cardiopulmonary bypass congenital heart disease pediatric
下载

摘要

BACKGROUND:The efficacy of intraoperative corticosteroids to improve outcomes following congenital cardiac operations remains controversial.
OBJECTIVES:The purpose of this study was to determine whether intraoperative methylprednisolone improves post-operative recovery in neonates undergoing cardiac surgery.
METHODS:Neonates undergoing cardiac surgery with cardiopulmonary bypass at 2 centers were enrolled in a double-blind randomized controlled trial of methylprednisolone (30 mg/kg) or placebo after the induction of anesthesia. The primary outcome was a previously validated morbidity-mortality composite that included any of the following events following surgery before discharge: death, mechanical circulatory support, cardiac arrest, hepatic injury, renal injury, or rising lactate level (>5 mmol/l).
RESULTS:Of the 190 subjects enrolled, 176 (n = 81 methylprednisolone, n = 95 placebo) were included in this analysis. A total of 27 (33%) subjects in the methylprednisolone group and 40 (42%) in the placebo group reached the primary study endpoint (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.31 to 1.3; p = 0.21). Methylprednisolone was associated with reductions in vasoactive inotropic requirements and in the incidence of the composite endpoint in subjects undergoing palliative operations (OR: 0.38; 95% CI: 0.15 to 0.99; p = 0.048). There was a significant interaction between treatment effect and center. In this analysis, methylprednisolone was protective at 1 center, with an OR: 0.35 (95% CI: 0.15 to 0.84; p = 0.02), and not so at the other center, with OR: 5.13 (95% CI: 0.85 to 30.90; p = 0.07).
CONCLUSIONS:Intraoperative methylprednisolone failed to show an overall significant benefit on the incidence of the composite primary study endpoint. There was, however, a benefit in patients undergoing palliative procedures and a significant interaction between treatment effect and center, suggesting that there may be center or patient characteristics that make prophylactic methylprednisolone beneficial.

译文

背景: 术中皮质类固醇对改善先天性心脏手术后结果的疗效仍有争议。
目的: 本研究的目的是确定术中甲泼尼龙是否能改善接受心脏手术的新生儿的术后恢复。
方法: 在两个中心接受体外循环心脏手术的新生儿在麻醉诱导后被纳入甲泼尼龙 (30 mg/kg) 或安慰剂的双盲随机对照试验。主要结果是一个先前验证的发病率-死亡率复合模型,该模型包括以下出院前手术的任何事件: 死亡、机械循环支持、心脏骤停、肝损伤、肾损伤, 或乳酸水平升高 (> 5 mmol/l)。
结果: 在 190 名受试者中,176 (n = 81 甲基强的松龙,n = 95 安慰剂) 被纳入该分析。甲泼尼龙组总共有 27 (33%) 个受试者,安慰剂组有 40 (42%) 个受试者达到了主要研究终点 (比值比 [OR]: 0.63; 95% 置信区间 [CI]: 0.31 到 1.3; p = 0.21)。在接受姑息手术的受试者中,甲泼尼龙与血管活性肌力需求的减少和复合终点的发生率相关 (OR: 0.38; 95% CI: 0.15-0.99; p = 0.048)。治疗效果和中心之间存在显著的交互作用。在该分析中,甲泼尼龙在 1 个中心具有保护作用,OR: 0.35 (95% CI: 0.15 至 0.84; p = 0.02),而在另一个中心则不是这样,OR: 5.13 (95% CI: 0.85 至 30.90; p = 0.07)。
结论: 术中甲泼尼龙未能显示出复合主要研究终点发生率的总体显著益处。然而,在接受姑息治疗的患者中有一个好处,治疗效果和中心之间有显著的相互作用,这表明可能有中心或患者的特征使预防性甲泼尼龙有益。

Cardiopulmonary bypass

儿科 手术 治疗方法
概述  :  

心肺转流术就是完成血液在体外的氧合循环,利用体外循环管道把静脉血从体内引出,乏氧的静脉血通过氧合器(人工肺)后变成富氧的动脉血,再利用机械泵做功把氧合后的血液源源不断的泵入体内,代替心脏的工作。通过这个过程血液完成了最基本的体外循环。应用一般应用于心脏手术,但是体外循环除了给全身供血外,还有一个很重要的工作就是心肌保护。阻断心脏冠脉血流后利用冷的心脏停搏液让心脏停止跳动,同时给予降温,降低心脏氧耗,减少心肌损伤,比如目前应于重症监护室的ECMO。管路和插管总预充容量越低,CPB期间输血量越

cardiopulmonary 英 /,kɑːdɪəʊ'pʌlmən(ə)rɪ/ 美 /,kɑrdɪo'pʌlmənəri/

释    义   adj. 心肺的;与心肺有关的

例    句   The probability of survival decreases by 10% for every minute of hesitation, and by 5% even ifcardiopulmonary resuscitation, better known as CPR, is performed. 每耽误一分钟,病人幸存的概率就降低10%,而即使实施了心肺复苏(也被称为CPR),幸存概率也同样会降低5%。


bypass 英 /ˈbaɪpɑːs/  美 /ˈbaɪpæs/

释    义   v. 绕过,避开;忽视,不顾(规章制度);设旁路,迂回     

n. 旁路,支路;旁通管,分流术

例    句   Vasoplegic syndrome is a form of vasodilatory shock that can occur after cardiopulmonary bypass. 血管麻痹综合征是一种心肺分流术后可能出现的一种血管扩张性休克状态。

请扫描右侧二维码,免费查看词汇专业知识背景