METHODS: Our study reviewed 1341 cases from a total of 1680 adult cardiac surgeries performed between June 2019 and May 2022 after excluding cases with off-pump procedures, ventricular assist device implantations, heart transplants, and aortic surgeries requiring systemic circulatory arrest. The study timely sorted periods including a baseline data from 2018, and other three periods since 2019 to analyze the effects of three different methylprednisolone dosage: 0 mg, 500 mg, and 1000 mg. We assessed the annual trends in methylprednisolone administration and compared morbidity and mortality rates across the groups.
RESULTS: We observed a significant decline in steroid use, with no-steroid surgeries increasing from 23% to 66.5% by period 3. Despite the decreased use of steroids, our study showed no increase in mortality, new-onset atrial fibrillation, acute kidney injury, cerebrovascular event and prolonged ventilation when compared to baseline data. Notably, less surgical site infection rate was observed in the no-steroid group.
CONCLUSIONS: The data indicates that a reduction or discontinuation of steroids during CPB can be performed without compromising patient outcomes. This could support a transition towards a more conservative use of steroids in adult cardiac surgery, aligning with current guidelines, and potentially reducing certain postoperative complications.
方法:我们的研究回顾了在2019年6月至2022年5月期间进行的1680例成人心脏手术中的1341例病例,这些病例排除了非体外循环手术的病例。心室辅助装置植入,心脏移植,需要全身循环停止的主动脉手术。该研究及时排序,包括2018年的基线数据,以及2019年以来的其他三个时期,以分析三种不同剂量的甲基强的松龙的影响:0mg,500毫克,和1000毫克。我们评估了甲基强的松龙给药的年度趋势,并比较了各组的发病率和死亡率。
结果:我们观察到类固醇使用显着下降,到第3期,无类固醇手术从23%增加到66.5%。尽管减少了类固醇的使用,我们的研究显示死亡率没有增加,新发心房颤动,急性肾损伤,与基线数据相比,脑血管事件和通气时间延长。值得注意的是,无类固醇组手术部位感染率较低.
结论:数据表明,在CPB期间减少或停用类固醇可以在不影响患者预后的情况下进行。这可以支持在成人心脏手术中更保守地使用类固醇的过渡,符合当前的指导方针,并有可能减少某些术后并发症。