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 fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 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 midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;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 gt; 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 dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
目的 研究氯胺酮能否降低咪達唑侖誘導急診危重患者氣管插管對血壓的影響。 方法 將2010年6月－2011年12月收治的56例急診危重呼吸衰竭成年患者，隨機分成咪達唑侖+芬太尼（MF）組和咪達唑侖+氯胺酮（MK）組，氣管插管前咪達唑侖0.05 mg/kg靜脈注入，然后MF組芬太尼2 μg/kg靜脈注入，MK組氯胺酮0.5 mg/kg靜脈注入，待患者達鎮靜狀態后實施氣管插管。記錄用藥前和插管后10 min的收縮壓（SBP）、舒張壓（DBP）、平均動脈壓（MAP）、心率（HR）的變化，觀察低血壓的發生情況。 結果 實施藥物誘導氣管插管后血壓下降以MF組更明顯（P＜0.01）。低血壓發生率MF組為51.7%，MK組為18.5%，兩組比較差異有統計學意義（χ2=6.715，P=0.01）。 結論 急診危重患者氣管插管應用氯胺酮可減少咪達唑侖所致低血壓的發生率。