非甾体类抗炎药在围术期使用的心血管事件风险的Meta分析

Risk of cardiovascular events in the use of nonsteroidal anti-inflammatory drugs during the perioperative period:a meta-analysis

目的评价在围术期使用非甾体类抗炎药(NSAIDs)的心血管不良事件的风险。方法计算机检索PubMed、Web of Science、Medline、Cochrane Library、CNKI和万方数据库中正式发表的中英文文献,收集NSAIDs在围术期使用的随机对照试验(RCT),前瞻性队列研究和回顾性研究等,通过心血管不良事件(心肌梗死、心绞痛、心肌缺血、心律失常)的发生情况来评价NSAIDs的心血管不良事件的风险。结果共纳入8篇文献15 623例患者,其中非选择性NSAIDs文献有5篇(n=13 019),选择性环氧化酶-2(COX-2)抑制剂文献有3篇(n=2 604)。NSAIDs在围术期使用减少了心血管不良事件的发生(OR=0.59,95%CI 0.45~0.77,P=0.000 1),非选择性NSAIDs在围术期使用减少了心血管不良事件的发生(OR=0.42,95%CI 0.31~0.58,P<0.001),选择性COX-2抑制剂在围术期或短期使用增加了心血管不良事件的发生(OR=2.53,95%CI 1.26~5.09,P=0.009)。结论具有心血管风险的患者围术期建议使用非选择性NSAIDs。

Objective To evaluate the risk of cardiovascular adverse events using nonsteroidal anti-inflammatory drugs during the perioperative period. Methods A systematic review of formally published in English and Chinese literature was conducted by using computerized database on PubMed, Web of Science, Medline, Cochrane Library, CNKI and Wanfang database. The literature about controlled clinical study of nonsteroidal anti-inflammatory drugs in perioperative use, a prospective cohort study and a retrospective review were collected. The cardiovascular risk was evaluated by the number of adverse cardiovascular events cases （myocardial infarction, angina, myocardial ischemia, arrhythmia） occurred during the period of drug use. The relevant data was extracted and their heterogeneity was tested. Results A total of 8 articles including 15 623 patients met the inclusion criteria, including 5 articles （n = 13 019） on non-selective nonsteroidal anti-inflammatory drugs, and 3 articles （n=2 604） about selective （cyclooxygenase 2） COX-2 inhibitors. Nonsteroidal anti-inflammatory drugs used in the perioperative or a short term would reduce the risk of adverse cardiovascular events （OR = 0. 59, 95 % CI 0. 45-0. 77, P = 0. 000 1）, non-selective nonsteroidal anti-inflammatory drugs using in the perioperative or a short term would reduce the risk of adverse cardiovascular events, the difference being statistically significant （OR=0. 42, 95%CI 0.31-0. 58, P〈0. 001）. A selective COX-2 inhibitor using in the perioperative or short-term might increase cardiovascular adverse events （OR=2. 53, 95%CI 1.26-5.09, P=0. 009）. Conclusion Non-selective nonsteroidal anti-inflammatory drugs should be chosen for patients at high risk of adverse cardiovascular events during the perioperative period.