發(fā)布時間：2018-06-23 20:18

  本文選題：西地那非 + 肺動脈高壓�。� 參考：《廣西醫(yī)科大學》2012年碩士論文

【摘要】：目的評價西地那非治療兒童肺動脈高壓(PH)的療效及其安全性。 方法計算機檢索Cochrane圖書館的臨床對照試驗中心注冊庫、EMBASE、PubMed、CNKI、VIP、萬方數(shù)字化期刊群。檢索時間均從建庫至2011年5月。輔以手工檢索相關會議論文集,獲得西地那非治療兒童PH的隨機對照試驗(RCT)。采用Cochrane評價手冊5.0推薦的方法對納入研究的方法學質量進行評估。合并分析采用Review Manager5.0軟件進行,對無法進行合并分析的結果進行描述性分析。 結果共納入11個研究,共582例患兒。3篇正確描述了隨機序列的產(chǎn)生,4篇正確描述了分配隱藏,6篇描述使用了盲法及盲法的具體實施方法,7篇正確描述了退出或失訪情況。Meta分析結果顯示：采用西地那非治療后,患兒病死率有所下降[RR=0.18,95%CI(0.07,0.48)]；肺動脈收縮壓及平均肺動脈壓明顯下降[MD=-10.92,95%CI(-15.84,-6.01)；MD=-9.11,95%CI(-11.29,-6.92)]。另外,西地那非有助于降低PH患兒OI值[MD=-12.53,95%CI(-18.60,-6.47)],改善患兒動脈血氧分壓[MD=12.39,95%CI(6.00,18.77)],并且基本不影響體循環(huán)血壓[MD=0.01,95%CI(-6.64,6.67)]。6個研究報道了研究過程中不良發(fā)應的發(fā)生情況,研究期間無藥物相關死亡,各研究均報道患兒對西地那非有較好的耐受性。不良反應主要為：短暫陰莖勃起、暫時性鼻阻塞、胃腸道出血、胃腸道反應等。 結論西地那非能有效降低PH患兒死亡風險,有效降低患兒升高的肺動脈壓；并且能改善患兒氧合能力,改善患兒動脈血氧分壓。短期運用西地那非安全性及耐受性均較好。但是對于西地那非確切療效及遠期安全性的評價仍有待大樣本,高質量及長期隨訪的RCT進一步證實。
[Abstract]:Objective to evaluate the efficacy and safety of sildenafil in the treatment of pulmonary hypertension (PH) in children. Methods the library of Cochrane Clinical controlled trial Center was searched by computer for EMBASE PubMED CNKII VIPs and Wanfang Digital Journal Group. The retrieval time is from the construction of the database to May 2011. A randomized controlled trial (RCT) of sildenafil for treatment of children with PH was obtained by manual retrieval of related proceedings. Methods recommended by Cochrane Review Manual 5.0 were used to assess the quality of methodology included in the study. The merging analysis is carried out by Review Manager 5.0 software, and the results that can not be combined analysis are analyzed in a descriptive way. The results were included in 11 studies, A total of 582 children with 3 articles correctly described the generation of random sequences, 4 correctly described the distribution, concealment, 6 descriptions of the use of blind method and the implementation of blind method 7 correctly described the situation of withdrawal or loss of interviews. Meta-analysis results show : after treatment with sildenafil, The mortality of children decreased [RRV 0.18 95 CI (0.07 鹵0.48)], pulmonary arterial systolic pressure and mean pulmonary artery pressure decreased significantly [MD-10.92 鹵95CI (-15.84 鹵-6.01) CI -9.11 1 95 CI (-11.29 -6.92)]. In addition, sildenafil can decrease the OI value of children with PH [MD-12.53-95 CI (-18.60 鹵-6.47)], improve the partial pressure of oxygen in children's arteries [MD-12.39 ~ 95CI (6.00 ~ 18.77)], and have no effect on systemic blood pressure [MD0.0195CI (-6.64c6.67)]. All studies reported better tolerance to sildenafil in children. The main adverse reactions were: temporary penile erection, temporary nasal obstruction, gastrointestinal bleeding, gastrointestinal reaction and so on. Conclusion sildenafil can effectively reduce the risk of death and increase pulmonary artery pressure in children with PH, and can improve oxygenation ability and oxygen partial pressure of arterial blood in children. Short-term use of sildenafil is safe and well tolerated. However, the evaluation of the efficacy and long-term safety of sildenafil still needs to be confirmed by high quality and long term follow-up RCT.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.4

【參考文獻】

相關期刊論文 前10條

1 彭幫田;張巖偉;;西地那非治療先天性心臟病并肺動脈高壓的療效[J];臨床醫(yī)學;2009年10期

2 童凡;杜立中;施麗萍;;西地那非與前列地爾治療先天性心臟病術后肺動脈高壓的療效對比[J];中華急診醫(yī)學雜志;2006年11期

3 裘剛;張育才;黃綺薇;戎群芳;龔小慧;黃敏;;西地那非治療新生兒持續(xù)肺動脈高壓比對研究(英文)[J];臨床兒科雜志;2009年08期

4 劉雪芹;杜軍保;楊曉征;李萬鎮(zhèn);;口服西地那非治療特發(fā)性肺動脈高壓1例[J];實用兒科臨床雜志;2007年19期

5 陸慰萱;靳建軍;;肺動脈高壓診斷策略[J];中國實用內(nèi)科雜志;2010年12期

6 鐘士慶;鄭景浩;;西地那非治療先天性心臟病手術后肺動脈高壓的臨床觀察[J];現(xiàn)代預防醫(yī)學;2010年04期

7 顧虹;卓玲;李強強;劉海菊;劉天洋;郭保靜;張陳;;西地那非在兒童先天性心臟病相關性肺動脈高壓中的應用[J];心肺血管病雜志;2011年03期

8 齊建光;杜軍保;;肺動脈高壓發(fā)病機制和診治研究進展[J];中國循證兒科雜志;2006年01期

9 黃愛蓮;龍湘鵬;;西地那非治療小兒肺動脈高壓的療效和安全性[J];中國醫(yī)學工程;2009年05期

10 馬超;孟保英;王元祥;彭樂;趙春玉;張青;潘曉蘭;王濤;;不同劑量西地那非術后治療嬰幼兒先天性心臟病合并肺動脈高壓的臨床研究[J];中國醫(yī)藥指南;2010年22期

相關碩士學位論文 前2條

1 童凡;西地那非治療小兒先心病術后肺動脈高壓的早期臨床療效研究[D];浙江大學;2005年

2 廖發(fā)榮;西地那非影響野百合堿所致大鼠肺動脈高壓的機制[D];廣西醫(yī)科大學;2007年

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本文編號：2058275