Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression
Combined steroid treatment for congenital heart surgery improves oxygen delivery and reduces postbypass inflammatory mediator expression
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DOI：
10.1161/01.cir.0000070955.55636.25
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发表时间：
2003-06-10
期刊：
影响因子：
37.8
通讯作者：
Nelson, DP
中科院分区：
文献类型：
--
作者：
Schroeder, VA;Pearl, JM;Nelson, DP
背景-体外循环期间使用类固醇被认为可以通过调节与旁路相关的炎症来改善心肺功能。本研究旨在比较术前和术中甲基强的松龙（MP）与术中单独使用MP对旁路术后炎症和临床结局的影响。方法和结果：29例接受旁路手术的儿科患者被随机分配接受术前和术中MP（旁路前4小时和旁路预充时30 mg/kg，n = 14）或仅术中MP（30 mg/kg，n = 15）。通过核糖核酸酶保护法测定配对心房活检（旁路手术前后）中心肌炎症介质mRNA的表达。采用酶联免疫吸附法（ELISA）检测转流前后血清IL-6、IL-10水平。术后结果通过插管时间、CICU住院时间、液体平衡、动静脉氧分压差（DeltaA-VO 2）和正性肌力药需求进行评估。与术中单独使用MP相比，术前和术中联合使用MP可降低转流前后心肌IL-6、MCP-1和ICAM-1的mRNA表达（P < 0.05）。接受联合类固醇治疗的患者在转流结束时血清IL-6较低，IL-10升高（P < 0.05），尽管24小时的差异可以忽略不计。联合MP治疗与术后前24小时的液体需求减少、体温降低和Δ A-VO 2降低相关（P < 0.05），沿着其他临床结果的改善趋势。结论-与术中类固醇治疗相比，术前和术中联合应用类固醇可以更有效地减少炎症介质的表达，并与O-2例先天性心脏病手术后24小时内分娩。这些发现需要在更大规模的多中心试验中得到证实。
Background-Steroid administration during cardiopulmonary bypass is thought to improve cardiopulmonary function by modulating bypass-related inflammation. This study was designed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome.Methods and Results-Twenty-nine pediatric patients undergoing bypass procedures were randomly assigned to receive preoperative and intraoperative MP (30 mg/kg 4 hours before bypass and in bypass prime, n = 14) or intraoperative MP only (30 mg/kg, n = 15). Myocardial inflammatory mediator mRNA expression was determined in paired atrial biopsies (before and after bypass) by ribonuclease protection. Before and after bypass, serum IL-6 and IL-10 were measured by ELISA. Postoperative outcome was assessed by intubation time, CICU length of stay, fluid balance, arterio-venous O-2 difference (DeltaA-VO2), and inotrope requirements. Compared with intraoperative MP alone, combined preoperative and intraoperative MP was associated with reduced myocardial mRNA expression for IL-6, MCP-1, and ICAM-1 both before and after bypass (P < 0.05). Patients who received combined steroids had lower serum IL-6 and increased IL-10 at end-bypass (P < 0.05), although differences were negligible by 24 hours. Combined MP treatment was associated with reduced fluid requirements, lower body temperature, and lower DeltaA-VO2 for the first 24 hours after surgery (P < 0.05), along with trends toward improvement in other clinical outcomes.Conclusions-Compared with intraoperative steroid treatment, combined preoperative and intraoperative steroid administration attenuates inflammatory mediator expression more effectively and is associated with improved indexes of O-2 delivery in the first 24 hours after congenital heart surgery. These findings need to be confirmed in a larger multicenter trial.