大剂量围手术期皮质类固醇在接受大剂量皮质类固醇治疗的大肠直肠手术患者中的应用：是否必要或过度治疗？
High-dose perioperative corticosteroids in steroid-treated patients undergoing major colorectal surgery: necessary or overkill?
机构信息
Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
出版信息
Am J Surg. 2012 Oct;204(4):481-6. doi: 10.1016/j.amjsurg.2011.09.036. Epub 2012 Jun 29.
BACKGROUND
Steroid-treated patients undergoing major colorectal surgery are routinely treated with high-dose steroids (HDS) to prevent perioperative adrenal insufficiency and cardiovascular collapse. However, there is no evidence to support this practice.
METHODS
A retrospective analysis of 97 consecutive steroid-treated patients with inflammatory bowel disease who underwent major colorectal surgery was performed. The incidence of hemodynamic instability and surgical outcomes were compared in patients treated with perioperative low-dose steroids (LDS) versus HDS.
RESULTS
Forty-three patients were treated with HDS, and 54 patients received LDS. There was no significant difference in hemodynamic instability between HDS-treated (74%) and LDS-treated (78%) patients. No patients required rescue HDS for adrenal insufficiency.
CONCLUSIONS
Steroid-treated patients with inflammatory bowel disease undergoing major colorectal surgery appear to have no clinically significant hemodynamic instability when managed with LDS versus HDS. A prospective study assessing perioperative steroid dosing in patients with inflammatory bowel disease is in progress.
背景
接受大结肠直肠手术的类固醇治疗患者通常接受大剂量类固醇（HDS）治疗，以预防围手术期肾上腺功能不全和心血管崩溃。但是，没有证据支持这种做法。
方法
对 97 例连续接受类固醇治疗的炎症性肠病患者进行了回顾性分析，这些患者接受了大结肠直肠手术。比较了接受围手术期低剂量类固醇（LDS）与 HDS 治疗的患者的血流动力学不稳定和手术结果。
结果
43 例患者接受 HDS 治疗，54 例患者接受 LDS 治疗。HDS 治疗（74％）和 LDS 治疗（78％）患者之间的血流动力学不稳定无显着差异。没有患者因肾上腺功能不全而需要挽救性 HDS。
结论
接受大结肠直肠手术的炎症性肠病类固醇治疗患者在接受 LDS 与 HDS 治疗时似乎没有明显的血流动力学不稳定。目前正在进行一项评估炎症性肠病患者围手术期类固醇剂量的前瞻性研究。
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