Sun Linli, Wang Chunxia, Zhou Yulu, Sun Wei, Wang Chunjiang
Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of Pharmacy, Yinan County People's Hospital, Linyi, China.
Front Pharmacol. 2021 Sep 24;12:697287. doi: 10.3389/fphar.2021.697287. eCollection 2021.
To evaluate the efficacy and safety of different doses of sildenafil for persistent pulmonary hypertension of the newborn (PPHN) with Bayesian random effects network meta-analysis. We searched Chinese and English databases for randomized controlled trials (RCTs) concerning sildenafil in newborns with persistent pulmonary hypertension from 1998 to December 2020. Twenty-two RCTs including over 2131 patients were included. Sildenafil was administered by nasal feeding at 0.3-2 mg/kg every 4-6 h. The network meta-analysis revealed that 1.5 mg/kg of sildenafil led to a significant decrease in pulmonary artery systolic pressure (PASP) compared with 0.3 and 0.6 mg/kg ( < 0.05); 1.5 mg/kg was better than 0.3, 0.5, and 1.0 mg/kg at increasing the partial pressure of oxygen (PaO) ( < 0.05); 1.5 mg/kg was better than 0.5, 0.6 and 1.0 mg/kg at reducing the partial pressure of carbon dioxide (PaCO) ( < 0.05); and 1.2 mg/kg was better than 0.3, 0.5 and 1.0 mg/kg at increasing the arterial oxygen saturation (SaO) ( < 0.05). The surface under the cumulative ranking analysis (SUCRA) results showed that 1.5 mg/kg had the best effect in reducing PASP (SUCRA = 92.0%, moderate certainty evidence) and PaCO (91.1%) and increasing PaO (SUCRA = 79.3%, moderate certainty evidence), 2.0 mg/kg had the best effect in increasing SaO (SUCRA = 88.6%, moderate certainty evidence) and total effective rate (SUCRA = 93.5%, low certainty of evidence)). No severe adverse effects were observed with the different doses of sildenafil. Different doses of sildenafil can significantly improve PPHN, and 1.5 mg/kg of sildenafil has better clinical efficacy and does not increase the probability of adverse reactions.
采用贝叶斯随机效应网络荟萃分析，评估不同剂量西地那非治疗新生儿持续性肺动脉高压（PPHN）的疗效和安全性。我们检索了中文和英文数据库，查找1998年至2020年12月期间有关西地那非治疗持续性肺动脉高压新生儿的随机对照试验（RCT）。纳入了22项RCT，涉及2131例以上患者。西地那非通过鼻饲给药，剂量为0.3 - 2mg/kg，每4 - 6小时一次。网络荟萃分析显示，与0.3mg/kg和0.6mg/kg相比，1.5mg/kg西地那非可使肺动脉收缩压（PASP）显著降低（P<0.05）；在提高氧分压（PaO）方面，1.5mg/kg优于0.3mg/kg、0.5mg/kg和1.0mg/kg（P<0.05）；在降低二氧化碳分压（PaCO）方面，1.5mg/kg优于0.5mg/kg、0.6mg/kg和1.0mg/kg（P<0.05）；在提高动脉血氧饱和度（SaO）方面，1.2mg/kg优于0.3mg/kg、0.5mg/kg和1.0mg/kg（P<0.05）。累积排序曲线下面积分析（SUCRA）结果显示，1.5mg/kg在降低PASP（SUCRA = 92.0%，中等确定性证据）和PaCO（91.1%）以及提高PaO（SUCRA = 79.3%，中等确定性证据）方面效果最佳，2.0mg/kg在提高SaO（SUCRA = 88.6%，中等确定性证据）和总有效率（SUCRA = 93.5%，低确定性证据）方面效果最佳。不同剂量西地那非均未观察到严重不良反应。不同剂量西地那非均可显著改善PPHN，1.5mg/kg西地那非具有更好的临床疗效，且不会增加不良反应的发生概率。
