Cerfolio Robert J, Bryant Ayesha S, Thurber John S, Bass Cynthia Sales, Lell William A, Bartolucci Alfred A
Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
Ann Thorac Surg. 2003 Oct;76(4):1029-33; discussion 1033-5. doi: 10.1016/s0003-4975(03)00879-8.
Postpneumonectomy pulmonary edema and pneumonia are life threatening and seemingly unavoidable complications after pneumonectomy. We theorized that an intraoperative dose of intravenous steroids (as a prophylactic measure to reduce pulmonary injury to the remaining lung) just before pulmonary artery ligation might decrease this problem.
Seventy-two patients (52 men) who had pneumonectomy during two time periods were studied prospectively. Thirty-five patients received 250 mg of methylprednisolone sodium succinate (Solumedrol; Upjohn, Kalamazoo, MI) just before pulmonary artery ligation (S group) and 37 did not (non-S group). Groups were matched for known or suspected preoperative, intraoperative, and postoperative risk factors for postpneumonectomy pulmonary edema.
The incidence of postpneumonectomy pulmonary edema or adult respiratory distress syndrome was less in the S group (0 of 35, 0% versus 5 of 37, 13.5%, p = 0.049), the overall major complication rate was less in the S group (7 of 35, 20% versus 16 of 37, 43%, p = 0.04), and the length of hospital stay was shorter in the S group (6.1 days versus 11.9 days, p = 0.02). In addition, there were no bronchopleural fistulas in the S group compared with two (both right-sided) in the non-S group.
The intraoperative intravenous administration of 250 mg of methylprednisolone sodium succinate just before pulmonary artery ligation during pneumonectomy may reduce the incidence of postpneumonectomy pulmonary edema and adult respiratory distress syndrome as well as decrease other major complications and shorten the hospital stay. It does not seem to increase the incidence of bronchopleural fistula. Further randomized trials are needed.
肺切除术后肺水肿和肺炎是肺切除术后威胁生命且似乎难以避免的并发症。我们推测在肺动脉结扎前术中给予一剂静脉类固醇（作为减少对剩余肺脏肺损伤的预防措施）可能会减少这一问题。
前瞻性研究了两个时间段内接受肺切除术的72例患者（52例男性）。35例患者在肺动脉结扎前接受250毫克琥珀酸甲泼尼龙（甲强龙；优普强公司，卡拉马祖，密歇根州）（S组），37例未接受（非S组）。两组在已知或疑似肺切除术后肺水肿的术前、术中和术后危险因素方面进行了匹配。
S组肺切除术后肺水肿或成人呼吸窘迫综合征的发生率较低（35例中的0例，0% 对比37例中的5例，13.5%，p = 0.049），S组的总体主要并发症发生率较低（35例中的7例，20% 对比37例中的16例，43%，p = 0.04），S组的住院时间较短（6.1天对比11.9天，p = 0.02）。此外，S组无支气管胸膜瘘，而非S组有2例（均为右侧）。
肺切除术中在肺动脉结扎前静脉给予250毫克琥珀酸甲泼尼龙可能会降低肺切除术后肺水肿和成人呼吸窘迫综合征的发生率，减少其他主要并发症，并缩短住院时间。它似乎不会增加支气管胸膜瘘的发生率。需要进一步的随机试验。
