Diller Christin N, Hartwell Lauren, Connor Jean A
Dimens Crit Care Nurs. 2022;41(3):151-156. doi: 10.1097/DCC.0000000000000520.
Although a variety of doses and duration of hydrocortisone have been reported as a treatment modality for congenital heart surgery patients with refractory hypotension, there remains a lack of understanding of the clinical use in pediatric cardiac programs.
The aim of this study was to describe the current practice of steroid use for refractory hypotension in postoperative congenital heart surgery patients.
Survey participants were recruited from the Consortium of Congenital Cardiac Care-Measurement of Nursing Practice. The survey focused on 4 areas: diagnosis, intervention, duration of therapy, and clinical decision making. Data were summarized using descriptive statistics.
Among the programs, 24 of 31 (77%) responded, with 21 (95%) using hydrocortisone as a treatment modality. Most, 20 (83%), reported no written clinical guideline for the use of hydrocortisone. Variation in dosing existed as 3 centers (14%) use 50 mg/m2/d, 6 (29%) use 100 mg/m2/d, and 8 (38%) indicated that dosing varies by provider.
Nearly all centers reported using hydrocortisone for the treatment of hypotension refractory to fluid resuscitation and vasoactive medications. Substantial variation in practice exists in areas of diagnosis, dosing, and duration of hydrocortisone. More research is needed to develop a clinical practice guideline to standardize practice.
虽然已有多种氢化可的松剂量和疗程被报道可用于治疗先天性心脏病手术中出现难治性低血压的患者，但儿科心脏治疗方案中的临床应用仍缺乏了解。
本研究旨在描述目前在先天性心脏病手术后患者中使用类固醇治疗难治性低血压的情况。
调查参与者来自先天性心脏护理实践联盟。该调查聚焦于4个领域：诊断、干预、治疗疗程及临床决策。数据采用描述性统计进行总结。
在各治疗方案中，31个方案中有24个（77%）做出回应，其中21个（95%）使用氢化可的松作为治疗方式。多数，即20个（83%）报告没有关于氢化可的松使用的书面临床指南。剂量存在差异，3个中心（14%）使用50mg/m²/天，6个（29%）使用100mg/m²/天，8个（38%）表示剂量因提供者而异。
几乎所有中心都报告使用氢化可的松治疗对液体复苏和血管活性药物难治的低血压。在氢化可的松的诊断、剂量和疗程方面存在很大的实践差异。需要更多研究来制定临床实践指南以规范实践。
