Sharma Vipul Krishen, Joshi Saajan, Joshi Ankur, Kumar Gaurav, Arora Harmeet, Garg Anurag
Department of Cardiothoracic Anesthesiology, Military Hospital (Cardiothoracic Center), Armed Forces Medical College, Pune, Maharashtra, India.
Ann Card Anaesth. 2015 Oct-Dec;18(4):510-6. doi: 10.4103/0971-9784.166457.
Pulmonary hypertension (PHT), if present, can be a significant cause of increased morbidity and mortality in children undergoing surgery for congenital heart diseases (CHD). Various techniques and drugs have been used perioperatively to alleviate the effects of PHT. Intravenous (IV) sildenafil is one of them and not many studies validate its clinical use.
To compare perioperative PaO 2 - FiO 2 ratio peak filling rate (PFR), systolic pulmonary artery pressure (PAP) - systolic aortic pressure (AoP) ratio, extubation time, and Intensive Care Unit (ICU) stay between two groups of children when one of them is administered IV sildenafil perioperatively during surgery for CHDs.
Patients with ventricular septal defects and proven PHT, <14 years of age, all American Society of Anesthesiologists physical status III, undergoing cardiac surgery, were enrolled into two groups - Group S (IV sildenafil) and Group C (control) - over a period of 14 months, starting from October 2013. Independent t-test and Mann-Whitney U-test were used to compare the various parameters between two groups.
PFR was higher throughout, perioperatively, in Group S. PAP/AoP was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean group extubation time was 7 ± 7.34 h, whereas in Group C it was 22.1 ± 10.6. Postoperative ICU stay in Group S and Group C were 42.3 ± 8.8 h and 64.4 ± 15.9 h, respectively.
IV sildenafil, when used perioperatively, in children with CHD having PHT undergoing corrective surgery, improves not only PaO 2 - FiO 2 ratio and PAP - AoP ratio but also reduces extubation time and postoperative ICU stay.
肺动脉高压（PHT）若存在，可能是先天性心脏病（CHD）患儿手术发病率和死亡率增加的重要原因。围手术期已采用多种技术和药物来减轻PHT的影响。静脉注射西地那非是其中之一，且很少有研究证实其临床应用效果。
比较两组CHD手术患儿围手术期的动脉血氧分压（PaO₂）- 吸入氧分数值（FiO₂）比值、峰值充盈率（PFR）、收缩期肺动脉压（PAP）- 收缩期主动脉压（AoP）比值、拔管时间及重症监护病房（ICU）住院时间，其中一组患儿在CHD手术围手术期静脉注射西地那非。
年龄小于14岁、美国麻醉医师协会身体状况分级均为Ⅲ级、患有室间隔缺损且确诊为PHT并接受心脏手术的患者，从2013年10月开始的14个月内被纳入两组——S组（静脉注射西地那非）和C组（对照组）。采用独立样本t检验和曼 - 惠特尼U检验比较两组间的各项参数。
围手术期全程S组的PFR均较高。S组和C组的PAP/AoP分别为0.3和0.4。S组的平均拔管时间为7±7.34小时，而C组为22.1±10.6小时。S组和C组术后在ICU的住院时间分别为42.3±8.8小时和64.4±15.9小时。
对于患有PHT且接受矫正手术的CHD患儿，围手术期使用静脉注射西地那非不仅可改善PaO₂ - FiO₂比值和PAP - AoP比值，还可缩短拔管时间和术后ICU住院时间。
