Thompson Elizabeth J, Foote Henry P, King Caitlin E, Srinivasan Sabarish, Ciociola Elizabeth C, Leung Dennis, Rotta Alexandre T, Hill Kevin D, Cohen-Wolkowiez Michael, Hornik Christoph P
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Cardiol Young. 2021 May;31(5):707-733. doi: 10.1017/S1047951121001463. Epub 2021 Apr 19.
Targeted drug development efforts in patients with CHD are needed to standardise care, improve outcomes, and limit adverse events in the post-operative period. To identify major gaps in knowledge that can be addressed by drug development efforts and provide a rationale for current clinical practice, this review evaluates the evidence behind the most common medication classes used in the post-operative care of children with CHD undergoing cardiac surgery with cardiopulmonary bypass.
We systematically searched PubMed and EMBASE from 2000 to 2019 using a controlled vocabulary and keywords related to diuretics, vasoactives, sedatives, analgesics, pulmonary vasodilators, coagulation system medications, antiarrhythmics, steroids, and other endocrine drugs. We included studies of drugs given post-operatively to children with CHD undergoing repair or palliation with cardiopulmonary bypass.
We identified a total of 127 studies with 51,573 total children across medication classes. Most studies were retrospective cohorts at single centres. There is significant age- and disease-related variability in drug disposition, efficacy, and safety.
In this study, we discovered major gaps in knowledge for each medication class and identified areas for future research. Advances in data collection through electronic health records, novel trial methods, and collaboration can aid drug development efforts in standardising care, improving outcomes, and limiting adverse events in the post-operative period.
冠心病患者需要有针对性的药物研发工作，以规范治疗、改善预后并减少术后不良事件。为了找出药物研发工作可解决的主要知识空白，并为当前临床实践提供理论依据，本综述评估了在接受体外循环心脏手术的先天性心脏病患儿术后护理中使用的最常见药物类别背后的证据。
我们使用与利尿剂、血管活性药物、镇静剂、镇痛药、肺血管扩张剂、凝血系统药物、抗心律失常药、类固醇及其他内分泌药物相关的控制词汇和关键词，对2000年至2019年期间的PubMed和EMBASE进行了系统检索。我们纳入了对接受体外循环修复或姑息治疗的先天性心脏病患儿术后给予药物的研究。
我们共识别出127项研究，涉及各类药物的总计51573名儿童。大多数研究是单中心的回顾性队列研究。在药物处置、疗效和安全性方面存在显著的年龄和疾病相关变异性。
在本研究中，我们发现了各类药物在知识方面的主要空白，并确定了未来研究的领域。通过电子健康记录、新型试验方法和合作在数据收集方面取得的进展，有助于药物研发工作在规范治疗、改善预后和减少术后不良事件方面发挥作用。
