咪达唑仑联合氯胺酮急诊危重患者气管插管镇静对血压的影响  

Midazolam combined ketamine sedation in emergency intubation in critically ill patients and its effect on blood pressure

作　　者：杨明全[1] 郑刚[1] 周传正[1] 周洁[1] 曹建伟[1] 肖国辉[1] 李强[1] 谭小飞[1] 

机构地区：[1]自贡市第一人民医院重症医学科,四川自贡643000

出　　处：《中国急救医学》2013年第4期326-329,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的研究咪达唑仑联合氯胺酮急诊危重患者气管插管镇静对血压的影响。方法急诊危重需要紧急气管插管患者81例，随机分成咪达唑仑＋芬太尼（MF，n=41）组和咪达唑仑＋氯胺酮（MK，n=40）组；气管插管前咪达唑仑0．05mg／kg静脉注入，之后MF组芬太尼1～2μg/kg静脉注入，MK组氯胺酮0．5—1mg／kg静脉注入，待患者达镇静状态后实施气管插管。记录入室时、插管前和插管后10min、插管后60min的SBP、DBP、MAP、HR的变化，以插管后10min为观察点，观察低血压的发生情况。结果MK组咪达唑仑用量明显少于MF组，差异有统计学意义（P〈0．01）。MK组和MF组血压均有下降，SBP、DBP、MAP插管前后对照差异有统计学意义（P〈0．01）。组间比较，血压下降以MF组更明显，插管后SBP比较有统计学意义（P〈0．05）；MAP和DBP差异无统计学意义（P〉0．05）。诱导插管后两组HR均有减慢，差异有统计学意义（MF组P〈0．01，MK组P〈0．05），组间比较差异无统计学意义（P〉0．05）。血压下降幅度以MF组SBP最显著，组间比较差异有统计学意义（P〈0．05）。DBP下降幅度两组相似，差异无统计学意义（P〉0．05）。插管后10minMF组有17例低血压，MK组有8例低血压，其低血压发生率分别为MF组为41．46％，MK组为20％，组间比较有统计学差异（P〈0．05）。住ICU天数及28d死亡率两组相似，差异无统计学意义（P〉0．05）。结论急诊危重患者气管插管氯胺酮镇静可降低咪达唑仑所致低血压的发生率。Objective To study the effects of midazolam combined with ketamine sedation in emergency intubation in critically ill patients and its effect on blood pressure. Methods The 81 critical patients who were admitted to the ICU were randomly assigned by a computerised random - number generator list to receive 0.05 mg/kg of midazolam ＋ 1 - 2 μg/kg of fentanyl （ MF group, n = 41 ） or 0.05 mg/kg of midazolam ＋ 0.5 - 1 mg/kg of ketamine （ MK group, n = 40） for intubation. Record SBP, DBP, MAP, HR changes when entering ICU, before intubation and 10 rain, 60 min after intubation, to observation of hypotension of occurrence 10 min after intubation. Results In group MK midazolam dosage was lower than that in MF group, there was statistically significant difference （P 〈 0. 01 ）. MK group and MF group were decreased blood pressure, SBP, DBP, MAP intubation before and after the statistical differences were significant （P 〈 0. O1 ）. Comparison between groups, blood pressure decreased in MF group was more significant, SBP after intubation compared with statistical significance （ P 〈 0.05 ） ; MAP and DBP difference does not have statistical difference （ P 〉 0.05 ）. After intubation in two groups of HR were decreased, and there was significant difference （P 〈 0. 01, MF group, MK group, P 〈 0.05 ）. But there were no statistical differences （ P 〉 0. 05 ）. Pressure drop in MF group SBP significantly, compared between groups with significant difference （ P 〈 0. 05 ）. DBP decline was similar in the two groups, no statistical difference （ P 〉 O. 05 ）. 10 rain after intubation of 17 cases with hypotension in group MF, 8 cases with hypotension in group MK, the incidence of hypotension were 41.46% in MF group, MK group was 20%, there was a statistically significant difference between groups （P 〈 0.05）. For ICU days and the 28 d mortality was similar in the two groups, no statistical difference （ P 〉 0.05 ）. Conclusion Emergency intubation in critically ill patients wi

关 键 词：氯胺酮 咪达唑仑 气管插管 急诊 低血压 

分 类 号：R459.7[医药卫生—急诊医学]