糖皮质激素可减少轻度新生儿先天性心脏病手术后的肺损伤

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糖皮质激素可减少轻度新生儿先天性心脏病手术后的肺损伤

贵州医科大学 高鸿教授课题组

翻译：吴学艳 编辑：佟睿 审校：曹莹

01

左中括号 目的 左中括号

本研究旨在探讨新生儿先天性心脏病手术后肺损伤是否表现为肺水肿，以及应激剂量糖皮质激素(SDC)方案是否可减轻新生儿先天性心脏病手术后的肺损伤。

0 2左中括号 设计 左中括号

一项随机、双盲、安慰剂对照临床试验的补充报告。

0 3左中括号 地点设置 左中括号

一所儿科专科医院。

04 左中括号 研究对象 左中括号

在体外循环下接受先天性心脏病手术的40例新生儿(年龄≤28天)。

05 左中括号 干预 左中括号

麻醉诱导后，将患儿随机分为接受静脉注射甲强龙2 mg/kg或注射安慰剂b，脱机后6h开始给予注射氢化可的松或安慰剂治疗，糖皮质激素治疗疗程为5d，具体如下：第一个48h治疗剂量为 0.2 mg/kg/h，第二个48h治疗剂量为 0.1 mg/kg/h，最后以0.05 mg/kg/h连续治疗24h。

0 6测量及主要结果 左中括号

SDC患者术后第1天(POD1)、第2(POD2)、3天(POD3)胸片肺水肿评分低于安慰剂组(p = 0.03)；此外，安慰剂组的肺水肿评分略有增加，为0.9，而SDC组的肺水肿评分维持在术前水平。SDC组术后动态呼吸系统顺应性高于对照组(P<0.01)，持续到POD3；然而，术后氧合、机械通气时间以及炎症和氧化应激的气管吸出物生物标志物，即白细胞介素-6、白细胞介素-8、抵抗素和8-异构前列腺素，在两组之间没有差异。

0 7结论 左中括号

SDC方案减少了轻度、临床意义不明的影像学肺水肿的发展，改善了术后动态呼吸系统顺应性，且无不良反应，但未能改善术后氧合和机械通气时长。

Lung Injury After Neonatal Congenital Cardiac Surgery Is Mild and Modifiable by Corticosteroids

Abstract

Objectives: The present study was performed to determine whether lung injury manifests as lung edema in neonates after congenital cardiac surgery and whether a stress-dose corticosteroid (SDC) regimen attenuates postoperative lung injury in neonates after congenital cardiac surgery.

Design: A supplementary report of a randomized, double-blinded, placebo-controlled clinical trial.

Setting: A pediatric tertiary university hospital.

Participants: Forty neonates (age ≤28 days) undergoing congenital cardiac surgery with cardiopulmonary bypass.

Interventions: After anesthesia induction, patients were assigned randomly to receive intravenously either 2 mg/kg methylprednisolone or placebo b, which was followed by hydrocortisone or placebo bolus six hours after weaning from CPB for five days as follows: 0.2 mg/kg/h for 48 hours, 0.1 mg/kg/h for the next 48 hours, and 0.05 mg/kg/h for the following 24 hours.

Measurements and main results: The chest radiography lung edema score was lower in the SDC than in the placebo group on the first postoperative day (POD one) (p = 0.03) and on PODs two and three (p = 0.03). Furthermore, a modest increase in the edema score of 0.9 was noted in the placebo group, whereas the edema score remained at the preoperative level in the SDC group. Postoperative dynamic respiratory system compliance was higher in the SDC group until POD three (p < 0.01). However, postoperative oxygenation; length of mechanical ventilation; and tracheal aspirate biomarkers of inflammation and oxidative stress, namely interleukin-6, interleukin-8, resistin, and 8-isoprostane, showed no differences between the groups.

Conclusions: The SDC regimen reduced the development of mild and likely clinically insignificant radiographic lung edema and improved postoperative dynamic respiratory system compliance without adverse events, but it failed to improve postoperative oxygenation and length of mechanical ventilation.

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