Ekeløf N P, Olsen N V, Ording H
Anaestesiologisk afdeling I, Amtssygehuset i Herlev.
Ugeskr Laeger. 1995 May 8;157(19):2703-7.
Non-steroidal anti-inflammatory drugs (NSAID) are now commonly used in the treatment of postoperative pain. In normovolaemic conditions, prostaglandins do not seem to play a substantial role in maintaining renal function. However, numerous studies have shown that during activation of vasoconstrictor systems the synthesis of renal prostaglandins counteracts the vasoconstrictor effects and thereby maintains renal function. In animals, renal blood flow and GFR are markedly decreased when an NSAID is administered in the presence of renal hypoperfusion. Major surgery decreases renal function secondary to stimulation of the adrenosympathetic system and the renin-angiotensin system, and it has previously been demonstrated that maintenance of renal blood flow during laparotomy in dogs depends on an intact prostaglandin synthesis. Perioperative effects of NSAIDs are only sparsely investigated in humans, and studies on the effect on renal haemodynamics have not been presented. As in unanaesthetized volunteers, NSAID have been found to decrease the postoperative excretion of water, sodium and potassium. It therefore still remains unclarified whether general anaesthesia and surgery increase the risk of renal side effects of NSAIDs. Because of the potential risk of peri- and postoperative complications that may further deteriorate renal function, NSAIDs should not be used preoperatively, and not in patients in unstable haemodynamic states.
非甾体抗炎药（NSAID）目前常用于术后疼痛的治疗。在血容量正常的情况下，前列腺素似乎在维持肾功能方面不起重要作用。然而，大量研究表明，在血管收缩系统激活期间，肾前列腺素的合成可抵消血管收缩作用，从而维持肾功能。在动物中，当在肾灌注不足的情况下给予NSAID时，肾血流量和肾小球滤过率会显著降低。大手术会因刺激肾上腺交感神经系统和肾素-血管紧张素系统而导致肾功能下降，此前已有研究表明，犬类开腹手术期间肾血流量的维持依赖于完整的前列腺素合成。NSAID的围手术期效应在人类中研究较少，且尚未有关于其对肾血流动力学影响的研究报道。与未麻醉的志愿者情况一样，已发现NSAID会减少术后水、钠和钾的排泄。因此，全身麻醉和手术是否会增加NSAID肾副作用的风险仍不明确。由于围手术期和术后并发症可能进一步损害肾功能的潜在风险，NSAID不应在术前使用，也不应在血流动力学不稳定的患者中使用。
