体外循环预充糖皮质激素对小儿简单先天性心脏病手术的临床作用

The clinical effect of extracorporeal circulation glucocorticoids priming on simple congenital heart surgery in children

目的观察心肺转流(CPB)预充液中使用糖皮质激素对小儿心脏手术乳酸及临床结果的影响,为临床实践提供相应的依据。方法2023年2月至2024年1月,选取择期行室间隔缺损修补术和(或)房间隔缺损修补术的简单先天性心脏病患儿54例,随机分为两组,每组27例。对照组不使用地塞米松;地塞米松组预充液中加入5 mg/kg地塞米松。分别于麻醉诱导后CPB前、CPB15 min、主动脉开放前5 min、CPB结束时、术毕、入ICU后2 h取血样行动脉血气、乳酸和血糖水平测试,记录临床主要结果。结果两组患者血糖、手术室气管插管拔管率、ICU时间、机械通气时间、发热天数、最高体温、室上速发生率、死亡率、住院时间、住院费用对比均无统计学意义(P<0.05)。地塞米松组乳酸在T1、T4显著高于对照组(P<0.05)。结论简单先心手术CPB预充液中加入地塞米松对控制术中及术后乳酸水平无积极作用,对术中及术后血糖水平无明显影响,也不能改善小儿心脏手术后的临床结果。

Objective To observe the effect of glucocorticoids in cardiopulmonary bypass(CPB)prime solution on lactate and clinical outcomes in pediatric cardiac surgery,providing corresponding basis for clinical practice.Methods From February 2023 to January 2024,54 children with simple congenital heart disease underwent elective ventricular septal defect repair and/or atrial septal defect repair surgery were selected and randomly divided into two groups,with 27 cases in each group.The control group did not use dexamethasone,and 5 mg/kg dexamethasone was added to the prime solution in the dexamethasone group.Blood samples were collected for arterial blood gas,lactate and blood glucose levels before CPB,15 minutes after anesthesia induction,5 minutes before aortic opening,at the end of CPB,after surgery,and 2 hours after admission to the ICU,and the main clinical results were recorded.Results There was no significant difference in the blood glucose levels,rate of tracheal intubation and extubation in the operating room,ICU stay,mechanical ventilation time,fever days,highest body temperature,incidence of supraventricular speed,mortality rate,length of hospital stay and hospitalization expenses between the two groups of patients(P>0.05).The lactate levels in the dexamethasone group were significantly higher than those in the control group at T1 and T4(P<0.05).Conclusion The use of dexamethasone in CPB prime solution in simple cardiac surgery had no positive effect on the control of intraoperative and postoperative lactate levels,and no obvious effect on intraoperative and postoperative blood glucose levels,which could not improve the clinical results after pediatric cardiac surgery.