Abstract
Purpose: To investigate the efficacy of the combined use of sildenafil and magnesium sulfate in the treatment of persistent pulmonary hypertension of the newborn (PPHN), and its influence on hemodynamics.Methods: A total of 174 children with persistent pulmonary hypertension who were treated in Ganzhou People’s Hospital, Ganzhou, China were selected and randomly assigned to joint group (JG) and control group (CG), with 87 patients in each group. The CG group received magnesium sulfate, while the JG group received sildenafil plus magnesium sulphate. The respiratory parameters of the children were analyzed using blood gas analyzer, while their hemodynamic indices were evaluated using color Doppler echocardiography. The levels of cytokines and inflammatory factors were determined by enzyme-linked immunosorbent assay (ELISA).Results: Time taken for symptom disappearance, oxygen therapy, and hospitalization period were shorter in JG than in CG (p < 0.05). Post-treatment, the respiratory parameters (PaO2, PaCO2, and SaO2) in both groups s improved, with lower levels of PaO2 and PaCO2, and a higher level of SaO2 in JG (p < 0.05). Following treatment, the levels of systemic vascular resistance (SVR), posterior pulmonary vascular resistance (PVR) and pulmonary artery pressure (PA) in JG were significantly reduced, relative to CG (p < 0.05). Similarly, the expression of endothelin -1 (ET-1), brain natriureticpeptide (BNP), and angiotensin 1 (ANG-1) improved, with lower levels of ET-1 and BNP, and a higher level of ANG-1 in JG (p < 0.05). There was post-treatment reduction as well in IL-6 and TNF-α, with lower levels in JG (p < 0.05). Patients in JG showed higher total treatment effectiveness and a lowerincidence of adverse reactions than those in CG (p < 0.05).Conclusion: The combined use of sildenafil and magnesium sulfate enhances the management of PPHN, ameliorates respiratory parameters, hemodynamics, and levels of cytokines and inflammatory factors. These findings provide evidence-based medical references for a new treatment strategy for PPHN.
Highlights
METHODSPersistent pulmonary hypertension of the newborn (PPHN) is a common disease with extremely high morbidity and mortality
Other studies have shown that magnesium sulfate reduced the incidence of complications such as arterial blood pressure, arrhythmia, and pulmonary artery pressure caused by tracheal intubation, and ameliorated the hemodynamics of patients [12]
The expressions of systemic vascular resistance (SVR), PVR, and PA in the joint group (JG) after treatment were markedly decreased, relative to control values, suggesting that sildenafil plus magnesium sulfate was better at dilating the blood vessels and reducing pulmonary hypertension, pulmonary vascular resistance and artery pressure in children, thereby improving their hemodynamics
Summary
Persistent pulmonary hypertension of the newborn (PPHN) is a common disease with extremely high morbidity and mortality. A total of 174 children with persistent pulmonary hypertension admitted into our hospital from May 2018 to August 2019 served as the research subjects. They were randomly assigned to the joint group (JG) and the control group (CG), with 87 patients in each group. Patients in JG were treated with sildenafil tablets (Pfizer, Dalian, China, H20020527), in addition to the treatment in the control group. Measured data are presented as mean ± SD and paired t-test was applied for intra-group comparison before and after treatment. Differences were considered statistically significant at p < 0.05
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