The Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2011 Apr;91(4):1222-7. doi: 10.1016/j.athoracsur.2010.11.005.
Corticosteroids are commonly administered perioperatively in pediatric cardiac surgery to reduce cardiopulmonary bypass induced inflammation. However, their effects on outcomes and potential for adverse events are not well defined.
A review was undertaken of cardiac operations between September 2004 and December 2007 carrying a comprehensive Aristotle score 10 or greater. A nonrandomized comparison was undertaken comparing those patients having received intraoperative methylprednisolone at anesthesia induction or in the bypass circuit prime with those who did not. To account for nonrandom assignment of steroid use, a propensity model was created to establish each patient's probability of having received steroids (∼150 variables evaluated, 17 in final model, c-stat 0.94, p < 0.001). Associations between postoperative outcomes and intraoperative steroid use were modeled in multivariable linear regression models adjusted for propensity score and relevant surgical characteristics.
In 221 identified cases, 134 (61%) patients received intraoperative steroids; of these, 44 (33%) also received preoperative doses. In propensity-adjusted regression models, intraoperative steroid use was associated with lower chest tube volume loss in the first 24 postoperative hours (-5.3 mL/kg, p < 0.001), and shorter durations of stay in intensive care (-2.3 days, p < 0.001) and hospital (-4.1 days, p < 0.001). Use of an additional preoperative dose resulted in further improvements, especially a reduction in duration of mechanical ventilation (-1.7 days versus no steroids, -1.2 days versus intraoperative steroids only, p = 0.002). Steroids were not associated with increased postoperative lactate, creatinine, or glucose levels, or odds of infection.
Intraoperative steroid use is associated with improved postoperative outcomes for children undergoing high-risk cardiac surgery, with further benefits associated with a preoperative dose.
在小儿心脏手术中，皮质类固醇通常在围手术期使用，以减少体外循环引起的炎症。然而，它们对结果的影响和发生不良事件的可能性尚不清楚。
回顾了 2004 年 9 月至 2007 年 12 月期间进行的心脏手术，这些手术的综合 Aristotle 评分均大于或等于 10 分。采用非随机比较方法，比较接受术中麻醉诱导或体外循环预充甲基泼尼松龙的患者与未接受者。为了说明类固醇使用的非随机分配，建立了一个倾向模型来确定每位患者接受类固醇的可能性（评估了约 150 个变量，最终模型中有 17 个，C 统计量为 0.94，p<0.001）。在调整了倾向评分和相关手术特征的多变量线性回归模型中，对术后结局与术中类固醇使用之间的关系进行了建模。
在 221 例确定的病例中，134 例（61%）患者接受了术中类固醇治疗；其中 44 例（33%）还接受了术前剂量。在调整后的倾向评分回归模型中，术中类固醇使用与术后 24 小时内胸腔引流管失血量减少（-5.3 毫升/公斤，p<0.001）和重症监护室（-2.3 天，p<0.001）和住院时间缩短（-4.1 天，p<0.001）相关。使用额外的术前剂量可进一步改善结果，尤其是减少机械通气时间（与无类固醇相比，-1.7 天；与仅术中类固醇相比，-1.2 天，p=0.002）。类固醇与术后乳酸、肌酐或葡萄糖水平升高或感染几率无关。
在接受高危心脏手术的儿童中，术中使用类固醇与术后结果改善相关，术前剂量可带来额外的益处。
