Прием нестероидных противовоспалительных препаратов для обезболивания при травмах: есть ли риск нарушения костного метаболизма и несращения переломов костей?

Согласно экспериментальным исследованиям, нестероидные противовоспалительные препараты (НПВП) могут снижать темпы репаративных процессов и нарушать восстановление костной ткани после переломов. Значение этого эффекта НПВП для реальной клинической практики является предметом дискуссии. Нами был проведен анализ публикаций по проблеме несращения или развития переломов на фоне приема НПВП, представленных в системах PubMed и MEDLINE. С 1976 по 2021 г. было опубликовано 75 работ по данной теме, 19 из которых представляли наблюдательные, когортные и рандомизированные контролируемые исследования и исследования «случай – контроль», 4 – метаанализы. По данным метаанализов, включавших от 6 до 16 исследований, имелась ассоциация между приемом НПВП и несращением костей после переломов или послеоперационной травмы: отношение шансов от 2,07 (95%-й доверительный интервал (95% ДИ): 1,19–3,61) до 5,27 (95% ДИ: 2,34–11,88). Ряд крупных исследований подтверждают повышение риска несращения переломов и развития «маршевых» переломов у пациентов, получавших НПВП. Риск несращения был повышен при использовании НПВП более 2 недель и в высоких дозах. При кратковременном применении НПВП (менее 2 недель) и использовании этих препаратов в педиатрической практике частота нарушений репарации костной ткани не повышалась. 

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