Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
J Thorac Cardiovasc Surg. 2014 Mar;147(3):902-8. doi: 10.1016/j.jtcvs.2013.06.010. Epub 2013 Jul 16.
Neonatal cardiac surgery requiring cardiopulmonary bypass results in a heightened inflammatory response. Perioperative glucocorticoid administration is commonly used in an attempt to reduce the inflammatory cascade, although characterization of the cytokine response to steroids in neonatal cardiac surgery remains elusive because of highly variable approaches in administration. This randomized trial was designed to prospectively evaluate the effect of specific glucocorticoid dosing protocols on inflammatory markers in neonatal cardiac surgery requiring cardiopulmonary bypass.
Neonates scheduled for cardiac surgery were randomly assigned to receive either 2-dose (8 hours preoperatively and operatively, n = 36) or single-dose (operatively, n = 32) methylprednisolone at 30 mg/kg per dose in a prospective double-blind trial. The primary outcome was the effect of these steroid regimens on markers of inflammation. Secondary analyses evaluated the association of specific cytokine profiles with postoperative clinical outcomes.
Patient demographics, perioperative variables, and preoperative indices of inflammation were similar between the single- and 2-dose groups. Preoperative cytokine response after the 2-dose methylprednisolone protocol was consistent with an anti-inflammatory effect, although this did not persist into the postoperative period. Premedication baseline levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor α were predictive of postoperative intensive care unit and hospital length of stay. Only interleukin-8 demonstrated a postoperative response associated with duration of intensive care unit and hospital stay.
The addition of a preoperative dose of methylprednisolone to a standard intraoperative methylprednisolone dose does not improve markers of inflammation after neonatal cardiac surgery. The routine administration of preoperative glucocorticoids in neonatal cardiac surgery should be reconsidered.
需要体外循环的新生儿心脏手术会引起强烈的炎症反应。围手术期给予糖皮质激素常用于减轻炎症级联反应，但由于糖皮质激素给药方式存在高度差异，因此类固醇对新生儿心脏手术中细胞因子反应的特征仍难以捉摸。本随机试验旨在前瞻性评估特定糖皮质激素给药方案对需要体外循环的新生儿心脏手术中炎症标志物的影响。
计划接受心脏手术的新生儿被随机分配接受 2 剂量（术前 8 小时和手术时，n=36）或单剂量（手术时，n=32）甲泼尼龙，剂量为 30mg/kg/剂，在一项前瞻性双盲试验中。主要结局是这些类固醇方案对炎症标志物的影响。二次分析评估了特定细胞因子谱与术后临床结局的关联。
单剂量和 2 剂量组的患者人口统计学、围手术期变量和术前炎症指标相似。2 剂量甲泼尼龙方案后的术前细胞因子反应与抗炎作用一致，尽管这种作用在术后并未持续存在。白细胞介素-6、白细胞介素-8、白细胞介素-10 和肿瘤坏死因子-α的术前药物基线水平预测术后重症监护病房和住院时间。只有白细胞介素-8表现出与重症监护病房和住院时间长短相关的术后反应。
在新生儿心脏手术后，在标准术中甲泼尼龙剂量中添加术前剂量的甲泼尼龙并不能改善炎症标志物。在新生儿心脏手术中常规给予术前糖皮质激素应重新考虑。
