The Clinical Effect And Safety Analysis Of Milrinone In The Treatment Of Persistent Pulmonary Hypertension In The Newborn

Persistent pulmonary hypertension of the newborn is a neonatal respiratory and circulatory disease,with a high incidence of neonatal diseases.The mortality of neonatal respiratory failure accompanied by PPHN is as high as 40%-50%^[1].The pathophysiological mechanisms of PPHN are complex and diverse,involving multiple categories such as molecular biology and biomedicine,etc.Its main pathophysiological features include hypoxic pulmonary artery vasoconstriction and hypoxic pulmonary artery vascular remodeling^[2].Studies have shown that the high risk of PPHN is related to cesarean section,oligohydramnios,premature delivery or near-term delivery,and pre-pregnancy body mass index>27^[3].At present,it has been confirmed that inhalation of nitric oxide is the main first-line treatment,but iNO is an invasive and high-consumable treatment.Therefore,as a challenging disease,it is of great importance to explore the pathological mechanism of PPHN and seek a more effective and concise treatment for PPHN.Cyclic adenosine monophosphate（cAMP）is a kind of intracellular signaling molecule,it can mediate the prostacyclin pathway in pulmonary vascular endothelial cells to expand pulmonary blood vessels.Milrinone is an inhibitor of phosphodiesterase 3（PDE-3）,which can inhibit the activity of PDE-3,reduce the degradation rate of cAMP,and increase the intracellular cAMP concentration.Therefore,milrinone can act on the prostacyclin pathway which is mediated by cAMP to relieve pulmonary vasoconstriction.At the same time,milrinone also has a positive inotropic effect.For PPHNchildren with cardiac insufficiency,milrinone can improve cardiac ejection fraction^[4].Objective:The changes of pulmonary artery systolic pressure（PASP）,arterial oxygen partial pressure（PaO₂）,arterial oxygen saturation（SaO₂）,arterial blood carbon dioxide partial pressure（PaCO₂）,systolic blood pressure（SBP）and arterial blood pH（PH）were observed before and after treatment in the children with PPHN.To evaluate the curative effect,cure rate and the adverse reactions.To explore whether milrinone can be used as a treatment of PPHN.provide a better choice for alleviating the pain,shortening the whole treatment time,increasing the cure rate and reducing the incidence of sequelae.Methods:From February 2018 to January 2019,seventy five newborns with PPHN hospitalized in the neonatal pediatrics department of Baoding First Central Hospital were selected.In this study,the subjects were randomly divided into one control group and four experimental groups with fifteen cases in each group.The control group was administered with Sidenafil(1mg^-1·kg^-1,Q6h,D0 group),and the experimental group was treated with continuous intravenous infusion of milrinone.According to the different dosage of milrinone,the experimental group was divided into 0.125ug/（kg·min）,（D1 group）;0.25ug/（kg·min）,（D2 group）;0.5ug/（kg·min）,（D3group）;0.75ug/（kg·min）,（D4 group）.The sex,age,gestational age and weight of all subjects were recorded.The pulmonary artery systolic blood pressure（PASP）,arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）,blood oxygen partial pressure（PaO₂）,systolic blood pressure（SBP）and PH were measured before and after treatment.The data were analyzed statistically.The levels of PASP,PaO₂,SaO₂,PaCO₂,PH,SBP were compared before treatment.The levels of PASP,PaO₂,SaO₂,PaCO₂,PH,SBP were compared after treatment.The levels of PASP,PaO₂,SaO₂,PaCO₂,PH,SBP after treatment in each group were compared.The cure rate,effective rate and ineffective rate of each group were compared.If P<0.05,the difference was statistically significant.The adverse reactions were observed.Results:There was significant difference of PASP,PaO₂,SaO₂,PaCO₂,PH,SBP before and after treatment in the experimental group,and the curative effect of the 0.5ug/（kg·min）,（D3 group）and 0.75ug/（kg·min）,（D4 group）higher than remaining groups,but there was no significant difference between the D3 group and D4 group（P>0 05）.There was a significant difference in SBP,PaCO₂,PASP levels before and after treatment in the control group（P<0.05）.There was no significant difference in the level of PaO₂,SaO₂,PH between before and after treatment in the control group（P>0 05）.The cure rate of each group was compared.The cure rate of 0.5ug/（kg·min）,（D3group）and 0.75ug/（kg·min）,（D4）was higher than that in other three groups（P<0.05）.The clinical symptoms were improved in different degrees after treatment.Arrhythmia,thrombocytopenia,hypotension and other adverse reactions were not found.Conclusion:Milrinone has a significant clinical significance in the treatment of PPHN.It can effectively improve the clinical symptoms and reduce the pulmonary artery pressure.No adverse reactions have been found at present.