PDF(Pubmed)
Abstract：
Inflammation may contribute to postoperative cardiac complications and ketorolac, an anti-inflammatory agent inhibiting cyclooxygenase (COX), shows promise in enhancing cardiac graft patency by suppressing endothelial cell proliferation in animal studies. However, the safety of postoperative ketorolac use remains controversial. This study investigates the association between early ketorolac application and complications following cardiac surgery. Data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database fueled this retrospective cohort study. The primary outcome is a composite of mortality, pulmonary insufficiency, severe acute kidney injury (AKI), hemorrhage or hematoma, infection, cardiogenic shock, and cerebrovascular infarction postcardiac surgery. Propensity score matching (PSM; 1:1 match, caliper 0.2), multivariate logistic regression, interaction stratification analysis, pairwise algorithmic, and overlap weight model analyses were employed. Following inclusion and exclusion criteria, 7143 patients who underwent valvular surgery or coronary artery bypass grafting (CABG) were included. PSM created a balanced cohort of 3270 individuals (1635 in the ketorolac group). The matched cohort exhibited an 8.1% overall rate of postoperative complications, with a lower composite outcome rate in patients receiving ketorolac within 48 h of surgery compared with those without (PSM, OR 0.70 [95% CI, 0.54-0.90]). Consistent associations were observed in total cohort analyses, sensitivity, and subgroup analyses. Early ketorolac use within 48 h post-CABG or valvular procedures in adults is independently associated with a lower incidence of composite postoperative adverse events. Prospective trials are warranted to assess causality.
摘要：
炎症可能导致术后心脏并发症和酮咯酸，抑制环氧合酶（COX）的抗炎药，在动物研究中显示了通过抑制内皮细胞增殖来增强心脏移植物通畅性的希望。然而,术后使用酮咯酸的安全性仍存在争议.这项研究调查了心脏手术后早期应用酮咯酸与并发症之间的关系。来自重症监护医学信息集市（MIMIC-IV）数据库的数据推动了这项回顾性队列研究。主要结果是死亡率的综合结果，肺功能不全,严重急性肾损伤（AKI），出血或血肿，感染,心源性休克,心脏手术后脑血管梗塞。倾向得分匹配(PSM；1:1匹配，卡尺0.2),多元逻辑回归，相互作用分层分析，成对算法，并采用重叠权重模型分析。按照纳入和排除标准，包括7143例接受瓣膜手术或冠状动脉旁路移植术（CABG）的患者。PSM创建了一个由3270名个体组成的平衡队列(酮咯酸组中为1635名)。匹配的队列显示术后并发症的总发生率为8.1%，与没有手术的患者相比，在手术后48小时内接受酮咯酸的患者的综合结局率较低(PSM，或0.70[95%CI，0.54-0.90]）。在总队列分析中观察到一致的关联，灵敏度,和亚组分析。成人CABG或瓣膜手术后48小时内早期使用酮咯酸与复合术后不良事件发生率较低独立相关。有必要进行前瞻性试验以评估因果关系。
