皮质类固醇在体外循环下小儿心脏手术中作用的Meta分析

A Mate-analysis of prophylactic steroids for pediatric cardiac surgery

目的评价预防剂量的皮质类固醇在体外循环下小儿心脏手术中的作用。方法计算机检索PubMed、Cochrane Library、EMBASE、中国生物医学文献数据库、中文科技期刊全文数据库、中国期刊全文数据库,检索时间截止2009年6月,检索策略通过多次预检索后确定。采用Cochrane协作网提供的RevMan 5.0统计软件进行Meta分析。结果仅有5篇文献包括147例患儿符合纳入标准。Meta分析结果显示,围手术期使用皮质类固醇不能缩短患者在重症监护室的停留时间[SMD-0.32,95%CI(-0.69,0.05),P=0.09]和机械通气时间[SMD-0.11,95%CI(-0.50,0.29),P<0.59],但可降低直肠温度峰值[MD-0.52,95%CI(-0.65,-0.39),P<0.00001]。结论现有的证据表明预防剂量的类固醇不能减轻手术后的炎症反应,需要进一步精心设计和高质量的随机对照试验评估该干预措施的利弊。

Objective To review systematically the beneficial and harmful effects of the prophylactic administration of corticosteroids, compared with placebo, in pediatric cardiac surgery. Methods The following databases were searched： PubMed （1956 to 2009-06）, Cochrane library （3 issue, 2009）, EMBASE （1974 to 2009-06）, Chinese Biomedical Literature Database （1978 to 2009- 06）, Chinese Scientific Journals Fulltext Database（1989 to 2009-06）, China Journal Fulltext Database （1994 to 2009-06）. Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized by using RevMan 5.0 software provided by the Cochrane Collaboration. Results A total of five trials （142 participants） were included for systematic review. Meta-analysis showed that perioperative use of corticosteroids can not be shortened intensive care unit stay [SMD -0.32, 95%CI （-0.69, 0.05）, P=0.09] and duration of ventilation [SMD -0.11, 95%CI （-0.50, 0.29）, P 〈0.59], reduce the peak core temperature [MD -0.52, 95%CI （-0.65, -0.39）, P 〈0.00001]. Conclusion The use of prophylactic steroids in pediatric patients to reduce postoperative complications commonly following cardiopulmonary bypass surgery is not supported by the existing evidence. Further well-designed, adequatelypowered and randomly controlled trials are needed to estimate more accurately the benefit and harm of this intervention.