Ketamine Reduces the Influence of Midazolam-induced Emergency Intubation in Critically Ill Patients on Blood Pressure_West China Medical Journal

Authors：

YANG Mingquan , XIAO Guohui , LI Qang , ZHENG Gang , ZHOU Chuanzheng , ZHOU Jie , CAO Jianwei , TAN Xiaofei.

Intensive Care Unit, the First Peoples’ Hospital of Zigong City, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

Keywords：

氯胺酮; 咪达唑仑; 气管插管; 急诊; 低血压

DOI：

10.7507/1002-0179.20130178

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目的　研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。方法　将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。结果　实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。结论　急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。

Citation： YANG Mingquan,XIAO Guohui,LI Qang,ZHENG Gang,ZHOU Chuanzheng,ZHOU Jie,CAO Jianwei,TAN Xiaofei.. Ketamine Reduces the Influence of Midazolam-induced Emergency Intubation in Critically Ill Patients on Blood Pressure. West China Medical Journal, 2013, 28(4): 560-562. doi: 10.7507/1002-0179.20130178 Copy

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1. 　Reynolds SF, Heffner J. Airway management of the critically ill patient[J]. Chest, 2005, 1127(4): 1397-1412.
2. 　Li J, Murphy H, Bugas C, et al. Complications of emergency intubation with and without paralysis[J]. Am J Emerg Med, 1999, 17(2): 141-143.
3. 　Jacoby J, Heller M, Nicholas J, et al. Etomidate versus midazolam for out-of-hospital intubation: a prospective, randomized trial[J]. Ann Emerg Med, 2006, 47(6): 525-30.
4. 　Reynolds SF, Heffner J. Airway management of the critically ill patient: rapid-sequence intulation[J]. Chest, 2005, 127(4): 1397- 1412.
5. 　杨明全, 郑刚, 徐俊, 等, 咪达唑仑急诊诱导经鼻气管插管对血压的影响[J].中国误诊学杂志, 2006, 6(2): 236-237.
6. 　杨明全, 徐俊, 周洁.咪达唑仑用于急诊危重患者所致低血压的相关性分析[J]. 中国急救医学, 2007, 27(9): 840-842.
7. 　Choi YF, Wong TW, Lau CC. Midazolam is more likely to cause hypotension than etomidate in emergency department rapid sequence intubation[J]. Emerg Med J, 2004, 21(6): 700-702.
8. 　Jabre P, Combes X, Lapostolle F, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial[J]. Lancet, 2009, 374(9686): 293-300.
9. 　戴雄伟, 沈志忠, 范圣登. 咪唑安定对氯胺酮麻醉诱导的影响[J]. 临床麻醉学杂志, 2003, 19(8): 484-487.
10. 　庄心良, 曾因明, 陈伯銮.现代麻醉学[M]. 2版. 北京: 人民卫生出版社, 2003: 475-481.
11. 　安刚, 薜富善. 现代麻醉技术[M].北京: 科学技术文献出版社, 1999: 208-224.
12. 　王厚力, 赵静, 余学中. 急诊快速诱导插管药物对血压的影响[J].中国急救医学, 2003, 23(12): 856-858.

West China Medical Journal

Ketamine Reduces the Influence of Midazolam-induced Emergency Intubation in Critically Ill Patients on Blood Pressure

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