Verweij E J, Hogenbirk Karin, Roest Arno A W, van Brempt Ronald, Hazekamp Mark G, de Jonge Evert
Pediatric Intensive Care Unit, LUMC, Leiden, Netherlands.
Interact Cardiovasc Thorac Surg. 2012 Oct;15(4):685-9. doi: 10.1093/icvts/ivs292. Epub 2012 Jul 3.
Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency.
A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of <100 nmol/l and patients with a serum total cortisol of ≥ 100 nmol/l.
A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (<100 nmol/l) and 30 were assigned to Group 2 (≥ 100 nmol/l). Haemodynamics improved after hydrocortisone administration, with an increase in blood pressure, a decrease in administered vasopressors and inotropic drugs, an increase in urine production and a decrease in plasma lactate concentrations.
The effects of treatment with hydrocortisone in children with low cardiac output after cardiac surgery was similar in patients with a low baseline serum cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.
低心排血量综合征在小儿心脏手术后很常见。既往研究表明，对于危重症患儿难治性低心排血量综合征，给予氢化可的松可能改善血流动力学稳定性。本研究旨在验证以下假设：氢化可的松对低心排血量综合征患儿血流动力学的影响取决于（相对）肾上腺功能不全的存在。
对2005年11月1日至2008年12月31日期间小儿心脏手术后被诊断为难治性低心排血量综合征并接受氢化可的松治疗的患儿进行回顾性研究。我们研究了肾上腺功能不全（定义为总皮质醇的探索性临界值<100 nmol/l）患者与血清总皮质醇≥100 nmol/l患者之间氢化可的松治疗效果的差异。
共纳入62例符合低心排血量综合征纳入标准的患者。32例患者被分配到第1组（<100 nmol/l），30例被分配到第2组（≥100 nmol/l）。给予氢化可的松后血流动力学改善，表现为血压升高、血管升压药和正性肌力药物用量减少、尿量增加以及血浆乳酸浓度降低。
心脏手术后低心排血量患儿中，基线血清皮质醇浓度低的患者与基线皮质醇水平正常的患者使用氢化可的松治疗的效果相似。不应将肾上腺功能不全时皮质醇值100 nmol/l的探索性临界值用作这些患者使用氢化可的松治疗的标准。
