Effect of Dexamethasone on Atrial Fibrillation after Cardiac Surgery:Clinical Studies
|Keywords||Dexamethasone Atrial fibrillation Coronary bypass graft surgery Valvereplacement surgery Meta-analysis Prospective cohort study|
The high incidence of post-operative atrial fibrillation (POAF) is2to3days after cardiac surgery. It is consistent with the peak period of the systemic inflammatory response after cardiac surgery. Present study showed that corticosteroids can decrease the inflammation of the cascade activation after cardiopulmonary turn flow. So as to curtailed the recovery time of postoperative patients and reduced postoperative complications. European Society of Cardiology on cortisol and non-steroidal anti-inflammatory drugs to prevent heart surgery atrial fibrillation efficacy is inaccurate, the routine use of corticosteroids in most hospitals at home and abroad during cardiopulmonary bypass, but fewer clinical trials. POAF can increase cerebral vascular accident and a variety of complications, the incidence of aggravated chronic heart failure, prolonged hospitalization and increase the related medical expenses, risks associated with high postoperative mortality. In recent years, studies have proposed that dexamethasone can inhibit the inflammatory response after cardiopulmonary bypass, reducing tissue damage, and can theoretically reduce the incidence of atrial fibrillation after cardiac surgery.Part1Objective To assess the effect of preoperative dexamethasone on the occurrence of POAF. Methods RCTs were gathered though searches of PubMed(1966-2011.07), EMBASE (1974-2011.07), Cochrane Library(issue7,2011), Chinese Biomedical Literature Database(1978-2011.07), China Journal Fulltext Database (1994-2011.07), Chinese Scientific Journals Fulltext Database(1989-2011.07). Two reviewers independently assessed eligibility and quality of trials, then extracted data. Data were synthesized using RevMan5.0software provided by the Cochrane Collaboration. Results A total of four randomized controlled trials (667participants) were included for systematic review, Meta-analysis showed that there were statistical differences between dexamethasone and placebo in postoperative atrial fibrillation (RR=0.6,95%CI:0.40to0.92, P=0.02), dexamethasone did not reduce post-operative mortality (RR=0.79,95%CI:0.28to2.22, P=0.66). Conclusion Meta-analysis suggests that the perioperatie use of dexamethasone can reduce the incidence of atrial fibrillation in patients after cardiac surgery. Limited to incorporated into the limitations of the research and the type of surgery, dexamethasone dose, time and frequency, and recommend that future clinical studies to further explore this conclusion.Part2Objective Research the dexamethasone on the prevention of atrial fibrillation after cardiac surgery. Methods Case-control study on cases whose receiving cardiopulmonary bypass coronary bypass graft surgery, valve replacement surgery in the People’s Hospital of Gansu Provincial in May2009to February2011, analysis the difference of perioperative in the incidence of atrial fibrillation, mortality, postoperative complications, ventilator support time, ICU treatment time, days in hospital about dexamethasone group and blank control group, using SPSS17.0for statistical analysis. Results56cases were included, including20cases with coronary bypass graft surgery of the CPB and36cases with valve replacement surgery. There are28cases in the dexamethasone group and28cases in the control group. In the valve replacement surgery, the incidence of atrial fibrillation in the dexamethasone group lower than the control group (11.1%vs.44.4%, P=0.026), the average length of time in hospital in the dexamethasone group less than the control group (13.05±1.07days vs14.38±1.83days, P=0.008). During the coronary bypass graft surgery with cardiopulmonary bypass, the incidence of atrial fibrillation in the dexamethasone group and the control group was no significant difference (10.0%vs.20.0%, P=0.531). The average age of patients with first occurred atrial fibrillation was higher than did not occur (67.2±9.2vs56.6±7.8, P=0.0002).Conclusion Using dexamethasone in patients with valve replacement surgery can reduce the incidence of postoperative atrial fibrillation and shortening the postoperative recovery time. Using dexamethasone in patients with coronary bypass grafting can not reduce the postoperative incidence of atrial fibrillation. Yet age is one of the risk factors of atrial fibrillation after cardiac surgery.