Derrier M, Mercatello A
Département d'anesthésie et de réanimation chirurgicale, hôpital de la Croix-Rousse, Lyon, France.
Ann Fr Anesth Reanim. 1997;16(5):498-520. doi: 10.1016/s0750-7658(97)83344-8.
Nonsteroidal antiinflammatory drugs (NSAIDs), including various chemical families of drugs, inhibit prostaglandin synthesis and act on the central nervous system. Prostaglandins are involved in regulation of regional circulations, cell turn-over in the gastrointestinal tract, and in primary haemostasis. The patterns of action of NSAIDs result in analgesic properties, but also in adverse effects. NSAIDs are increasingly used perioperatively, alone or associated with opioids or local anaesthetics, because of their analgesic and opioid sparing properties. Some of their adverse effects, especially ischaemic acute renal failure and gastrointestinal complications, can be life-threatening, and increased haemorrhagic risk is an issue for spinal or epidural anaesthesia in patients taking aspirin. Safe use of NSAIDs is possible in consideration of contraindications (elderly patient, hypovolaemia, cirrhosis, congestive heart failure, renal failure, active gastrointestinal ulcer, bleeding diathesis, pregnancy), and requires close monitoring of renal function if they must be used in patients at risk for renal failure. NSAIDs are not ulcerogenic in the short-term in healthy subjects. They must be used with caution in patients with a preexisting haemostatic defect or undergoing haemorrhagic surgical procedures.
非甾体抗炎药（NSAIDs），包括各种化学类别的药物，可抑制前列腺素合成并作用于中枢神经系统。前列腺素参与局部循环调节、胃肠道细胞更新以及初级止血过程。NSAIDs的作用方式使其具有镇痛特性，但也会产生不良反应。由于其镇痛和节省阿片类药物的特性，NSAIDs在围手术期越来越多地单独使用或与阿片类药物或局部麻醉药联合使用。它们的一些不良反应，尤其是缺血性急性肾衰竭和胃肠道并发症，可能危及生命，对于服用阿司匹林的患者，出血风险增加是脊髓或硬膜外麻醉的一个问题。考虑到禁忌证（老年患者、低血容量、肝硬化、充血性心力衰竭、肾衰竭、活动性胃溃疡、出血体质、妊娠），NSAIDs可以安全使用，如果必须在有肾衰竭风险的患者中使用，则需要密切监测肾功能。NSAIDs在健康受试者中短期内不会引起溃疡。对于有既往止血缺陷或正在接受出血性外科手术的患者，必须谨慎使用。
