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新生儿心脏手术中的预防性皮质类固醇使用心肺旁路:系统性审查和元分析
Kumi Kataoka1,2, Sierra Cheng2, Makoto Sumie3,4,5,6,7
1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
Journal of anesthesia
|May 15, 2025
概括
皮质类固醇降低了心肺旁路 (CPB) 心脏手术后新生儿的炎症标志物. 然而,由于潜在的上腺功能不充分,不建议常规使用,尽管它们可能有利于选择婴儿.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 新生儿重症监护中心新生儿重症监护中心
- 炎症和免疫学 炎症和免疫学
背景情况:
- 接受心肺旁路术 (CPB) 的新生儿面临系统性炎症反应的重大风险.
- 导致这种风险的因素包括体型小和上腺不成熟的应激反应.
- 这种炎症可能导致心脏,呼吸和功能障碍.
研究的目的:
- 评估皮质类固醇在缓解带有CPB的心脏手术的新生儿系统性炎症反应方面的疗效.
- 评估皮质类固醇对关键炎症标志物 (IL-6,IL-10) 和临床结果的影响.
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 包括7个涉及316名新生儿的RCT,比较皮质类固醇与安慰剂.
- 主要结局包括血清IL-6和IL-10水平;次要结局是临床参数,如ICU停留和急性损伤.
主要成果:
- 皮质类固醇的使用在术后第一天显著降低了血IL-6和IL-10水平.
- 在二次临床结果中没有明显的改善,例如ICU停留时间或急性损伤的发生率.
- 使用GRADE方法评估证据的确定性.
结论:
- 皮质类固醇有效地降低了CPB心脏病手术后新生儿的炎症性细胞因子.
- 由于风险,包括上腺功能衰竭,不建议常规预防性使用皮质类固醇.
- 在外科手术期间使用的皮质类固醇可能有利于临床怀疑上腺功能不全的新生儿.
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