Pesonen E, Keski-Nisula J, Andersson S, Palo R, Salminen J, Suominen P K
Division of Anaesthesiology, Peijas Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Division of Anaesthesiology, Children's Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2016 Nov;60(10):1386-1394. doi: 10.1111/aas.12785. Epub 2016 Sep 7.
Corticosteroids are used in paediatric heart surgery to attenuate systemic inflammatory response. Glycocalyx regulates vascular permeability, shear stress and cell adhesion on the endothelium. Syndecan-1 serves as a biomarker of glycocalyx degradation. Hydrocortisone decreased endothelial glycocalyx degradation in an experimental model. Our hypothesis was that high-dose methylprednisolone decreases glycocalyx degradation as measured by plasma sydecan-1 concentration in children undergoing cardiac surgery.
Two double-blinded, randomized, placebo-controlled trials were conducted. In the first trial ('neonatal trial'), 40 neonates undergoing open heart surgery received either 30 mg/kg intravenous methylprednisolone (n = 20) or placebo (n = 20). In the second trial ('VSD trial'), 45 infants and very young children, undergoing ventricular or atrioventricular septal defect correction received one of the following: 30 mg/kg of methylprednisolone intravenously after anaesthesia induction (n = 15), 30 mg/kg methylprednisolone in the cardiopulmonary bypass prime solution (n = 15) or placebo (n = 15). Plasma syndecan-1 concentrations were measured. Results were expressed both as absolute concentrations and in relative concentrations as multiples of the baseline values of syndecan-1.
There were no statistically significant differences between the neonate trial groups for absolute syndecan-1 concentrations. However, operative administration of methylprednisolone to neonates significantly reduced the relative increases of syndecan-1 at weaning from cardiopulmonary bypass (P = 0.008) and at 6 h post-operatively (P = 0.018). There were no statistically significant differences in absolute or relative increases of syndecan-1 between the VSD trial study groups.
High-dose methylprednisolone reduces shedding of glycocalyx in neonates after complex cardiac surgery but not in older infants after repair of VSD/AVSD with shorter ischaemia times.
皮质类固醇用于小儿心脏手术以减轻全身炎症反应。糖萼调节血管通透性、剪切应力和内皮细胞上的细胞黏附。Syndecan-1作为糖萼降解的生物标志物。在一个实验模型中，氢化可的松减少了内皮糖萼的降解。我们的假设是，高剂量甲泼尼龙可降低心脏手术患儿血浆sydecan-1浓度所测得的糖萼降解。
进行了两项双盲、随机、安慰剂对照试验。在第一项试验（“新生儿试验”）中，40名接受心脏直视手术的新生儿接受30mg/kg静脉注射甲泼尼龙（n = 20）或安慰剂（n = 20）。在第二项试验（“室间隔缺损试验”）中，45名接受室间隔或房室间隔缺损修复的婴儿和幼儿接受以下之一：麻醉诱导后静脉注射30mg/kg甲泼尼龙（n = 15）、体外循环预充液中加入30mg/kg甲泼尼龙（n = 15）或安慰剂（n = 15）。测量血浆syndecan-1浓度。结果以绝对浓度和相对浓度表示，相对浓度以syndecan-1基线值的倍数表示。
新生儿试验组之间syndecan-1绝对浓度无统计学显著差异。然而，对新生儿手术中给予甲泼尼龙显著降低了体外循环撤机时（P = 0.008）和术后6小时（P = 0.018）syndecan-1的相对升高。室间隔缺损试验研究组之间syndecan-1的绝对或相对升高无统计学显著差异。
高剂量甲泼尼龙可减少复杂心脏手术后新生儿糖萼的脱落，但对缺血时间较短的室间隔缺损/房室间隔缺损修复术后的大龄婴儿无效。
