From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.
Anesth Analg. 2015 Aug;121(2):271-7. doi: 10.1213/ANE.0000000000000793.
Acute respiratory distress syndrome (ARDS) occurs uncommonly after cardiac surgery but has a mortality rate as high as 80%. Aspirin may prevent lung injury in at-risk patients by reducing platelet-neutrophil aggregates in the lung. We hypothesized that preoperative aspirin use would be associated with a decreased risk of ARDS after aortic valve replacement surgery.
We performed a retrospective single-center cohort study that included all adult patients who had aortic valve replacement surgery during a 5-year period. The primary outcome variable was postoperative ARDS. The secondary outcome variable was nadir PaO2/FIO2 ratio during the first 72 hours after surgery. Both crude and propensity score-adjusted logistic regression analyses were performed to estimate the odds ratio for developing ARDS in aspirin users. Subgroups were analyzed to determine whether preoperative aspirin use might be associated with improved oxygenation in patients with specific risk factors for lung injury.
Of the 375 patients who had aortic valve replacement surgery during the study period, 181 patients took aspirin preoperatively (48.3%) with most taking a dose of 81 mg (72.0%). There were 22 cases of ARDS in the cohort (5.5%). There was no significant difference in the rate of ARDS between aspirin users and nonusers (5.0% vs 6.7%, P = 0.52). There was also no significant difference in the nadir PaO2/FIO2 ratio between aspirin users and nonusers (P = 0.12). The crude odds ratio for ARDS in aspirin users was 0.725 (99% confidence interval, 0.229-2.289; P = 0.47), and the propensity score-adjusted odds ratio was 0.457 (99% confidence interval, 0.120-1.730; P = 0.13).
Within the constraints of this analysis that included only 22 affected patients, preoperative aspirin use was not associated with a decreased incidence of ARDS after aortic valve replacement surgery or improved oxygenation.
急性呼吸窘迫综合征（ARDS）在心脏手术后不常见，但死亡率高达 80%。阿司匹林通过减少肺中的血小板-中性粒细胞聚集，可能预防高危患者的肺损伤。我们假设，术前使用阿司匹林与主动脉瓣置换手术后 ARDS 的风险降低有关。
我们进行了一项回顾性单中心队列研究，纳入了 5 年内接受主动脉瓣置换手术的所有成年患者。主要结局变量是术后 ARDS。次要结局变量是术后 72 小时内最低 PaO2/FIO2 比值。均进行了未校正和倾向评分校正的 logistic 回归分析，以估计阿司匹林使用者发生 ARDS 的比值比。进行亚组分析，以确定术前阿司匹林使用是否可能与肺损伤特定危险因素患者的氧合改善相关。
在研究期间，375 名接受主动脉瓣置换手术的患者中，有 181 名患者术前服用阿司匹林（48.3%），大多数服用剂量为 81mg（72.0%）。该队列中有 22 例 ARDS。阿司匹林使用者和非使用者的 ARDS 发生率无显著差异（5.0%对 6.7%，P=0.52）。阿司匹林使用者和非使用者的最低 PaO2/FIO2 比值也无显著差异（P=0.12）。阿司匹林使用者发生 ARDS 的未校正比值比为 0.725（99%置信区间，0.229-2.289；P=0.47），倾向评分校正后的比值比为 0.457（99%置信区间，0.120-1.730；P=0.13）。
在包括仅 22 名受影响患者的本分析限制内，术前使用阿司匹林与主动脉瓣置换手术后 ARDS 的发生率降低或氧合改善无关。
