From the Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany (TS, LB, AL, H-JG).
Eur J Anaesthesiol. 2017 Oct;34(10):673-680. doi: 10.1097/EJA.0000000000000627.
Use of dipyrone (metamizole) in perioperative and ICU pain therapy remains controversial due to a lack of solid evidence weighing dipyrone benefit against its potential life-threatening complications. Although dipyrone has known analgesic and antipyretic properties, its mechanisms of actions are incompletely understood. Although dipyrone effects on renal vasodilator prostaglandin synthesis are documented, little is known about its potential renal side effects, especially in the critical care environment.
Investigation of the perioperative nephrotoxic potential of dipyrone in patients prone to acute kidney injury (AKI).
Retrospective cohort study.
Single centre study in a tertiary referral hospital from January 2013 until June 2013.
A total of 500 consecutive patients aged 18 years and older referred to the anaesthesia ICU. Patients were excluded if admitted from or discharged to other ICUs, if referred for post resuscitation care, or if repeatedly admitted to the ICU.
Incidence of AKI, as defined by the Kidney Disease: Improving Global Outcomes Acute Kidney Injury Work Group criteria, and duration of vasopressor therapy.
Use of dipyrone was associated with an increased incidence of AKI in a dose-dependent manner with a 1.6-fold increase in the incidence of AKI with each additional gram of intravenous dipyrone per day. Dipyrone dose of more than 2.5 g day was the best risk predictive cut-off for AKI. Patients receiving dipyrone on the ICU presented with a prolonged duration of vasopressor therapy.
Increasing dipyrone dosage is a potential independent risk factor for AKI in adult ICU patients and may prolong vasopressor therapy. Clinical evidence for a benefit of dipyrone therapy in the ICU is insufficient and needs further critical evaluation.
由于缺乏权衡双氯芬酸益处与潜在危及生命的并发症的可靠证据，双氯芬酸（麦角胺）在围手术期和 ICU 疼痛治疗中的使用仍存在争议。尽管双氯芬酸具有已知的镇痛和解热作用，但它的作用机制尚不完全清楚。尽管双氯芬酸对肾血管扩张性前列腺素合成的作用已得到证实，但对其潜在的肾副作用知之甚少，特别是在重症监护环境中。
研究易发生急性肾损伤（AKI）的围手术期患者双氯芬酸的肾毒性。
回顾性队列研究。
2013 年 1 月至 2013 年 6 月，在一家三级转诊医院进行的单中心研究。
共纳入 500 例年龄在 18 岁及以上的连续患者，转入麻醉 ICU。如果患者从其他 ICU 转入或转出、因复苏后护理而转入，或重复转入 ICU，则将其排除在外。
AKI 的发生率，根据肾脏病：改善全球结果急性肾损伤工作组的标准定义，以及血管加压素治疗的持续时间。
双氯芬酸的使用与 AKI 的发生率呈剂量依赖性增加，每天每增加 1 克静脉注射双氯芬酸，AKI 的发生率增加 1.6 倍。双氯芬酸剂量超过 2.5 g/天是 AKI 的最佳风险预测截断值。在 ICU 接受双氯芬酸治疗的患者血管加压素治疗时间延长。
在成人 ICU 患者中，增加双氯芬酸的剂量是 AKI 的一个潜在独立危险因素，可能会延长血管加压素的治疗时间。双氯芬酸治疗 ICU 患者的临床证据不足，需要进一步进行严格评估。
