Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Penn State Milton S. Hershey Medical Centre, Hershey, PA, USA.
J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2783-2791. doi: 10.1053/j.jvca.2024.07.001. Epub 2024 Jul 5.
Cardiac surgery can be complicated by the development of a systemic inflammatory response syndrome related to cardiopulmonary bypass. This potentially contributes to the occurrence of postoperative morbidity and mortality. Corticosteroids can be used to reduce such inflammation, but the overall balance between potential harm and benefit is unknown and may be age-dependent. The present meta-analysis aims to evaluate the effects of prophylactic corticosteroids in pediatric and non-elderly adult cardiac surgery patients.
Systematic review and meta-analysis of randomized trials.
Cardiac surgery with cardiopulmonary bypass.
Patients younger than 65 years old (pediatric and non-elderly adults).
Perioperative use of corticosteroids versus placebo or standard care.
Two independent investigators searched PubMed, EMBASE and the Cochrane Library from inception to January 20, 2024. The primary outcome was mortality at the longest follow-up available. Secondary outcomes included acute kidney injury, atrial fibrillation, myocardial injury, cerebrovascular events, and infections. Our search strategy identified a total of 17 randomized trials involving 6,598 patients. Mortality was significantly reduced in the corticosteroid group (78/3321 [2.3%] vs. 116/3277 [3.5%]; risk ratio = 0.69; 95% confidence interval, 0.52 to 0.92; P = 0.01; I2 = 0%; NNT = 91). Moreover, the highest postoperative vasoactive inotropic score (VIS) was significantly lower in corticosteroid group (MD: -2.07, 95% CI -3.69 to -0.45, P = 0.01, I2 = 0%). No significant differences in secondary outcomes between the two treatment groups were recorded.
This meta-analysis of randomized trials highlights the potential benefits of corticosteroids on survival in cardiac surgery for patients younger than 65 years old.
体外循环相关的全身炎症反应综合征可能会使心脏手术复杂化。这可能会导致术后发病率和死亡率增加。皮质类固醇可用于减轻这种炎症，但潜在危害与益处之间的总体平衡尚不清楚，并且可能依赖于年龄。本荟萃分析旨在评估预防性皮质类固醇在儿科和非老年成年心脏手术患者中的作用。
随机试验的系统评价和荟萃分析。
体外循环心脏手术。
年龄小于 65 岁的患者（儿科和非老年成年人）。
围手术期使用皮质类固醇与安慰剂或标准护理。
两名独立的调查员从成立之初到 2024 年 1 月 20 日搜索了 PubMed、EMBASE 和 Cochrane 图书馆。主要结局是可获得的最长随访时的死亡率。次要结局包括急性肾损伤、心房颤动、心肌损伤、脑血管事件和感染。我们的搜索策略总共确定了 17 项涉及 6598 名患者的随机试验。皮质类固醇组的死亡率显著降低（78/3321 [2.3%] vs. 116/3277 [3.5%]；风险比=0.69；95%置信区间，0.52 至 0.92；P=0.01；I2=0%；NNH=91）。此外，皮质类固醇组术后最高的血管活性正性肌力评分（VIS）显著降低（MD：-2.07，95%CI-3.69 至-0.45，P=0.01，I2=0%）。两组间次要结局无显著差异。
这项针对随机试验的荟萃分析强调了皮质类固醇在 65 岁以下心脏手术患者生存方面的潜在益处。
