Çocuklarda kortikosteroid tedavisinin kardiovasküler yan etkisi

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.

Anahtar Kelimeler:

kardiak disritmiler, kortikosteroidler, nabız hızı

Adverse cardiovascular effect of corticosteroid therapy in children

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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