Postoperative glucocorticoid enhances recovery after endovascular aortic repair for chronic type B aortic dissection: a single-center experience
Postoperative glucocorticoid enhances recovery after endovascular aortic repair for chronic type B aortic dissection: a single-center experience
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术后糖皮质激素可促进慢性 B 型主动脉夹层血管内修复术后的恢复：单中心经验
DOI：
10.1186/s12872-016-0234-2
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发表时间：
2016-03-25
影响因子：
2.1
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
--
作者：
Wu, Mengtao;Zhang, Lei;Jing, Zaiping
胸主动脉腔内修复术（TEVAR）是治疗B型主动脉夹层（TBAD）的一种微创方法。然而，TEVAR的治疗效果受到术后不良事件的挑战，这些不良事件是由炎症反应引起的。糖皮质激素因其强大而有效的抗炎特性而被广泛使用。然而，糖皮质激素在TBAD患者接受TEVAR后的预后影响仍不清楚。本研究的目的是评估术后糖皮质激素对TEVAR的TBADs.MethodsA的预后的潜在影响，共92例慢性TBADs患者接受TEVAR与硬膜外麻醉2012年6月至2014年6月之间进行了回顾性分析。将患者分为地塞米松（DXM）组和非地塞米松（N-DXM）组。TEVAR的适应证如下：灌注不良（n= 28），包含或即将破裂（n= 17），持续顽固性胸/背痛（n= 32），顽固性高血压（n= 15）。术后第2天N-DXM组疼痛评分明显高于对照组（3.60 ± 0.21比4.83 ± 0.32，P = 0.001）。两组患者的白色血细胞、体温、心率的峰值差异有统计学意义（13.01 ± 0.58 × 109/L vs 10.04 ± 0.61 × 109/L，37.67 ± 0.08 °C vs 37.92 ± 0.09 °C和89.06 ± 1.21 bpm vs 95.95 ± 1.70 bpm，P= 0.002，0.04和0.001）。DXM组术后第2、3天白色细胞明显升高（P= 0.009和0.023），术后第2、3、4天体温和心率明显下降（P= 0.001和0.028、P= 0.007和0.005、P= 0.024和0.018）。然而，两组在3个月随访时的假腔体积变化和内漏发生率相当。结论术后预防性应用糖皮质激素虽不能影响死亡率、切口感染及假腔容积的变化，但能促进生命体征的恢复，减轻术后疼痛。一项前瞻性随机对照试验已注册（NCT 02523300），在临床工作中推荐TEVAR手术后预防性使用糖皮质激素之前，将需要进行该试验。
BackgroundThoracic endovascular aortic repair (TEVAR) has been chosen as a less invasive alternative for type B aortic dissections (TBADs). However, the therapeutic effect of TEVAR has been challenged by postoperative adverse events, which were induced by inflammatory response. Glucocorticoids have been widely used because of the powerful and effective anti-inflammatory properties. Nevertheless, the prognostic effect of glucocorticoids after TBAD patients underwent TEVAR remains unclear. The objective of this study was to assess the potential effect of postoperative glucocorticoids on the prognosis of TEVAR for TBADs.MethodsA total of 92 chronic TBADs patients underwent TEVAR with epidural anesthesia between June 2012 and June 2014 was retrospectively reviewed. The patients were stratified into dexamethasone (DXM) and non-dexamethasone group (N-DXM). The indications for TEVAR were as following: malperfusion (n= 28); contained or impending rupture (n= 17); persistent intractable chest/back pain (n= 32); refractory hypertension (n= 15).ResultsNo 30-day mortality and incision infection occurred in each group. The postoperative pain score on the second day was significantly higher in N-DXM group (3.60 ± 0.21 versus 4.83 ± 0.32,P= 0.001). The differences of white blood cell, body temperature and heart rate were pronounced in both groups judged by the peak values (13.01 ± 0.58 × 109/L versus 10.04 ± 0.61 × 109/L, 37.67 ± 0.08 °C versus 37.92 ± 0.09 °C and 89.06 ± 1.21 bpm versus 95.95 ± 1.70 bpm,P= 0.002, 0.04 and 0.001, respectively). The white blood cells in DXM group significantly increased on the second and third postoperative day (P= 0.009 and 0.023), while the body temperature and heart rate showed an apparent decline on the second (P= 0.001 and 0.028), third (P= 0.007 and 0.005) and fourth postoperative days (P= 0.024 and 0.018). However, the changes of false lumen volumes and the endoleak incidence at 3-month follow-up were comparable in the two groups. No significant difference of post-implantation syndrome was observed either.ConclusionsAlthough postoperative prophylactic glucocorticoids administration was unable to influence mortality, incision infection or the change of false lumen volumes, it enabled to enhance the recovery of vital signs and alleviate the postoperative pain. A prospective, randomized controlled trial has been registered (NCT02523300), which will be warranted before prophylactic administration of glucocorticoids after TEVAR procedure could be recommended in the clinical work.