Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia.
Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic, Australia.
Heart Lung Circ. 2024 Apr;33(4):538-542. doi: 10.1016/j.hlc.2023.12.018. Epub 2024 Mar 8.
The use of non-steroidal anti-inflammatory drugs (NSAID) in patients undergoing pleurodesis remains controversial. Although many surgeons are comfortable prescribing NSAIDs post-operatively, some oppose this practice due to concerns of suppressing the inflammatory response and quality of pleurodesis. Only a small body of inconsistent publications exists with respect to guiding therapy in this common clinical scenario.
A retrospective cohort study was undertaken assessing effect of NSAID exposure on pleurodesis outcomes. An institutional thoracic surgery database was reviewed yielding 147 patients who underwent pleurodesis for pneumothorax between 2010 and 2018. Medical records and imaging were reviewed for patient characteristics, NSAID exposure, recurrent pneumothorax and other adverse events.
There was no overall difference between rates of recurrence and procedural failure of pleurodesis (Relative Risk [RR] 1.67 [95% CI 0.74-3.77]). However, NSAID exposure of >48 hours was associated with increased risk of recurrent pneumothorax (RR 2.16 [95% CI 1.05-4.45]). There was no increased rate of other adverse events related to NSAID usage.
NSAID exposure does not increase failure rates or other adverse events following pleurodesis for pneumothorax. However, prolonged NSAID exposure post-pleurodesis may increase procedural failure rates. Further large volume randomised control trials are required.
在进行胸膜固定术的患者中使用非甾体抗炎药（NSAID）仍然存在争议。尽管许多外科医生在手术后都可以放心地开 NSAID，但由于担心抑制炎症反应和胸膜固定术的质量，有些外科医生则反对这种做法。关于在这种常见临床情况下指导治疗的仅有少量不一致的出版物。
进行了一项回顾性队列研究，评估了 NSAID 暴露对胸膜固定术结果的影响。回顾了机构胸外科数据库，该数据库中纳入了 2010 年至 2018 年间因气胸而行胸膜固定术的 147 例患者。对患者特征、NSAID 暴露、气胸复发和其他不良事件的医疗记录和影像学进行了回顾。
胸膜固定术的复发率和手术失败率之间没有总体差异（相对风险 [RR] 1.67 [95% CI 0.74-3.77]）。然而，NSAID 暴露时间>48 小时与气胸复发的风险增加相关（RR 2.16 [95% CI 1.05-4.45]）。NSAID 使用与其他不良事件的发生率增加无关。
NSAID 暴露不会增加气胸胸膜固定术后的失败率或其他不良事件。然而，胸膜固定术后长时间使用 NSAID 可能会增加手术失败率。需要进一步进行大样本随机对照试验。
