徐军　李志飞　吕一枝

[摘要] 目的 研究西地那非聯合高频震荡通气（HFOV）治疗近足月儿持续性肺动脉高压（PPHN）的效果。 方法 将42例PPHN患儿分为三组：A组：常频同步间歇指令通气（SIMV）加西地那非；B组：单纯HFOV；C组：HFOV加西地那非。给药组（A组、C组）予西地那非q 6 h鼻饲，每次1 mg /kg加注射用水1 mL，给药72 h 后症状、肺动脉压力（PAP）、氧合指数无改善则停药。比较三组患儿治疗后2 h、6 h、12 h、24 h、36 h、48 h、60 h、72 h的血气指标及呼吸机参数，观察患儿的并发症、不良反应、临床疗效。 结果 C组患儿总的临床疗效率为92.86%（13/14），显著高于A组（χ2=6.300，P=0.012）、B组（χ2=9.956，P=0.002）患儿的临床疗效。A组与B组患儿总的临床疗效差异无统计学意义（χ2=0.583，P=0.445）。治疗前，三组患儿的PaO2、PaCO2、OI、FiO2、PAP指标无明显差异性（P>0.05）。治疗后72 h，三组患儿的PaO2水平有所上升，三组患儿的PaCO2、OI、FiO2、PAP水平有所下降，上述指标水平的升高或降低在C组中表现得更为显著，组间比较存在明显差异（P<0.05）。C组患儿的用氧时间、住院时间明显短于A组和B组，差异有统计学意义（P<0.05），但A组和B组患儿的用氧时间、住院时间无明显差异（P>0.05）。治疗结束后患儿出现不同程度的并发症，其中A组中出现气漏和颅内出血的患儿各1例，B组出现脑白质软化患儿1例，C组未发现并发症，三组患儿的并发症发生率差异无统计学意义（P>0.05）。在所有患儿中暂未发现呕吐、恶心、心律失常、低血压等不良反应。 结论 近足月PPHN患儿采取西地那非联合HFOV治疗，可明显改善患儿的临床症状，疗效较好，安全性高。

[关键词] 西地那非；高频震荡通气；近足月儿；持续性肺动脉高压

[中图分类号] R722.1 [文献标识码] B [文章编号] 1673-9701（2017）16-0054-04

[Abstract] Objective To study the effect of sildenafil combined with high frequency oscillation ventilation（HFOV） in the treatment of persistent pulmonary hypertension（PPHN） in near-term infants. Methods A total of 42 cases of PPHN children were divided into three groups： group A： synchronized intermittent mandatory ventilation（SIMV） combined with sildenafil； group B： HFOV alone； group C： HFOV combined with sildenafil. The administration group（group A and group C） was given sildenafil q for 6 h via nasal feeding， with 1 mg/kg each time plus injection of 1 mL water. 72 hours after administration， if the symptoms， pulmonary artery pressure（PAP） and oxygenation index were not improved， then the drugs were withdrawn. The blood gas indicators and ventilator parameters were compared between the three groups at 2， 6， 12， 24， 36， 48， 60 and 72 hours after treatment. The complications， adverse reactions and clinical efficacy were observed in the children patients. Results The total clinical efficacy in group C was 92.86%（13/14）， which was significantly higher than that in group A （χ2=6.300， P=0.012） and that in group B（χ2=9.956， P=0.002）. There was no significant difference in the total clinical curative effect between group A and group B （χ2=0.583， P=0.445）. There were no significant differences in PaO2， PaCO2， OI， FiO2 and PAP between the three groups before treatment（P>0.05）. After 72 hours of treatment， the levels of PaO2 in the three groups were increased. The levels of PaCO2， OI， FiO2 and PAP in the three groups were decreased and the increase or decrease of the above indices were more significant in group C， and there were significant differences compared between groups（P<0.05）. The oxygen using time and the length of stay in group C were significantly shorter than those in group A and group B， and the differences were significant（P<0.05）. However， there were no significant differences in oxygen using time and length of stay between group A and group B（P>0.05）. After the end of treatment， the children patients showed varying degrees of complications. Air leakage and intracranial hemorrhage were observed in 1 case in group A， white matter softening was observed in 1 case in group B， and no complications were observed in group C. There was no significant difference in the incidence rate of complications between the three groups（P>0.05）. No vomiting， nausea， arrhythmia， hypotension and other adverse reactions were found in all children patients. Conclusion Sildenafil combined with HFOV in the near-term infants with PPHN can significantly improve the clinical symptoms， with better curative effect and higher safety.

[Key words] Sildenafil； High-frequency oscillation ventilation； Near-term infants； Persistent pulmonary hypertension

近足月儿（晚期早产儿）是指胎龄为34～36+6周的早产儿，他们目前占所有早产儿的70%～75%[1]。近足月新生兒常行选择性剖腹产，本身就存在宫内感染、缺氧窘迫，容易导致吸入性肺炎、胎粪吸入综合征，也是并发持续肺动脉高压（persistent pulmonary hypertension，PPHN）的高危因素[2]。目前……