急性呼吸衰竭患者氯胺酮和咪达唑仑诱导抢救性气管插管的临床评价  

Clinical Evaluation of Induced Rescue Intubation by Ketamine and Midazolam in Patients with Respiratory Failure

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

机构地区：[1]自贡市第一人民医院ICU,四川自贡643000

出　　处：《中国呼吸与危重监护杂志》2013年第5期477-480,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的对急性呼吸衰竭患者氯胺酮和咪达唑仑诱导抢救性气管插管进行临床评价。方法急性呼吸衰竭抢救性气管插管患者81例,随机分成MF(咪达唑仑+芬太尼)组(n=41)和MK(咪达唑仑+氯胺酮)组(n=40)诱导麻醉实施气管插管。记录患者插管前及插管10 min后BP、HR、RR及SpO2的绝对差值、入ICU最初24 h的APACHEⅡ评分、入住ICU时间、28 d病死率、低血压等不良事件及困难气管插管的发生率,进行安全评价。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)。血压下降以MF组SBP(收缩压)下降最显著,组间比较差异有统计学意义(P<0.05)。低血压发生率MF组(41.5%)与MK组(20.0%)比较有显著差异(P<0.05)。低血压与咪达唑仑用量无相关性(r=-0.147,P=0.192)。其他不良事件除心律失常两组比较有显著差异(P<0.05)外,其余无显著差异(P>0.05)。入住ICU时间及28 d病死率两组相似(P>0.05)。困难气管插管两组患者均近半数,无显著差异(P>0.05)。结论急性呼吸衰竭患者氯胺酮诱导抢救性气管插管能减少咪达唑仑用量,降低其低血压发生率,气管插管并发症未见增加,临床实施具有可行性。氯胺酮诱导气管插管最适剂量需要进一步研究。Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure. Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0.05 mg/kg of midazolam ＋ 1 to 2 μg/kg of fentany] （ n = 41 ） , and a MK group to received 0.05 mg/kg of midazolam ＋ 0.5 to 1 mg/kg of ketamine （ n = 40） for rescue intubation. The APACHE Ⅱ score on initial 24 hours after admission in ICU,length of ICU stay,and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded. Results The midazolam close in the MK group was significantly less than that in the MF group （ P 〈 0. 01 ）. The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group （ P 〈 0. 05 ）. The incidence of hypotension was 41.5% in the MF group, significantly higher than that in the MK group （20. 0% ,P 〈 0. 05 ）. The incidence of hypotension had no correlation with midazolam dosage （ P 〉 0. 05 ）. There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups （ P 〉 0. 05 ）. The incidence of difficult tracheal intubation was nearly 50% in both groups. Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the close of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.

关 键 词：急性呼吸衰竭 氯胺酮 咪达唑仑 气管插管 并发症 

分 类 号：R614[医药卫生—麻醉学]