Li Zhenyu, Lv Xiaoming, Liu Qinmei, Dang Dan, Wu Hui
Department of Neonatology, The First Hospital of Jilin University, Changchun, China.
Transl Pediatr. 2021 Apr;10(4):998-1007. doi: 10.21037/tp-20-277.
Pulmonary hypertension (PH) is a life-threatening syndrome in neonates and has multiple and varied etiologies. However, few clinical studies have systematically evaluated the treatment regimens for this population. Phosphodiesterase (PDE) inhibitors, such as milrinone, tadalafil, dipyridamole, and sildenafil, are the most important regulators of vascular relaxation in the normal pulmonary vascular transition after birth, and these agents are widely used in the treatment of PH. Sildenafil, a representative PDE-5 inhibitor, has an important role as a single mode of therapy. However, the lack of evidence from pharmacokinetic and clinical trials has limited the emergence of standardized treatment regimens for sildenafil. There are also differing opinions among researchers regarding the best route of sildenafil administration. Due to the interindividual variability in the neonatal population, it is worth selecting the most suitable route of sildenafil administration according to the specific conditions of the neonatal population. These may be evaluated using the oxygenation index (OI), pulmonary artery pressure, mean blood pressure, and the serological index. This article reviews the clinical data on the use of sildenafil, focusing on the current and promising alternative routes of administration, which may affect subsequent clinical research in term and preterm neonates.
肺动脉高压（PH）是一种危及新生儿生命的综合征，病因多样。然而，很少有临床研究系统评估该人群的治疗方案。磷酸二酯酶（PDE）抑制剂，如米力农、他达拉非、双嘧达莫和西地那非，是出生后正常肺血管转变过程中血管舒张的最重要调节因子，这些药物广泛用于治疗PH。西地那非作为一种代表性的PDE-5抑制剂，在单一治疗模式中具有重要作用。然而，药代动力学和临床试验缺乏证据限制了西地那非标准化治疗方案的出现。研究人员对于西地那非的最佳给药途径也存在不同意见。由于新生儿群体存在个体差异，根据新生儿群体的具体情况选择最合适的西地那非给药途径是值得的。这些可以通过氧合指数（OI）、肺动脉压、平均血压和血清学指标来评估。本文综述了使用西地那非的临床数据，重点关注当前和有前景的替代给药途径，这可能会影响足月儿和早产儿随后的临床研究。
