Varan B, Tokel K, Mercan S, Dönmez A, Aslamaci S
Department of Pediatric Cardiology, Baskent University Faculty of Medicine, Ankara, Turkey.
Pediatr Cardiol. 2002 Jul-Aug;23(4):437-41. doi: 10.1007/s00246-002-0118-3.
The objective of our study was to investigate the safety and efficacy of high-dose methyl prednisolone (MP) in modifying the systemic inflammatory response (SIR) to cardiopulmonary bypass (CPB) and to compare its efficacy with low-dose MP in children undergoing cardiac surgery for congenital heart disease. Thirty children with congenital heart disease undergoing CPB were randomly assigned to two groups: group 1 (n = 15) received 30 mg/kg MP by an intravenous infusion for 30 minutes and group 2 (n = 15) received 2 mg/kg intravenously, before the onset of CPB. Postoperative clinical parameters were recorded, and serum interleukin (IL)-6 and 8 levels, acute phase reactants, and blood biochemistry were determined serially for both groups. In both groups plasma IL-6 and 8 levels were elevated above the preoperative levels at 2 and 24 hours after declamping. The peak levels were obtained at 2-hour samples. The difference between the two groups in terms of postoperative IL-6 and 8 levels was not statistically significant. C-reactive protein (CRP) levels and polymorphonuclear leukocyte counts, postoperative core temperature, duration of mechanical ventilation, period of stay in intensive care unit, oxygenation indices, and biochemical parameters of patients did not significantly differ in the two groups. Only 1 patient in group 1 had elevated liver enzymes, blood urea nitrogen, and creatinine in the postoperative period. No significant complications were observed due to treatment with high-dose MP. Although postoperative IL and CRP levels indicated a SIR in our patients, the clinical picture was apparently affected in only 1 patient and she was in the high-dose MP group. CPB initiates a SIR that is associated with an increase in neutrophil count, CRP, and IL-6 and 8 levels. High-dose (30 mg/kg) MP was not superior to low-dose (2 mg/kg) in blunting the SIR to CPB in pediatric patients undergoing open-heart surgery.
我们研究的目的是调查大剂量甲基泼尼松龙（MP）在改善体外循环（CPB）引起的全身炎症反应（SIR）方面的安全性和有效性，并将其疗效与接受先天性心脏病心脏手术的儿童中低剂量MP的疗效进行比较。30例接受CPB的先天性心脏病患儿被随机分为两组：第1组（n = 15）在CPB开始前通过静脉输注接受30mg/kg MP，持续30分钟；第2组（n = 15）在CPB开始前静脉接受2mg/kg。记录术后临床参数，并连续测定两组的血清白细胞介素（IL）-6和8水平、急性期反应物及血液生化指标。两组在夹闭后2小时和24小时时血浆IL-6和8水平均高于术前水平。峰值水平在2小时样本中获得。两组术后IL-6和8水平的差异无统计学意义。两组患者的C反应蛋白（CRP）水平、多形核白细胞计数、术后核心体温、机械通气时间、重症监护病房停留时间、氧合指数及生化参数无显著差异。第1组仅1例患者术后肝酶、血尿素氮和肌酐升高。未观察到因大剂量MP治疗引起的显著并发症。尽管术后IL和CRP水平表明我们的患者存在SIR，但临床表现仅在1例患者中受到明显影响，且她属于大剂量MP组。CPB引发了一种SIR，其与中性粒细胞计数、CRP以及IL-6和8水平的升高有关。在接受心脏直视手术的儿科患者中，大剂量（30mg/kg）MP在减轻CPB引起的SIR方面并不优于低剂量（2mg/kg）MP。
