Department of Anesthesiology, Mercy St. Vincent Medical Center, Toledo, Ohio 43608, USA.
Ann Thorac Surg. 2011 Aug;92(2):603-9. doi: 10.1016/j.athoracsur.2011.04.050.
The use of ketorolac, a potent cyclooxygenase-1 inhibitor, for analgesia after cardiac operations has been limited by concerns of increased cardiovascular events. However, a recent study found that its use after coronary artery bypass grafting was associated with improved survival.
This was a retrospective study of patients who received coronary arteriograms for symptoms suggestive of recurrent ischemic heart disease. Patients who received postoperative ketorolac were matched with nonusers by propensity scores. Graft occlusion rates were compared, and their association with ketorolac use was compared using Cox proportional hazard modeling.
Although the rate of graft occlusion was similar in the two groups, in 184 of the 303 propensity-matched patients (61%) who received ketorolac vs 202 of the 303 patients (67%) who did not (p=0.13), there was a longer time to angiographically proven occlusion in the patients who received ketorolac (2.80±2.19 vs 2.04±1.63 years; p<0.001). Cox modeling to control for the other variables and the longer time to angiography in the ketorolac group showed that ketorolac use was associated with nearly a halving of the hazard ratio (0.561; 95% confidence interval, 0.454 to 0.692; p<0.001) for any graft occlusion.
The use of ketorolac after coronary artery bypass grafting was associated with a lower rate of angiographically proven graft closure and suggests a mechanistic (improved graft patency) explanation for the previously reported survival benefit of ketorolac.
由于担心增加心血管事件，在心脏手术后使用强效环氧化酶-1 抑制剂酮咯酸进行镇痛的做法受到限制。然而，最近的一项研究发现，在冠状动脉旁路移植术后使用酮咯酸与存活率提高有关。
这是一项回顾性研究，纳入了因疑似复发性缺血性心脏病而接受冠状动脉造影的患者。通过倾向评分匹配术后使用酮咯酸和未使用酮咯酸的患者。比较两组的移植物闭塞率，并使用 Cox 比例风险模型比较其与酮咯酸使用的相关性。
尽管两组的移植物闭塞率相似，但在 303 名接受倾向评分匹配的患者中，184 名（61%）接受酮咯酸的患者与 303 名未接受酮咯酸的患者（67%）相比（p=0.13），接受酮咯酸的患者发生经血管造影证实的闭塞的时间更长[2.80±2.19 年比 2.04±1.63 年；p<0.001]。Cox 模型控制其他变量和酮咯酸组更长的血管造影时间显示，使用酮咯酸与降低风险比（HR）近一半相关（0.561；95%置信区间，0.454 至 0.692；p<0.001），提示任何移植物闭塞。
在冠状动脉旁路移植术后使用酮咯酸与经血管造影证实的移植物闭塞率较低相关，并提示酮咯酸先前报道的存活率获益的机制（改善移植物通畅性）解释。
