Intraoperative Steroid Use and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network's Public Database.
Intraoperative Steroid Use and Outcomes Following the Norwood Procedure: An Analysis of the Pediatric Heart Network's Public Database.
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DOI：
10.1097/pcc.0000000000000541
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发表时间：
2016-01
期刊：
影响因子：
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通讯作者：
Graham EM
中科院分区：
文献类型：
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作者：
Elhoff JJ;Chowdhury SM;Zyblewski SC;Atz AM;Bradley SM;Graham EM
支持在心脏手术期间使用类固醇的数据相互矛盾，而且大多数儿科研究都受到样本量小和/或心脏诊断多样化的限制。这项研究的目的是确定术中应用类固醇是否改善了诺伍德手术后的结果。对549名接受Norwood手术的新生儿进行了回顾性分析，这些数据来自儿科心脏网络的单心室重建(SVR)试验的公开数据集。分组比较以确定术中接受类固醇治疗的患者(n=498，91%)和未接受类固醇治疗的患者(n=51，9%)的预后是否存在差异。两组间的基线特征和术中变量相似，只是接受类固醇治疗的组心内直视手术的阻断时间和体外循环时间较短。与接受类固醇治疗的患者相比，术中未接受类固醇治疗的受试者住院时间延长(94%比83%，p=0.03)，但重症监护病房停留时间更长(16天(IQR 12-33)比14天(IQR 9-28，p=0.04))，住院时间(29天(IQR 21-50)比23天(IQR 15-40，p=0.01)。在多变量分析中，住院时间长短不再显著，但住院存活率倾向于有利于非类固醇组，优势比为3.52(95%可信区间为0.98-12.64，p=0.054)。在大型多中心SVR试验中，术中广泛使用类固醇。术中应用类固醇与预后的改善无关，而可能与诺伍德手术新生儿的住院存活率降低有关。这项研究强调了随机对照试验的必要性。
Data supporting the use of perioperative steroids during cardiac surgery are conflicting and most pediatric studies have been limited by small sample sizes and/or diverse cardiac diagnoses. The objective of this study was to determine if intraoperative steroid administration improved outcomes following the Norwood procedure. A retrospective analysis was performed on the 549 neonates who underwent a Norwood procedure in the publicly available datasets from the Pediatric Heart Network’s Single Ventricle Reconstruction (SVR) trial. Groups were compared to determine if outcomes differed between intraoperative steroid recipients (n=498, 91%) and non-recipients (n=51, 9%). Baseline characteristics and intraoperative variables were similar between groups with the exception of a shorter duration of cross clamp and cardiopulmonary bypass time in the group that received steroids. Subjects who did not receive intraoperative steroids had improved hospital survival (94% vs 83%, p=0.03), but longer intensive care unit stays (16 days (IQR 12–33) vs 14 days (IQR 9–28), p=0.04) and hospital stays (29 days (IQR 21–50) vs 23 days (IQR 15–40, p=0.01) than steroid recipients. In multivariate analysis lengths of stay associations were no longer significant but hospital survival trended towards favoring the non-steroids group with an odds ratio of 3.52 (95% confidence interval 0.98–12.64, p=0.054). In the large multi-centered SVR trial there was widespread use of intraoperative steroids. Intraoperative steroid administration was not associated with an improvement in outcomes and may be associated with a reduction in hospital survival in neonates undergoing the Norwood procedure. This study highlights the need for a randomized control trial.