Horneffer P J, Miller R H, Pearson T A, Rykiel M F, Reitz B A, Gardner T J
Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD 21205.
J Thorac Cardiovasc Surg. 1990 Aug;100(2):292-6.
Although the postpericardiotomy syndrome is a common complication of cardiac operations, the most effective drug regimen for the treatment of this condition has not been established. The present study was designed to evaluate the effectiveness of nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of postpericardiotomy syndrome, in a double-blind, placebo-controlled randomized trial with a 10-day course of ibuprofen or indomethacin. Of 1019 adult patients undergoing cardiac operations during a 14-month period, a diagnosis of postpericardiotomy syndrome was made in 187, and 149 were enrolled in the study. Diagnosis was based on the presence of at least two of the following: fever, anterior chest pain, and friction rub. Drug efficacy was defined as the resolution of at least two of these criteria within 48 hours of drug initiation. Ibuprofen and indomethacin were 90.2% and 88.7% effective, respectively, and both were significantly more effective than placebo (62.5%, p = 0.003). The occurrence of side effects, including nausea, vomiting, renal failure, and fluid retention, was low in all groups (13.1% for ibuprofen, 16.1% for indomethacin, and 16.7% for placebo [p = not significant). Length of hospital stay, incidence of ischemic events, and accumulation of significant pericardial effusions were similar in all groups. The results of this study demonstrate that both ibuprofen and indomethacin provide safe and effective symptomatic treatment for postpericardiotomy syndrome.
尽管心包切开术后综合征是心脏手术常见的并发症，但治疗该病症最有效的药物方案尚未确定。本研究旨在通过一项为期10天的布洛芬或吲哚美辛双盲、安慰剂对照随机试验，评估非甾体抗炎药（NSAIDs）治疗心包切开术后综合征的有效性。在14个月期间接受心脏手术的1019例成年患者中，187例被诊断为心包切开术后综合征，149例被纳入研究。诊断依据至少存在以下两项：发热、前胸疼痛和摩擦音。药物疗效定义为在开始用药后48小时内至少两项标准得到缓解。布洛芬和吲哚美辛的有效率分别为90.2%和88.7%，两者均显著优于安慰剂（62.5%，p = 0.003）。所有组中恶心、呕吐、肾衰竭和液体潴留等副作用的发生率都很低（布洛芬组为13.1%，吲哚美辛组为16.1%，安慰剂组为16.7%[p = 无显著性差异]）。所有组的住院时间、缺血事件发生率和大量心包积液的累积情况相似。本研究结果表明，布洛芬和吲哚美辛均可为心包切开术后综合征提供安全有效的对症治疗。
