Bertin Philippe
Service de Thérapeutique et de Rhumatologie, CHU Dupuytren, Limoges 87000.
Presse Med. 2006 Sep;35(9 Spec No 1):1S47-51.
When prescribing a non-steroidal anti-inflammatory treatment but also an analgesic or a glucocorticoid, the cardiovascular risk of the patient should be assessed. The analgesics have few cardiovascular side effects and the main complications observed are linked essentially to the vagal action of the opioids. Acetaminophen is considered by several scientific societies to be the first line analgesic treatment, particularly in case of cardiovascular risk but with caution since cardiovascular toxicity of acetaminophen cannot be totally excluded. An overdose of dextropropoxyphene can result in cardiotoxicity. On the other hand, the glucocorticoids need to be prescribed cautiously, at the lowest possible dose and for the shortest possible duration due to the non-negligible cardiovascular risk, hypertension, dyslipidemia, hypokaliemia.
在开具非甾体抗炎药治疗处方以及镇痛药或糖皮质激素处方时，应评估患者的心血管风险。镇痛药几乎没有心血管副作用，观察到的主要并发症基本上与阿片类药物的迷走神经作用有关。几个科学学会认为对乙酰氨基酚是一线镇痛治疗药物，尤其是在存在心血管风险的情况下，但要谨慎使用，因为不能完全排除对乙酰氨基酚的心血管毒性。右丙氧芬过量可导致心脏毒性。另一方面，由于存在不可忽视的心血管风险、高血压、血脂异常、低钾血症，糖皮质激素需要谨慎开具，使用尽可能低的剂量并尽可能短的疗程。
