Soto-Rivera Carmen L, Agus Michael S D, Sawyer Jaclyn E, Macrae Duncan J
1Divisions of Endocrinology and Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Division of Pharmacy, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 3Paediatric Critical Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Pediatr Crit Care Med. 2016 Mar;17(3 Suppl 1):S59-68. doi: 10.1097/PCC.0000000000000625.
To provide an overview of the current literature on the use of hormone replacement therapies in pediatric cardiac critical care.
PubMed, EMBASE, and the Cochrane Library were searched using keywords relevant to the hormonal therapy, with no limits on language but restricting the search to children 0-18 years old.
All clinical studies believed to have relevance were considered. Where studies in children were sparse, additional evidence was sought from adult studies.
All relevant studies were reviewed, and the most relevant data were incorporated in this review.
All authors of this review contributed to the appraisal of the data extracted. Challenges and revisions by the authors were conducted by group e-mail debate.
Glycemic control: although it is likely that some children could benefit, the routine use of tight glycemic control cannot be recommended in children after cardiac surgery. Thyroid hormone replacement: routine use of thyroid hormone replacement to normalize levels after cardiac surgery cannot be recommended on current evidence. Until further evidence from adequately powered studies is available, therapeutic decisions should be based on individual patient circumstances. Corticosteroids: 1) cardiopulmonary bypass: although studies seem to favor steroid administration during surgery with cardiopulmonary bypass, a large randomized controlled trial is required before strong recommendations can be made; 2) refractory hypotension: the evidence for the use of steroid replacement in refractory hypotension is poor, and no firm recommendations can be made; and 3) abnormal adrenal function after cardiac surgery: there is inadequate evidence on which to make recommendations on the use of corticosteroid replacement in children with critical illness-related corticosteroid insufficiency in children following cardiac surgery.
概述目前关于激素替代疗法在小儿心脏重症监护中应用的文献。
使用与激素治疗相关的关键词检索了PubMed、EMBASE和Cochrane图书馆，不限语言，但检索范围限于0至18岁的儿童。
考虑所有被认为相关的临床研究。在儿童研究较少的情况下，从成人研究中寻求额外证据。
对所有相关研究进行综述，并将最相关的数据纳入本综述。
本综述的所有作者都参与了对提取数据的评估。作者之间的质疑和修订通过小组电子邮件辩论进行。
血糖控制：虽然一些儿童可能会受益，但不建议在心脏手术后的儿童中常规使用严格的血糖控制。甲状腺激素替代：根据目前的证据，不建议常规使用甲状腺激素替代来使心脏手术后的甲状腺水平恢复正常。在获得来自足够大规模研究的进一步证据之前，治疗决策应基于个体患者的情况。皮质类固醇：1）体外循环：虽然研究似乎倾向于在体外循环手术期间给予类固醇，但在能够做出强有力的推荐之前，需要进行一项大型随机对照试验；2）难治性低血压：在难治性低血压中使用类固醇替代的证据不足，无法做出明确推荐；3）心脏手术后肾上腺功能异常：对于在心脏手术后患有危重病相关皮质类固醇功能不全的儿童中使用皮质类固醇替代治疗，尚无足够证据来做出推荐。
