Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy
Efficacy of Methylprednisolone in Preventing Lung Injury Following Pulmonary Thromboendarterectomy
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DOI：
10.1378/chest.10-2639
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发表时间：
2012-01-01
期刊：
影响因子：
9.6
通讯作者：
Fedullo, Peter F.
中科院分区：
文献类型：
--
作者：
Kerr, Kim M.;Auger, William R.;Fedullo, Peter F.
背景资料：我们试图确定的有效性和安全性的围手术期治疗甲基强的松龙对肺血栓endarterectomy.Methods后肺损伤的发展：这是一个随机的，前瞻性的，双盲，安慰剂对照研究的98例慢性血栓栓塞性肺动脉高压的成年患者正在接受肺血栓endarterectomy在一个单一的机构。患者接受安慰剂（n = 47）或甲泼尼龙（n = 51）（心肺转流准备时30 mg/kg，最终循环骤停后静脉推注500 mg，手术后36小时静脉推注250 mg）。主要终点是肺损伤的存在，由两名独立的、盲态的医生使用前瞻性定义的标准确定。次要终点包括无呼吸机、无ICU和无住院天数以及血液和BAL液中细胞因子的选定水平。结果：两个治疗组肺损伤的发生率相似（安慰剂组45%，类固醇组41%; P = 0.72）。治疗组间次要临床终点无统计学差异。与安慰剂相比，甲基强的松龙治疗与血浆IL-6和IL-8的统计学显著降低、血浆IL-10的显著增加以及术后IL-1 ra和IL-6的显著降低相关，但与术后1天获得的BAL液中的IL-8无关。围手术期甲基强的松龙不能降低肺血栓内膜切除术后肺损伤的发生率，尽管其对血浆和灌洗液有不良影响细胞因子水平。胸部2012; 141（1）：27-35
Background: We sought to determine the efficacy and safety of perioperative treatment with methylprednisolone on the development of lung injury after pulmonary thromboendarterectomy.Methods: This was a randomized, prospective, double-blind, placebo-controlled study of 98 adult patients with chronic thromboembolic pulmonary hypertension who were undergoing pulmonary thromboendarterectomy at a single institution. The patients received either placebo (n = 47) or methylprednisolone (n = 51) (30 mg/kg in the cardiopulmonary bypass prime, 500 mg IV bolus following the final circulatory arrest, and 250 mg IV bolus 36 h after surgery). The primary end point was the presence of lung injury as determined by two independent, blinded physicians using prospectively defined criteria. The secondary end points included ventilator-free, ICU-free, and hospital-free days and selected levels of cytokines in the blood and in BAL fluid.Results: The incidence of lung injury was similar in both treatment groups (45% placebo, 41% steroid; P = .72). There were no statistical differences in the secondary clinical end points between treatment groups. Treatment with methylprednisolone, compared with placebo, was associated with a statistically significant reduction in plasma IL-6 and IL-8, a significant increase in plasma IL-10, and a significant reduction in postoperative IL-Ira and IL-6, but not IL-8 in BAL fluid obtained 1 day after surgery.Conclusions: Perioperative methylprednisolone does not reduce the incidence of lung injury following pulmonary thromboendarterectomy surgery despite having an antiinflammatory effect on plasma and lavage cytokine levels. CHEST 2012; 141(1):27-35