Fudulu Daniel, Lightman Stafford, Caputo Massimo, Angelini Gianni
Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK.
Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Dorothy Hodgkin Building, Bristol, UK.
Indian J Thorac Cardiovasc Surg. 2018 Oct;34(4):483-487. doi: 10.1007/s12055-018-0670-y. Epub 2018 Apr 3.
Steroids in paediatric heart surgery are given prophylactically to blunt the systemic inflammatory response induced by the extracorporeal circuit and to improve clinical outcomes. However, there is an ongoing controversy about the impact of steroids on clinical outcomes after paediatric heart surgery. The hypothalamic-pituitary-adrenal axis is the primary neuroendocrine system activated during the stress of surgery. Relative adrenal insufficiency can accompany paediatric heart surgery; therefore, perioperative steroid supplementation is still administered by some centres. The studies that investigate the hypothalamic-pituitary-adrenal axis physiology during surgery have many limitations, and it is unclear how to define what is adrenal insufficiency. In this review, we focus on discussing the available evidence for steroid use in paediatric cardiac surgery.
小儿心脏手术中预防性使用类固醇可减轻体外循环引起的全身炎症反应并改善临床结局。然而，关于类固醇对小儿心脏手术后临床结局的影响一直存在争议。下丘脑-垂体-肾上腺轴是手术应激期间激活的主要神经内分泌系统。小儿心脏手术可能伴有相对肾上腺功能不全；因此，一些中心仍在围手术期补充类固醇。研究手术期间下丘脑-垂体-肾上腺轴生理学的研究有许多局限性，尚不清楚如何定义肾上腺功能不全。在本综述中，我们重点讨论小儿心脏手术中使用类固醇的现有证据。
