Çocuklarda kortikosteroid tedavisinin kardiovasküler yan etkisi

Year 2019, Volume: 17 Issue: 2, 290 - 299, 02.08.2019

Çelebi Kocaoğlu

Abstract

GİRİŞ ve
AMAÇ: Kortikosteroidler pediatri pratiğinde birçok klinik durum için sıkça
kullanılır. Steroidlerin kronik kullanımına bağlı yan etkiler iyi bilinmesine
rağmen, kısa süre kullanımda ortaya çıkan yan etkiler bakımından daha az
farkındalık vardır. Bu çalışmada biz düşük, orta ve yüksek doz kortikosteroidle
tedavi edilen hastalarda ilaç öncesi ve ilaç sonrası kan basınçlarını ve nabız
hızlarını değerlendirmeyi amaçladık. Kortikosteroid kullanımının klinik
yansımalarını tanımlamak için, kortikostroidle tedavi edilen ve edilmeyenlerin
bulgularını karşılaştırdık.

YÖNTEM ve GEREÇLER: Çalışmaya akut viral bronşiolitis ve nefrotik sendrom
nedeniyle kortikosteroid tedavisi alan, 0-16 yaş arasındaki hastalar dahil
edildi. Hastalar alınan kortikosteroid dozuna göre üç alt gruba bölündü.
Kontrol grubu corticosteroid tedavisi almayan hastalardan oluşturuldu.

BULGULAR: Hem kontrol grubunda, hem de grup-I ve grup-II de ilaç öncesi ve ilaç
sonrası nabız hızları ortalaması arasında fark varken, pulse kortikosteroid
alan grup-III’de ilaç öncesi ve ilaç sonrası ortalama nabız hızları arasında
fark yoktu. Aşikar kardiak disritmi hiçbir grupta gözlenmedi.

TARTIŞMA ve SONUÇ: Bizim çalışmamız gösterdi ki, kortikosteroid kullanımı ile
kardiak disritmiler arasında doğrudan bir nedensel ilişki yoktur. Muhtemeldir
ki, kortikosteroid tedavisi sonrası gelişen disritmiler multi faktorialdir.
Dolayısıyla, bu konuda herhangi bir yargıya varılmadan önce daha kapsamlı
çalışmalar yapılmalıdır. Sebep ne olursa olsun, özellikle karaciğer hastalığı
olan, kardiyak patolojisi olan veya kardiyak ilaç alan hastalar, disritmiler
konusunda yakından izlenmelidir. Kortikosteroidlerin, aksi ispatlanana kadar
kardiyak disritmileri presipite edebileceğinin farkında olunması önemlidir.

Keywords

kardiak disritmiler, kortikosteroidler, nabız hızı

Adverse cardiovascular effect of corticosteroid therapy in children

Abstract

INTRODUCTION:
Corticosteroids are widely used for many clinical conditions in pediatric
practice. Although the adverse effects arising from the use of chronic
corticosteroids are well-known, there is less awareness regarding the side
effects emerging from use in short period. We aimed at evaluating the
measurements of pre- and post-drug blood pressure and pulse rates in the
patients treated with low, medium, and high doses of corticosteroids. To define
the clinical reflections of corticosteroid treatment, we compared the findings
of those treated with and without corticosteroids.

METHODS: Patients between 0-16 years of age who received corticosteroid
treatment for acute viral bronchiolitis and nephrotic syndrome were included in
the study. Patients were divided into three subgroups with respect to corticosteroid
doses. The control group consisted of patients who did not  receive corticosteroid treatment. 

RESULTS: While there was difference between pre-drug and post-drug mean pulse
rates in control group and group-I and group-II in the steroid group; there was
no difference in group-III who received pulse corticosteroid therapy. No
evident cardiac dysrhythmia was observed in any group.

DISCUSSION AND CONCLUSION: Our study showed that there is no direct causal
relationship between corticosteroid use and cardiac dysrhythmias. It is likely
that dysrhythmias developing after corticosteroid treatment are multifactorial.
So, more comprehensive studies must be performed before any judgment is reached
in this topic. Whatever the reason, particularly patients with liver disease
and those with cardiac pathology or taking cardiac drug must be closely
monitored regarding dysrhythmias. It is important to be aware that
corticosteroids can precipitate cardiac dysrhythmias until proven otherwise in
other studies in large cohorts. 

Keywords

cardiac dysrhythmia, corticosteroids, pulse rate

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