The Effect And Efficacy Of Sildenafil On Plasma Cytokines In Neonates With Persistent Pulmonary Hypertension

Objective: To study the effect of sildenafil on plasma cytokines in persistent pulmonary hypertension of the newborn(PPHN)and compare the efficacy of conventional therapy and conventional therapy combined with sildenafil in the treatment of PPHN,and to analyze the efficacy and safety of sildenafil in the treatment of persistent pulmonary hypertension in newborns.Methods: From May 2014 to May 2017,136 children with pulmonary hypertension who were hospitalized in our hospital were selected as study objects,and were randomly divided into research group and control group,control group,The 68 cases of control group were received conventional therapy,such as mechanical ventilation,to maintain a stable environment,prevention of infection and positive etiological treatment etc.And 68 patients of research group were received conventional treatment and sildenafil.The drug was given by nasal feeding at a dose of 1.0 mg / kg plus 1 ml of water for injection at intervals of 6 hours with continuous treatment until the pulmonary artery pressure decreased to normal level.The reflux velocity of tricuspid valve was detected by GE doppler echocardiography.The pulmonary arterial pressure were calculated according to the simplified Bernoulli equation.ABL520 automatic blood gas analyzer were used to detect and record blood oxygen saturation,arterial blood oxygen partial pressure,arterial blood carbon dioxide partial pressure and arterial blood PH value.The BNP,ET-1,TNF-?,ANG-1 and IL-8 were detected by enzyme-linked immunosorbent assay.Based on the analysis of the changes of the indicators in the two groups of children with continuous pulmonary hypertension,the application effect and safety of the continuous pulmonary hypertension were analyzed.The indicators of both groups of children with continuous pulmonary hypertension were compared.The systolic blood pressure and pulmonary arterial pressure were observed in both groups of children after treatment.There was no obvious adverse reaction of the application of continuous pulmonary hypertension in neonates.The duration,hospitalization expense,length of hospital stay and total efficiency of the both groups of children,and the changes of plasma cytokines in the both groups after treatment were all compared.Results: There were no difference in the indicators of OI,PaCO2 and PaO2 in both groups(P>0.05).Compared with those before treatment,the indicators of OI,PaCO2 and PaO2 were significantly improved in the both groups(P< 0.05).Compared with the control group,the indicators of OI,PaCO2 and PaO2 were significantly improved in the research group(P< 0.05).There were no significant difference in PAP,SPO2,PaO2,PaCO2 and PH between the two groups(P>0.05).The difference of PAP,SPO2,PaO2,PaCO2 and PH value was statistically significant between before and after treatment in both groups(P< 0.05).SPO2,PaO2,as well as PH in the research group was obviously higher than that of control group,while PAP and PaCO2 were significantly lower than the control group.BNP,ET-1,TNF-?,ang-1 and IL-8 have no statistically significant difference between both groups(P>0.05).After treatment,there were significant differences in BNP,ET-1,TNF-?,ANG-1 and IL-8 between both groups(P < 0.05).ANG-1 in the research group was significantly higher than that in the control group,while BNP,ET-1,TNF-? and IL-8 in the research group were significantly lower than those in the control group(P < 0.05).Compared with the control group,the use time of ventilator in the research group was shorter(t = 2.49,P = 0.02).There was no difference in hospitalization costs between both groups(t = 1.71,P = 0.09).Compared with the control group,the research group had shorter hospital stay(t = 3.35,P = 0.00).Compared with the control group,the total effective rate of the research group was higher(t = 7.49,P = 0.01).Conclusions: Sildenafil have a certain impact on plasma cytokines in neonatal with pulmonary hypertension.The combined detection of BNP,ET-1,TNF-?,ANG-1 and IL-8 can more accurately reflect the therapeutic effect of neonatal pulmonary hypertension.There is no apparent adverse reaction to the use sildenafil in neonates with persistent pulmonary hypertension.Sildenafil has a significant effect on persistent pulmonary hypertension in newborns,which can further reduce pulmonary hypertension without affecting systemic systolic blood pressure,and can significantly improve the gas exchange function and hypoxemia in neonatal.In terms of clinical treatment,compared with conventional therapies,sildenafil used in neonatal pulmonary hypertension can shorten the duration of mechanical ventilation.The combination of conventional therapy and sildenafil has a positive effect on the treatment of persistent pulmonary hypertension in neonates,and the clinical treatment effect is obviously better than that of the conventional therapy alone.