺动脉高压比单用起效更迅速，疗效更佳，可以有效降低肺动脉压，改善氧合，缩短机械通气时间，减少并发症的发生，降低病死率和伤残率。%Objective: To investigate the therapeutic effects and safety of sildenafil plus magnesium sulfate(MgSO4)in the treatment of neonatal persistent pulmonary hypertention(PPHN)of newborn. Methods:A total of 81 infants with PPHN at our NTCU from January 2011 to December 2015 were divided randomly into three groups:group A(n=25, magnesium sulfate only), group B(n=27, sildenafil only)and group C(n=29, sildenafil plus magnesium sulfate). The gestational age and birth weight and the age of infant, between these three groups showed no difference. All infants received comprehensive treatment including mechanical ventilation, expansion of infusion, and so on. The pulmonary artery pressure was measured by echocardiography. PAMP, fraction ofinspired oxygen(FiO2), transcutaneous oxygen saturation(SPO2), arterial partial pressure of oxygen(PaO2), partial pressure of carbon dioxidein artery(PaCO2), and oxygen index(OI), heart rate, blood pressure before and at 2, 12, 24, 48, 72 h after treatment were compared between the three groups. Results:There was no significant difference of efficacy between the three groups. The PAMP were reduced after being treated(P<0.05). The PAMP at 24h after treatment were compared between the three groups,and there were significant difference of efficacy between group C and the others(P<0.05). Compared with before and at 2, 12, 24, 48, 72 h after treatment, improvement was seen in all the parameters such as transcutaneous oxygen saturation(SPO2), arterial partial pressure of oxygen(PaO2), partial pressure of carbon dioxidein artery(PaCO2),and oxygen index(OI), fraction of inspired oxygen(FiO2), there were significant difference(P<0.05). The arterial partial pressure of oxygen(PaO2)at 8, 12, 24, 48, 72 h after treatment were compared between the three groups, and there were significant difference of efficacy between group C and the others(P<0.05). No remarkable side effect such as low blood presure happened in all patients treated with sildenafil and magnesium sulfate(MgSO4). The PPHN were changed in 50 cases, significantly improved were 19 cases, and unchanged were in 12 cases. The total efficacy was 85.2%. The efficacy of group A was 76%. The efficacy of group B was 85.2%, and the efficacy of group C is 85.2%.Conclusion:Combination of sildenafil and magnesium sulfate for PPHN treatment can significantly reduce PAMP and improve oxygenation, shorten the duration of ventilation use and improve cure rate.
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