西地那非和前列地尔对风湿性心脏病肺动脉高压患者术中血流动力学的影响

摘要

目的 观察西地那非和前列地尔对风湿性心脏病肺动脉高压患者术中血流动力学的影响.方法 风湿性心脏病肺动脉高压患者45例,随机分为西地那非组(A组)、前列地尔组(B组)和对照组(C组),每组15例.A组鼻饲西地那非100 mg;B组静脉泵入前列地尔20 ng·kg1 ·min-1；C组用等量生理盐水.记录围手术期血流动力学指标以及术后呼吸机辅助时间和需吸入氧浓度.结果 与C组比较,A组、B组能显著降低平均肺动脉压(MPAP)、肺动脉血管阻力指数(PVRI)(P＜0.05)；与B组比较,A组能显著降低体循环血管阻力指数(SVRI)( P＜0.05)；A组术后呼吸机辅助时间及吸入氧浓度均低于B组(P＜0.05).结论 西地那非的改善风湿性心脏病肺动脉高压患者术中血流动力学及心肺保护作用优于前列地尔.%Objective To explore and compare the effects of sildenafil and alprostadil on the hemodynamics in the patients with rheumatic heart disease complicated with pulmonary hypertension undergoing cardiac valve replacement under cardiopulmonary bypass(CPB). Methods A total of 45 patients was assigned into three groups of A (tube feeding sildenafil 100 mg), B (infusion of alprostadil 20 ng · kg-1 · min-1) and C( infusion of normal saline) with 15 cases each. Perioperative hemodynamics was continuously recorded. The time of mechanical ventilation and the concentration of inspired oxygen needed after operation were closely monitored as welL Results Mean pulmonary arterial pressureC MPAP) and pulmonary vascular resistance index(PVRI) were significantly lower in groups of A and B than those in group C(P<0. 05). Systemic vascular resistance index(SVRI) was significantly lower in group A than that in group B(P<0. 05). Compared to group B, the time for mechanical ventilation was shorter and the fraction of inspired oxygen needed after operation was lower in group A(P<0. 05). Conclusion Sildenafil is superior to alprostadil in improving the hemodynamics and cardiopulmonary function in the patients with severe rheumatic mitral stenosis and pulmonary hypertension undergoing cardiac valve replacement under CPB.