Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1542-1547. doi: 10.1053/j.jvca.2019.10.015. Epub 2019 Oct 18.
Corticosteroids attenuate an inflammatory reaction in pediatric heart surgery. Inflammation is a source of free oxygen radicals. Children with a cyanotic heart defect are prone to increased radical stress during heart surgery. The authors hypothesized that high-dose methylprednisolone reduces inflammatory reaction and thereby also oxidative stress in infants with a univentricular heart defect undergoing the bidirectional Glenn procedure.
A double-blind, placebo-controlled, randomized clinical trial.
Operating room and pediatric intensive care unit of a university hospital.
The study comprised 29 infants undergoing the bidirectional Glenn procedure with or without aortic arch or pulmonary arterial repair.
After anesthesia induction, the patients received intravenously either 30 mg/kg of methylprednisolone (n = 15) or the same volume of saline as placebo (n = 14).
Plasma interleukin-6, interleukin-8, interleukin-10 (biomarkers of inflammation), and 8-hydroxydeoxyguanosine concentrations (a biomarker of oxidative stress) were measured at the following 4 time points: preoperatively, during cardiopulmonary bypass, after protamine administration, and 6 hours postoperatively. The study parameters did not differ between the study groups preoperatively. Methylprednisolone reduced the proinflammatory cytokines interleukin-6 and interleukin-8 and increased the anti-inflammatory cytokine interleukin-10 postoperatively. Despite reduced inflammation, there were no differences in 8-hydroxydeoxyguanosine between the methylprednisolone and placebo groups.
The proinflammatory reaction and increase in free radical stress were not interrelated during congenital heart surgery in cyanotic infants with a univentricular heart defect undergoing the bidirectional Glenn procedure. High-dose methylprednisolone was ineffective in attenuating free radical stress.
皮质类固醇可减轻儿科心脏手术中的炎症反应。炎症是自由基的来源。患有紫绀性心脏缺陷的儿童在心脏手术期间容易受到自由基应激的增加。作者假设，大剂量甲基强的松龙可减少炎症反应，从而减轻接受双向 Glenn 手术的单心室心脏缺陷婴儿的氧化应激。
双盲、安慰剂对照、随机临床试验。
大学医院的手术室和儿科重症监护病房。
该研究包括 29 名接受双向 Glenn 手术的婴儿，其中包括或不包括主动脉弓或肺动脉修复。
麻醉诱导后，患者静脉内给予 30mg/kg 的甲基强的松龙（n=15）或相同体积的生理盐水作为安慰剂（n=14）。
在以下 4 个时间点测量血浆白细胞介素-6、白细胞介素-8、白细胞介素-10（炎症标志物）和 8-羟基脱氧鸟苷浓度（氧化应激标志物）：术前、体外循环期间、鱼精蛋白给药后和术后 6 小时。研究组在术前无差异。甲基强的松龙降低了术后促炎细胞因子白细胞介素-6 和白细胞介素-8，并增加了抗炎细胞因子白细胞介素-10。尽管炎症减轻，但甲基强的松龙和安慰剂组之间的 8-羟基脱氧鸟苷无差异。
在接受双向 Glenn 手术的紫绀性单心室心脏缺陷婴儿的先天性心脏手术中，促炎反应和自由基应激增加之间没有相关性。大剂量甲基强的松龙在减轻自由基应激方面无效。
