Soltani Ghasem, Abbasi Tashnizi Mohammad, Moeinipour Ali Asghar, Ganjifard Mahmoud, Esfahanizadeh Jamil, Sepehri Shamloo Alireza, Purafzali Firuzabadi Seyed Javad, Zirak Nahid
Department of Anesthesiology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Iran Red Crescent Med J. 2013 Jun;15(6):483-7. doi: 10.5812/ircmj.8105. Epub 2013 Jun 5.
Cardiac surgery under Cardiopulmonary bypass causes a systemic inflammatory response with a multifactorial etiology including direct tissue damage, ischemia and stimulation of immune system induced by cardiopulmonary bypass. This study was designed due to the high prevalence and complications of this stimulated immune system in mortality, morbidity, length of ICU stay, and mechanical ventilation.
This study was aimed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome.
Sixty pediatric patients (age < 5years) undergoing cardiopulmonary bypass surgery between September 2011-2012 at Imam Reza hospital-Mashhad were randomly assigned to receive preoperative and intraoperative MP (group 1: 30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative temperature (peak temperature and average temperature during the first 24 hours), amount of inotropic, duration of mechanical ventilation, ICU stay, WBC, BUN, creatinine, and CRP were recorded and compared in both groups. Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if necessary, and Chi-squared distribution.
Patient characteristics including age, weight, gender, and duration of bypass were almost similar in both groups (P > 0.05). No significant difference in amount of inotropic medications used for hemodynamic supports, duration of mechanical ventilation, peak and average temperature and length of ICU stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP) only WBC counts raised more in group 2 when compared to group 1(P < 0.05).
There was no difference in clinical outcome after cardiac surgery when we administered an additional dose of methylprednisolone compared to a single dose of methylprednisolone.
体外循环下心脏手术会引发全身炎症反应，其病因多方面，包括直接组织损伤、缺血以及体外循环诱导的免疫系统刺激。鉴于这种受刺激的免疫系统在死亡率、发病率、重症监护病房（ICU）住院时间和机械通气方面的高发生率及并发症，开展了本研究。
本研究旨在比较术前及术中使用甲泼尼龙（MP）与仅术中使用MP在体外循环后炎症及临床结局方面的差异。
2011年9月至2012年期间，在马什哈德伊玛目礼萨医院接受体外循环手术的60例儿科患者（年龄<5岁）被随机分为两组，一组接受术前及术中MP（第1组：30mg/kg，体外循环前4小时及体外循环预充液中给药，n = 30），另一组仅术中使用MP（第2组：30mg/kg，n = 30）。记录并比较两组患者术后体温（最高体温及术后24小时平均体温）、血管活性药物用量、机械通气时间、ICU住院时间、白细胞计数（WBC）、血尿素氮（BUN）、肌酐及C反应蛋白（CRP）。必要时，采用SPSS 13.0软件，通过t检验、曼-惠特尼检验及卡方分布对数据进行分析。
两组患者的年龄、体重、性别及体外循环时间等患者特征基本相似（P>0.05）。在用于血流动力学支持的血管活性药物用量、机械通气时间、最高及平均体温以及ICU住院时间方面，未观察到显著差异。在实验室检查（WBC、BUN、肌酐、CRP）中，与第1组相比，仅第2组的白细胞计数升高更明显（P<0.05）。
与单剂量甲泼尼龙相比，额外给予一剂甲泼尼龙后心脏手术后的临床结局并无差异。
