Gastrointestinal Surgery, Chunzhou County Hospital of Huai'an City, Huai'an, China.
Pediatric Surgery, Huai'an Maternal and Child Health Care Hospital, China.
Clin Cardiol. 2023 Jun;46(6):607-614. doi: 10.1002/clc.24018. Epub 2023 Apr 26.
The advantages and disadvantages of using corticosteroids in children undergoing cardiac surgery is still contentious. To examine how perioperative corticosteroids affect postoperative mortality and clinical outcomes in pediatric cardiac surgery with cardiopulmonary bypass (CPB). We used MEDLINE, EMBASE, and the Cochrane Database to conduct a comprehensive search up through January 2023. Children aged 0-18 undergoing cardiac surgery were included in the meta-analysis of randomized controlled studies comparing perioperative corticosteroids with other therapeutic therapies, placebo, or no treatment. All-cause hospital mortality was the primary endpoint of the study. Hospitalization duration was a secondary result. The Cochrane Risk of Bias Assessment Tool was used to evaluate the research quality. Ten trials and 7798 pediatric participants were included in our analysis. Children taking corticosteroids had no significant difference in all-cause in-hospital mortality using a random-effect model with relative risk (RR) = 0.38, 95% confidence interval (CI) = 0.16-0.91, I = 79%, p = .03 for methylprednisolone and RR = 0.29, 95% CI = 0.09-0.97, I = 80%, p = .04. For the secondary outcome, there was a significant difference between the corticosteroid and placebo groups, with pooled standard mean difference (SMD) = -0.86, 95% CI = -1.57 to -0.15, I = 85%, p = .02 for methylprednisolone and SMD = -0.97, 95% CI -1.90 to -0.04, I = 83%, p = .04 for dexamethasone. Perioperative corticosteroids may not improve mortality, but they reduce hospital stay compared to placebo. Further evidence from randomized controlled studies with larger samples is required for approaching at a valid conclusion.
在接受心脏手术的儿童中使用皮质类固醇的优缺点仍存在争议。本研究旨在探讨心脏体外循环（CPB）手术后围手术期皮质类固醇对儿科心脏手术术后死亡率和临床结局的影响。我们使用 MEDLINE、EMBASE 和 Cochrane 数据库对截至 2023 年 1 月的文献进行了全面检索。纳入比较围手术期皮质类固醇与其他治疗方法、安慰剂或无治疗的随机对照研究的meta 分析的儿童年龄为 0-18 岁。研究的主要终点为全因住院死亡率。次要结果为住院时间。采用 Cochrane 偏倚风险评估工具评估研究质量。本研究共纳入 10 项试验和 7798 名儿科参与者。采用随机效应模型，相对风险（RR）=0.38，95%置信区间（CI）=0.16-0.91，I²=79%，p=0.03 时，使用皮质类固醇的儿童全因院内死亡率无显著差异；RR=0.29，95% CI=0.09-0.97，I²=80%，p=0.04 时，甲泼尼龙的 RR 值。对于次要结局，皮质类固醇组和安慰剂组之间存在显著差异，合并标准均数差（SMD）=-0.86，95% CI=-1.57 至-0.15，I²=85%，p=0.02 时，甲泼尼龙的 SMD 值；SMD=-0.97，95% CI=-1.90 至-0.04，I²=83%，p=0.04 时，地塞米松的 SMD 值。与安慰剂相比，围手术期皮质类固醇可能不会降低死亡率，但可缩短住院时间。需要更多来自更大样本量的随机对照研究的证据来得出有效的结论。
