目的 探讨波生坦联合伐地那非治疗先天性心脏病术后肺动脉高压的临床疗效。方法 选取2013年1月-2015年1月在聊城市第二人民医院心胸外科接受治疗的先天性心脏病术后肺动脉高压患者76例,随机分为对照组和治疗组,每组各38例。对照组口服盐酸伐地那非片,20 mg/次,1次/d。治疗组在对照组的基础上口服波生坦片,根据患者体质量给药,体质量<10 kg:15.625 mg/次;体质量10~20 kg:31.25 mg/次;体质量21~40 kg:62.5 mg/次,1次/d。两组患儿均治疗6个月。观察两组的临床疗效,同时比较治疗前后两组呼吸困难评分(Borg评分)、脑钠尿肽(BNP)、心脏功能分级(NYHAFC)、血氧饱和度(SpO₂)、6 min步行实验距离(6 MWTD)及右心导管检查结果变化情况。结果 治疗后,对照组和治疗组的总有效率分别为73.68%、92.11%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者Borg评分、BNP及NYHAFC均明显降低,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的下降幅度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者肺动脉收缩压(sPAP)、肺动脉平均压(mPAP)、肺动脉收缩压/体循环动脉收缩压(Pp/Ps)均明显降低,而肺循环血流量/体循环血流量(Qp/Qs)明显增高,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者SpO₂和6 MWTD均明显增加,同组治疗前后比较差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异具有统计学意义(P<0.05)。结论 波生坦联合伐地那非治疗先天性心脏病术后肺动脉高压具有较好的临床疗效,可提高患者的运动能力,改善患者的心脏功能,缓解呼吸困难症状,具有一定的临床推广应用价值。

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.