Lenclen R, Karam T, Gajdos V, Mourdie J, Hoenn E, Campot K, Paupe A
Centre hospitalier intercommunal poissy-Saint-Germain, Site de poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France.
Arch Pediatr. 2001 Jan;8(1):32-8. doi: 10.1016/s0929-693x(00)00163-9.
The aim of this study was to analyze the time course of cardiovascular effects in glucocorticoid-treated premature infants with bronchopulmonary dysplasia (BPD).
In a retrospective case study, 63 ventilator-dependent very-low-birth-weight neonates (mean gestational age = 27.9 +/- 2 weeks and mean birth weight = 920 +/- 275 g) treated with dexamethasone (52%) or betamethasone (48%) were studied. The average value for each study day was calculated for systolic arterial blood pressure and heart rate.
At initiation of treatment, blood pressures increased significantly from pre-treatment to day 1 and continued to increase during the first week: as a percentage of pre-treatment baseline the mean increase for systolic arterial blood pressure was 19% (95% confidence interval [CI] = 16, 22) on day 2 (P < 0.001). The maximum amplitude of variation was observed before day 2 for 75% of the study group. As a group as a whole, the heart rate value significantly decreased on day 1 (mean difference = -14.6 beats/min; 95% CI = -16.5, -12.6; P < 0.001), and then reached pre-treatment value within one week. Cardiovascular response was independent of gestational age, birth weight and postnatal age at the beginning of treatment.
During postnatal steroid therapy a rise in blood pressure is a common side effect, but bradycardia is mentioned very occasionally. The present study shows a marked increase in blood pressure during the first 48 hours concomitant with a decrease in heart rate. The inverse relationship between systolic arterial blood pressure and heart rate suggests a baroreflex response.
本研究旨在分析糖皮质激素治疗支气管肺发育不良（BPD）的早产婴儿心血管效应的时间进程。
在一项回顾性病例研究中，对63例依赖呼吸机的极低出生体重儿（平均胎龄=27.9±2周，平均出生体重=920±275g）进行了研究，这些患儿接受了地塞米松（52%）或倍他米松（48%）治疗。计算每个研究日收缩动脉血压和心率的平均值。
治疗开始时，血压从治疗前到第1天显著升高，并在第一周持续升高：作为治疗前基线的百分比，收缩动脉血压在第2天的平均升高为19%（95%置信区间[CI]=16,22）（P<0.001）。75%的研究组在第2天之前观察到最大变化幅度。作为一个整体组，心率值在第1天显著下降（平均差异=-14.6次/分钟；95%CI=-16.5，-12.6；P<0.001），然后在一周内恢复到治疗前值。心血管反应与治疗开始时的胎龄、出生体重和出生后年龄无关。
产后类固醇治疗期间血压升高是常见的副作用，但心动过缓很少被提及。本研究显示在最初48小时内血压显著升高，同时心率下降。收缩动脉血压与心率之间的反比关系提示压力反射反应。
