Keski-Nisula Juho, Suominen Pertti K, Olkkola Klaus T, Peltola Kaija, Neuvonen Pertti J, Tynkkynen Paula, Salminen Jukka T, Andersson Sture, Pesonen Eero
Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland.
Ann Thorac Surg. 2015 Jan;99(1):180-5. doi: 10.1016/j.athoracsur.2014.08.042. Epub 2014 Nov 18.
We compared the antiinflammatory and cardioprotective effects of the two most common regimens of corticosteroid administration in pediatric cardiac surgical procedures: a single dose delivered either at anesthesia induction or by cardiopulmonary bypass (CPB) prime.
Forty-five children, aged between 1 and 18 months and undergoing ventricular septal or atrioventricular septal defect correction, were randomized in double-blind fashion into three groups. The anesthesia induction group received 30 mg/kg methylprednisolone intravenously after anesthesia induction, and the CPB-prime group received 30 mg/kg methylprednisolone by CPB circuit. The placebo group received saline solution. Plasma concentrations of methylprednisolone, interleukin (IL)-6, IL-8 and IL-10, and troponin were measured at anesthesia induction before the study drug, 30 minutes on CPB, after patients were weaned from CPB, and 6 hours after cessation of CPB.
Equally high methylprednisolone concentrations were detected in both methylprednisolone groups, but the measured peak concentration occurred earlier in the induction group. Significantly lower IL-8 concentrations were observed just after patients were weaned from and 6 hours after CPB in the anesthesia induction group compared with the placebo (p = 0.002, p = 0.001) and prime groups (p = 0.003, p = 0.006). Significant reductions of troponin were detected in both methylprednisolone groups compared with placebo (induction, p = 0.001; prime, p = 0.002) 6 hours after patients were weaned from CPB.
Methylprednisolone administration at anesthesia induction was superior in terms of antiinflammatory action. Methylprednisolone administration in CPB-prime only a few minutes before aortic cross-clamping and cardioplegia resulted in mean troponin reductions similar to those of administration at anesthesia induction. Corticosteroids may have direct cardioprotective properties, as reported in experimental studies.
我们比较了儿科心脏手术中两种最常用的皮质类固醇给药方案的抗炎和心脏保护作用：在麻醉诱导时或通过体外循环（CPB）预充液给予单剂量。
45名年龄在1至18个月之间、接受室间隔或房室间隔缺损矫正手术的儿童，以双盲方式随机分为三组。麻醉诱导组在麻醉诱导后静脉注射30mg/kg甲泼尼龙，CPB预充液组通过CPB回路给予30mg/kg甲泼尼龙。安慰剂组接受生理盐水。在研究药物给药前的麻醉诱导时、CPB进行30分钟时、患者脱离CPB后以及CPB停止6小时后，测量血浆中甲泼尼龙、白细胞介素（IL）-6、IL-8和IL-10以及肌钙蛋白的浓度。
在两个甲泼尼龙组中均检测到同样高的甲泼尼龙浓度，但诱导组中测得的峰值浓度出现得更早。与安慰剂组（p = 0.002，p = 0.001）和预充液组（p = 0.003，p = 0.006）相比，麻醉诱导组患者在脱离CPB后即刻及CPB后6小时观察到IL-8浓度显著降低。与安慰剂组相比，两个甲泼尼龙组在患者脱离CPB 6小时后均检测到肌钙蛋白显著降低（诱导组，p = 0.001；预充液组，p = 0.002）。
在抗炎作用方面，麻醉诱导时给予甲泼尼龙更具优势。在主动脉阻断和心脏停搏前几分钟通过CPB预充液给予甲泼尼龙导致的肌钙蛋白降低均值与麻醉诱导时给药相似。如实验研究报道，皮质类固醇可能具有直接的心脏保护特性。
