Suominen Pertti K, Dickerson Heather A, Moffett Brady S, Ranta Seppo O, Mott Antonio R, Price Jack F, Heinle Jeffrey S, McKenzie E Dean, Fraser Charles D, Chang Anthony C
Department of Anaesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Pediatr Crit Care Med. 2005 Nov;6(6):655-9. doi: 10.1097/01.pcc.0000185487.69215.29.
To assess the hemodynamic effects and safety of hydrocortisone in neonates with low cardiac output syndrome requiring high levels of inotropic support and fluid resuscitation after cardiac surgery.
Retrospective chart review.
Fifteen-bed pediatric cardiovascular intensive care unit.
Twelve neonates with low cardiac output syndrome after cardiac surgery to whom hydrocortisone was administered according to one of two dosing regimens (100 mg/[m.day] for 2 days, 50 mg/[m.day] for 2 days, and 25 mg/[m.day] for 1 day or 100 mg/[m.day] for 1 day, 50 mg/[m.day] for 2 days, and 25 mg/[m.day] for 2 days) were identified from the Department of Pharmacy database between September 2002 and January 2004.
None.
The mean and systolic blood pressure increased significantly 3 hrs after hydrocortisone treatment from the values preceding hydrocortisone administration. The mean blood pressure increased from 44.0+/-3.0 to 55.4+/-2.3 mm Hg (p=.01) and the systolic blood pressure increased from 64.2+/-4.7 to 78.3+/-3.4 mm Hg (p=.04). Comparable beneficial changes were also seen in the heart rate, which decreased from 168.3+/-4.6 to 148.3+/-5.6 beats/min (p=.004) after 24 hrs of hydrocortisone administration and remained at this level during the 72 hrs of follow-up. Significant weaning of epinephrine infusions was possible, from a mean dose of 0.16 to 0.06 microg/(kg.min) (p=.008), within 24 hrs after the initiation of steroid administration, and this reduction was not offset by increases in other inotropic agents. hydrocortisone administration caused nonsignificant increases in mean blood glucose concentration (from 116.2+/-20.6 to 156.0+/-25.6 mg/dL; p=.64), mean white blood cell count (from 16.6+/-1.6 to 18.9+/-2.6 x 10 U/L; p=.35), and sodium level (from 144.7+/-1.3 to 145.3+/-1.3 mmol/L; p=.51). Ten of the 12 patients (83.3%) survived.
Most of the hemodynamically compromised neonates who were unresponsive to high doses of inotropic agents and fluid resuscitation after heart surgery responded to hydrocortisone with improvement of hemodynamic parameters and a decrease in inotropic requirements.
评估氢化可的松对心脏手术后需要高剂量血管活性药物支持及液体复苏的低心排血量综合征新生儿的血流动力学影响及安全性。
回顾性病历审查。
拥有15张床位的儿科心血管重症监护病房。
2002年9月至2004年1月期间，从药房数据库中识别出12例心脏手术后出现低心排血量综合征的新生儿，这些新生儿接受了两种给药方案之一的氢化可的松治疗（2天内每日100mg/[m²·天]，2天内每日50mg/[m²·天]，1天内每日25mg/[m²·天]；或1天内每日100mg/[m²·天]，2天内每日50mg/[m²·天]，2天内每日25mg/[m²·天]）。
无。
氢化可的松治疗3小时后，平均血压和收缩压较给药前显著升高。平均血压从44.0±3.0mmHg升至55.4±2.3mmHg（p = 0.01），收缩压从64.2±4.7mmHg升至78.3±3.4mmHg（p = 0.04）。心率也出现了类似的有益变化，氢化可的松给药24小时后，心率从168.3±4.6次/分钟降至148.3±5.6次/分钟（p = 0.004），并在后续72小时内维持在该水平。在开始使用类固醇药物后的24小时内，肾上腺素输注量显著减少，平均剂量从0.16降至0.06μg/(kg·min)（p = 0.008），且这种减少并未被其他血管活性药物用量的增加所抵消。氢化可的松给药导致平均血糖浓度（从116.2±20.6mg/dL升至156.0±25.6mg/dL；p = 0.64）、平均白细胞计数（从16.6±1.6升至18.9±2.6×10⁹/L；p = 0.35）和钠水平（从144.7±1.3mmol/L升至145.3±1.3mmol/L；p = 0.51）出现非显著性升高。12例患者中有10例（83.3%）存活。
大多数心脏手术后对高剂量血管活性药物和液体复苏无反应的血流动力学受损新生儿对氢化可的松有反应，血流动力学参数得到改善，血管活性药物需求减少。
