Department of Pediatrics, Baylor College of Medicine, Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas.
Department of Pediatrics, Baylor College of Medicine, Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas.
Ann Thorac Surg. 2021 Oct;112(4):1363-1370. doi: 10.1016/j.athoracsur.2020.09.062. Epub 2020 Dec 9.
Corticosteroids suppress the inflammatory response to cardiopulmonary bypass in children undergoing cardiac surgery. What is less clear is the impact of corticosteroids on the postoperative course.
A systematic review and meta-analysis was made of prospective randomized blinded placebo-controlled trials of pediatric patients who received corticosteroids or saline placebo before surgery was performed. Ten studies met inclusion criteria for a total of 768 patients. In a prespecified subgroup analysis, studies that either were limited to The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery congenital heart surgery mortality categories 1 and 2 or excluded neonates were eliminated and a secondary analysis was conducted, which consisted of seven studies and 555 patients.
Corticosteroids were associated with a significant improvement in fluid balance at 24 and 36 hours after surgery, with a mean difference of -15.2 mL/kg (95% confidence interval, 25.3 to -5.1 mL/kg; P < .01) and -5.7 mL/kg (95% confidence interval, -9.8 to -1.6 mL/kg; P < .01), respectively. Corticosteroids had no impact on the incidence of infection or mortality. With the secondary analysis, corticosteroids were associated with a trend toward significance in shortening the duration of mechanical ventilation (mean difference -0.7 days; 95% confidence interval, -1.7 to 0.1; P = .08).
Corticosteroids were found to have a favorable impact on postoperative fluid balance and may be associated with shortening the duration of mechanical ventilation. Although corticosteroids had no impact on mortality, they may be beneficial particularly for neonates and patients undergoing highly complex surgery.
皮质类固醇可抑制儿童心脏手术体外循环中的炎症反应。皮质类固醇对术后过程的影响尚不清楚。
对接受皮质类固醇或生理盐水安慰剂的儿科患者进行了手术前的前瞻性随机双盲安慰剂对照试验进行了系统评价和荟萃分析。有十项研究符合共 768 名患者的纳入标准。在预先指定的亚组分析中，排除了仅限于胸外科医师学会-欧洲心血管外科学会先天性心脏病手术死亡率 1 类和 2 类的研究或排除新生儿的研究，并进行了二次分析，其中包括七项研究和 555 名患者。
皮质类固醇与术后 24 小时和 36 小时的液体平衡有显著改善，平均差异为-15.2 mL/kg（95％置信区间，25.3 至-5.1 mL/kg；P<.01）和-5.7 mL/kg（95％置信区间，-9.8 至-1.6 mL/kg； P<.01）。皮质类固醇对感染或死亡率没有影响。在二次分析中，皮质类固醇与机械通气时间缩短有显著趋势（平均差异-0.7 天；95％置信区间，-1.7 至 0.1； P=0.08）。
皮质类固醇对术后液体平衡有有利影响，并且可能与缩短机械通气时间有关。尽管皮质类固醇对死亡率没有影响，但对于新生儿和接受高度复杂手术的患者，皮质类固醇可能是有益的。
