van Osch Dirk, Dieleman Jan M, Nathoe Hendrik M, Boasson Marc P, Kluin Jolanda, Bunge Jeroen J H, Nierich Arno P, Rosseel Peter M, van der Maaten Joost M, Hofland Jan, Diephuis Jan C, de Lange Fellery, Boer Christa, van Dijk Diederik
Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, Netherlands.
Ann Thorac Surg. 2015 Dec;100(6):2237-42. doi: 10.1016/j.athoracsur.2015.06.025. Epub 2015 Aug 25.
Cardiac surgery with the use of cardiopulmonary bypass is associated with a systemic inflammatory response. Intraoperative corticosteroids are administered to attenuate this inflammatory response. The recent Dexamethasone for Cardiac Surgery (DECS) trial could not demonstrate a beneficial effect of dexamethasone on major adverse events in cardiac surgical patients. Previous studies suggest that corticosteroids may affect postoperative coagulation and blood loss, and therefore could influence the risk of surgical reinterventions. We investigated the effects of prophylactic intraoperative dexamethasone treatment on the rate of rethoracotomy after cardiac surgery.
We performed a post-hoc additional data collection and analysis in the DECS trial. A total of 4,494 adult patients undergoing cardiac surgery with cardiopulmonary bypass were randomly assigned to intravenous dexamethasone (1.0 mg/kg) or placebo. The primary endpoint for the present study was the incidence of any rethoracotomy within the first 30 postoperative days. Secondary endpoints included the reason for rethoracotomy and the incidence of perioperative transfusion of blood products.
In the dexamethasone group, 217 patients (9.7%) underwent a rethoracotomy, and in the placebo group, 165 patients did (7.3%; relative risk 1.32, 95% confidence interval: 1.09 to 1.61, p = 0.005). The most common reason for rethoracotomy was tamponade in both groups: 3.9% versus 2.1%, respectively (relative risk 1.84, 95% confidence interval: 1.30 to 2.61, p < 0.001).
Intraoperative high-dose dexamethasone administration in cardiac surgery was associated with an increased rethoracotomy risk.
使用体外循环的心脏手术会引发全身炎症反应。术中使用皮质类固醇以减轻这种炎症反应。近期的心脏手术地塞米松（DECS）试验未能证明地塞米松对心脏手术患者的主要不良事件有有益影响。先前的研究表明，皮质类固醇可能会影响术后凝血和失血，因此可能会影响手术再次干预的风险。我们研究了术中预防性使用地塞米松治疗对心脏手术后再次开胸率的影响。
我们在DECS试验中进行了事后额外的数据收集和分析。共有4494例接受体外循环心脏手术的成年患者被随机分配至静脉注射地塞米松（1.0mg/kg）或安慰剂组。本研究的主要终点是术后30天内任何再次开胸的发生率。次要终点包括再次开胸的原因和围手术期血液制品输注的发生率。
地塞米松组有217例患者（9.7%）进行了再次开胸，安慰剂组有165例患者（7.3%）进行了再次开胸；相对风险为1.32，95%置信区间：1.09至1.61，p = 0.005。两组再次开胸最常见的原因均为心包填塞：分别为3.9%和2.1%（相对风险1.84，95%置信区间：1.30至2.61，p < 0.001）。
心脏手术中术中给予高剂量地塞米松与再次开胸风险增加相关。
