Dreher Molly, Glatz Andrew C, Kennedy Andrea, Rosenthal Tami, Gaynor J William
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
J Extra Corpor Technol. 2015 Sep;47(3):155-9.
Cardiac surgery with the use of cardiopulmonary bypass (CPB) is known to induce an inflammatory response in patients. This response may be even more pronounced in pediatric patients given their small body size compared to adults. Several interventions have been instituted in an effort to attenuate this response, including the use of corticosteroids in the pump prime. However, the clinical effectiveness and potential harmful effects of steroid use have been the source of recent debate. Therefore, our institution made the decision to evaluate the use of methylprednisolone in our CPB prime. This evaluation was performed as a formal quality improvement project at The Children's Hospital of Philadelphia. Methylprednisolone was eliminated from the CPB prime for 6 months. At the end of this time period, The Society of Thoracic Surgeons Congenital Heart Surgery Database was used to evaluate clinical outcomes of patients (n = 222). These outcomes were then compared to patients operated on during the 6 months prior to elimination of methylprednisolone (n = 303). No significant clinical benefit was identified in the group of patients who received methylprednisolone. When compared to the group who did not receive methylprednisolone, significantly more patients in the steroids group had a postoperative wound infection (p = .037) or respiratory failure requiring tracheostomy ( p = .035). No other differences in clinical outcomes were identified between the two groups. No significant differences in clinical outcomes were identified between neonates who received methylprednisolone (n = 55) and neonates who did not receive steroids (n = 58). Due to the lack of clinical benefit seen with its use, as well as its potential contribution to the incidence of wound infection, methylprednisolone continues to be excluded from the CPB prime at our institution. Methylprednisolone is still given intraoperatively at the request of the attending anesthesiologist and on bypass during orthotopic transplant procedures according to institutional protocol.
已知使用体外循环（CPB）进行心脏手术会在患者体内引发炎症反应。与成人相比，儿科患者由于体型较小，这种反应可能更为明显。为了减轻这种反应，已经采取了多种干预措施，包括在预充液中使用皮质类固醇。然而，类固醇使用的临床有效性和潜在有害影响一直是近期争论的焦点。因此，我们机构决定评估在CPB预充液中使用甲泼尼龙的情况。这项评估是在费城儿童医院作为一个正式的质量改进项目进行的。甲泼尼龙从CPB预充液中被停用6个月。在这个时间段结束时，使用胸外科医师协会先天性心脏病手术数据库评估患者（n = 222）的临床结局。然后将这些结局与停用甲泼尼龙前6个月接受手术的患者（n = 303）进行比较。在接受甲泼尼龙的患者组中未发现显著的临床益处。与未接受甲泼尼龙的组相比，使用类固醇的组中术后伤口感染（p = 0.037）或需要气管切开的呼吸衰竭（p = 0.035）的患者明显更多。两组之间在其他临床结局方面未发现差异。接受甲泼尼龙的新生儿（n = 55）和未接受类固醇的新生儿（n = 58）之间在临床结局上未发现显著差异。由于使用甲泼尼龙未显示出临床益处，以及其对伤口感染发生率的潜在影响，甲泼尼龙在我们机构的CPB预充液中仍然被排除。根据机构规程，在原位移植手术中，应主麻醉医师的要求，术中仍会给予甲泼尼龙，且在体外循环期间也会使用。
