2020 年第 8 期 第 15 卷

波生坦对先天性心脏病合并肺动脉高压患儿心肺功能及血浆N末端B型脑钠肽前体水平的影响

Effect of bosentan on cardiopulmonary function and plasma N-terminal pro-brain natriuretic peptide level in children with congenital heart disease complicated with pulmonary hypertension

作者：张德重刘彩霞智喜强杨晋明马新平

英文作者：Zhang Dezhong Liu Caixia Zhi Xiqiang Yang Jinming Ma Xinping 

单位：山西省儿童医院心胸外科，太原030013

英文单位：Department of Cardiothoracic Surgery Shanxi Children′s Hospital Taiyuan 030013 China 

关键词：先天性心脏病；肺动脉高压；波生坦；西地那非；N末端B型脑钠肽前体

英文关键词：Congenitalheartdisease;Pulmonaryhypertension;Bosentan;Sildenafil;N-terminalpro-brainnatriureticpeptide 

• 摘要：

• 目的 探讨波生坦对先天性心脏病合并肺动脉高压患儿心肺功能及血浆N末端B型脑钠肽前体（NT-proBNP）水平的影响。方法 选择2013年3月至2019年3月山西省儿童医院收治的先天性心脏病合并肺动脉高压患儿300例。按照随机数字表法分为对照组和观察组，各150例。对照组在基础干预基础上口服枸橼酸西地那非治疗，观察组在基础干预基础上口服波生坦治疗。2组均治疗1个月，观察比较2组患儿治疗前后平均肺动脉压及血浆NT-proBNP水平以及心功能和肺功能指标变化。结果 治疗后 2组肺动脉压及NT-proBNP均较治疗前下降，且观察组低于对照组［（30±5）mmHg（1 mmHg=0.133 kPa）比（33±5）mmHg、（126±16）ng/L比（157±18）ng/L］，差异均有统计学意义（均P<0.05）。治疗后观察组6 min步行距离、右心室射血分数、第1秒用力呼气容积、用力肺活量、第1秒用力呼气容积占用力肺活量百分比均高于对照组，差异均有统计学意义（均P<0.05）。结论 波生坦治疗能够降低无用药禁忌的先天性心脏病合并肺动脉高压患儿肺动脉压力及NT-proBNP水平，有助于改善患儿的心肺功能，促进心肺功能恢复。

• Objective To investigate the effects of bosentan on cardiopulmonary function and plasma N-terminalpro-brain natriuretic peptide(NT-proBNP) level in children with congenital heart disease complicated with pulmonary hypertension. Methods A total of 300 children with congenital heart disease complicated with pulmonary hypertension admitted to Children′s Hospital of Shanxi from March 2013 to March 2019 were selected. They were  randomly divided into the control group and the observation group, with 150 cases in each group. The control group was treated with sildenafil citrate on the basis of basic intervention, and the observation group was treated with bosentan on the basis of basic intervention. The mean pulmonary artery pressure and NT-proBNP, changes in cardiac function and lung function indicators of both groups were compared before and after treatment. Results After treatment, the pulmonary artery pressure and NT-proBNP level of the two groups were lower than before treatment, and those in observation group were lower than thoese in control group［（30±5）mmHg vs （33±5）mmHg, （126±16）ng/L vs （157±18）ng/L， all P<0.05］. After treatment, the 6 minutes walking distance, right ventricular ejection fraction, forced expiratory volume in the first second, forced vital capacity and forced expiratory volume in the first second accounted for the percentage of forced vital capacity in observation group were higher than those in control group, the differences were statistically significant(all P<0.05). Conclusion Except for some congenital heart diseases that are contraindicated, bosentan treatment can reduce the pulmonary artery pressure and NT-proBNP levels in children with congenital heart disease complicated with pulmonary hypertension, which can improve the cardiopulmonary function and promote the recovery of cardiopulmonary function.