Study on Ketorolac for Improving Outcomes and Prognosis in Patients With Stanford Type A Aortic Dissection

The composite endpoint includes death (the worst outcome); malperfusion syndrome (including myocardial ischemia, stroke, lower limb paralysis, acute abdominal syndrome, renal failure requiring temporary dialysis, or symptoms and signs of limb ischemia); permanent dialysis, tracheostomy, or neurological deficits at discharge; postoperative mechanical circulatory support or unplanned cardiac reoperation (excluding reoperation for bleeding); postoperative cardiac arrest, multiple organ failure, or mechanical ventilation support for more than 72 hours; and postoperative hospital stay of 91 days or longer.

erythrocyte sedimentation rate (ESR), an indicator of systemic inflammation that reflects the rate at which red blood cells settle in a vertical tube over a specified period. Elevated ESR levels may suggest ongoing inflammatory responses, infection, or tissue injury

The perioperative use of opioids such as fentanyl and remifentanil is also assessed

C-reactive protein (CRP), an acute-phase protein synthesized by the liver that rises rapidly in response to infection, inflammation, or tissue injury. CRP serves as a sensitive biomarker of systemic inflammatory response and will be used to assess the perioperative inflammatory status in patients with Stanford Type A aortic dissection.

interleukin-6 (IL-6), a pro-inflammatory cytokine produced by various cells in response to tissue injury, infection, or stress. IL-6 plays a key role in the acute-phase inflammatory response and is closely associated with the severity of systemic inflammation.

A Complete Blood Count (CBC) is a common blood test that evaluates overall health and detects a wide range of disorders, including infections, anemia, and leukemia. It measures several components and features of the blood

Procalcitonin (PCT) is a protein precursor of the hormone calcitonin, which is involved in calcium metabolism. Normally, PCT is produced in the thyroid C cells and is present in very low levels in the blood. However, during severe bacterial infections, levels rise significantly, making it a useful biomarker for diagnosing and monitoring bacterial infections, sepsis, and guiding antibiotic therapy.

Prothrombin Time (PT) is a blood test that measures how long it takes for plasma to clot after adding thromboplastin (a reagent that activates the extrinsic pathway of coagulation). It evaluates the function of the extrinsic pathway (Factor VII) and common pathway (Factors X, V, II, and fibrinogen).

Activated Partial Thromboplastin Time (aPTT) is a fundamental coagulation test that measures the time required for plasma to clot after activation of the intrinsic pathway. This test evaluates the functionality of all coagulation factors except Factor VII and XIII.

Platelet function refers to the ability of platelets to participate in hemostasis through adhesion, activation, aggregation, and procoagulant activity. Proper platelet function is essential for primary hemostasis and vascular repair.

Alanine Aminotransferase (ALT), also known as serum glutamate-pyruvate transaminase (SGPT), is a liver enzyme primarily found in hepatocytes. It plays a key role in amino acid metabolism by catalyzing the transfer of an amino group from alanine to α-ketoglutarate, producing pyruvate and glutamate.

Creatinine is a waste product generated from the breakdown of creatine phosphate in muscles. It is filtered by the kidneys and excreted in urine, making it a key marker for kidney function.

Creatine Kinase (CK), also known as Creatine Phosphokinase (CPK), is an enzyme that plays a critical role in cellular energy metabolism. It catalyzes the conversion of creatine + ATP ↔ phosphocreatine + ADP, providing rapid energy for muscle contraction.

Cardiopulmonary Bypass (CPB) Time refers to the duration (in minutes) during which a patient's circulatory and respiratory functions are temporarily supported by a heart-lung machine during cardiac surgery. This allows surgeons to operate on a still, bloodless heart.

Total Surgical Duration refers to the entire time from skin incision to wound closure during a surgical procedure. It is a critical metric in perioperative medicine, influencing patient outcomes, resource utilization, and surgical team performance.

Postoperative drainage refers to the fluid collected from surgical sites via drains, providing critical information about healing and complications. Monitoring its volume and characteristics helps guide clinical decisions.

Transfusion requirements refer to the amount and type of blood products needed during or after surgery to maintain adequate oxygenation, hemostasis, and hemodynamic stability. The volume transfused depends on blood loss, preoperative anemia, and patient physiology.

Postoperative sternal infection (PSI) refers to surgical site infections involving the sternum after cardiac or thoracic surgery, particularly following median sternotomy. These infections range from superficial wound complications to life-threatening mediastinitis.

Incidence: 20-40% of surgical patients experience inadequately controlled pain requiring rescue analgesia.

Risk Factors:

Major surgery (e.g., orthopedic, abdominal)

Preoperative opioid use

Younger age

Nausea is an unpleasant, subjective sensation of impending vomiting, often accompanied by autonomic symptoms like pallor, sweating, and increased salivation. As a common postoperative complication, it represents a significant challenge in perioperative care.

Vomiting (emesis) is the forceful expulsion of gastric contents through the mouth resulting from coordinated contractions of the abdominal, thoracic, and gastrointestinal musculature. As a protective reflex mediated by the brainstem, it serves to eliminate harmful substances but becomes clinically significant when occurring postoperatively or pathologically.

Gastrointestinal (GI) discomfort refers to a spectrum of subjective abdominal symptoms occurring postoperatively, distinct from nausea/vomiting. This nonspecific symptom complex affects 15-40% of surgical patients and significantly impacts recovery trajectories.

imaging-based radiomics and biomechanical analyses from CTA and other modalities are used to evaluate aortic tissue density

maging-based radiomics and biomechanical analyses from CTA and other modalities are used to evaluate aortic tissue strength

imaging-based radiomics and biomechanical analyses from CTA and other modalities are used to evaluate abnormal blood flow

Survival rate refers to the percentage of patients who remain alive for a specified period after diagnosis or treatment of a disease. It is a key metric in evaluating treatment efficacy, disease prognosis, and healthcare outcomes.

NYHA classification is a widely used system to categorize the severity of heart failure symptoms based on a patient's physical limitations. It helps clinicians assess disease progression, guide treatment decisions, and predict outcomes.