氯胺酮降低咪达唑仑诱导急诊危重患者气管插管对血压的影响

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0．05mg／kg静脉注入，然后MF组芬太尼2μg／kg静脉注入，MK组氯胺酮O．5mg／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10min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（x2=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。

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

Objective To study whether ketamine can reduce the influence of midazolam-induced emergency intubation in critically ill patients on blood pressure. Methods In this randomized, controlled, and single-blind trial, 56 patients were randomly assigned by a computerized random-number generator list to receive 0.05mg/kg of midazolam＋0.2 ug/kg of fentanyl （MF group, n=29） or 0.05mg/kg of midazolam ＋ 0.5 mg/kg of ketamine （MK group, n=27） for intubation. We recorded SBP, DBP, MAP, and HR changes, and observed the occurrence of hypotension before patients took the drugs and 10 minutes after intubation. Results The blood pressure fell in MF group more significantly （P 〈 0.01） after intubation with application of drugs. The incidence of hypotension was 51.7% in MF group, and 18.5% in MK group. The two groups showed a very significant difference （3（2=6.715, P=-0.01）. Conclusion Application of ketamine for emergency intubation in critically ill patients can reduce the incidence of hypotension induced by midazolam.