正反方辩论：依托咪酯在血流动力学不稳定的重症患者中是否安全？
Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients?
作者信息
Flynn Gordon, Shehabi Yahya
出版信息
Crit Care. 2012 Jul 19;16(4):227. doi: 10.1186/cc11242.
Abstract
Etomidate is an induction agent known for its smooth intubating conditions and cardiovascular stability. Studies, however, have shown that a single dose of etomidate can result in a prolonged adrenal insufficiency. The impact of this in patients with sepsis has been a matter for debate. This review presents a pro/con case for using etomidate in hemodynamically unstable critically ill patients and provides guidance for alternative induction techniques and when the use of etomidate might be justified despite these concerns.
摘要
依托咪酯是一种诱导剂，以其能产生平稳的插管条件和心血管稳定性而闻名。然而，研究表明，单次使用依托咪酯会导致肾上腺功能不全持续时间延长。其对脓毒症患者的影响一直是个有争议的问题。本综述针对血流动力学不稳定的危重症患者使用依托咪酯的利弊进行了分析，并就替代诱导技术以及尽管存在这些担忧但在何种情况下使用依托咪酯可能合理提供了指导。
相似文献
1
Pro/con debate: Is etomidate safe in hemodynamically unstable critically ill patients?正反方辩论：依托咪酯在血流动力学不稳定的重症患者中是否安全？
Crit Care. 2012 Jul 19;16(4):227. doi: 10.1186/cc11242.
2
Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock?: a critical appraisal.对于感染性休克患者，我们应该使用依托咪酯作为气管插管的诱导剂吗？：一项批判性评估。
Chest. 2005 Mar;127(3):1031-8. doi: 10.1378/chest.127.3.1031.
3
Etomidate for rapid sequence intubation in the emergency department: is adrenal suppression a concern?急诊科依托咪酯用于快速顺序诱导插管：肾上腺抑制是否值得关注？
CJEM. 2006 Sep;8(5):347-50. doi: 10.1017/s1481803500014044.
4
Clinical controversies: etomidate as an induction agent for endotracheal intubation in patients with sepsis: continue to use etomidate for intubation of patients with septic shock.临床争议：依托咪酯作为脓毒症患者气管插管的诱导剂：对于感染性休克患者，继续使用依托咪酯进行插管。
Ann Emerg Med. 2008 Jul;52(1):13-4. doi: 10.1016/j.annemergmed.2008.01.344.
5
Advantages and disadvantages of etomidate use for intubation of patients with sepsis.依托咪酯用于脓毒症患者插管的优缺点。
Pharmacotherapy. 2012 May;32(5):475-82. doi: 10.1002/j.1875-9114.2012.01027.x. Epub 2012 Apr 9.
6
Controversies surrounding the use of etomidate for rapid sequence intubation in patients with suspected sepsis.有关在疑似脓毒症患者中使用依托咪酯进行快速序贯插管的争议。
Ann Pharmacother. 2010 Jul-Aug;44(7-8):1307-13. doi: 10.1345/aph.1M664. Epub 2010 Jun 8.
7
Etomidate for intubation of patients who have sepsis or septic shock--where do we go from here?依托咪酯用于脓毒症或脓毒性休克患者的插管——我们接下来该何去何从？
Crit Care. 2012 Dec 27;16(6):189. doi: 10.1186/cc11889.
8
Etomidate, adrenal function, and mortality in critically ill patients.依托咪酯、肾上腺功能与危重症患者死亡率。
Respir Care. 2013 Apr;58(4):639-46. doi: 10.4187/respcare.01956.
9
Etomidate: not worth the risk in septic patients.依托咪酯：对脓毒症患者而言不值得冒险使用。
Ann Emerg Med. 2008 Jul;52(1):14-6. doi: 10.1016/j.annemergmed.2008.01.001.
10
Ketamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial.氯胺酮/丙泊酚混合剂与依托咪酯用于危重症患者插管：KEEP PACE 随机临床试验。
J Trauma Acute Care Surg. 2019 Oct;87(4):883-891. doi: 10.1097/TA.0000000000002448.
引用本文的文献
1
Shock in the post-operative ICU: the etomidate enigma.术后重症监护病房中的休克：依托咪酯之谜。
Anaesthesiol Intensive Ther. 2025 Jul 4;57(1):136-138. doi: 10.5114/ait/200293.
2
Exploring Ciprofol Alternatives: A Comprehensive Review of Intravenous Anesthesia Options.探索丙泊酚的替代药物：静脉麻醉选择的全面综述。
Cureus. 2024 Apr 4;16(4):e57581. doi: 10.7759/cureus.57581. eCollection 2024 Apr.
3
Current trends in emergency airway management: a clinical review.急诊气道管理的当前趋势：一项临床综述。
Clin Exp Emerg Med. 2024 Sep;11(3):243-258. doi: 10.15441/ceem.23.173. Epub 2024 Mar 15.
4
Comparison of the influence of low dose etomidate and propofol as priming dose on the incidence of etomidate induced myoclonus: a randomised, double-blind clinical trial.比较小剂量依托咪酯和丙泊酚作为预注剂量对依托咪酯诱发肌阵挛发生率的影响：一项随机、双盲临床试验。
Braz J Anesthesiol. 2022 Mar-Apr;72(2):261-266. doi: 10.1016/j.bjane.2021.02.047. Epub 2021 Apr 2.
5
[Different levels of experience with anesthetic agents of German emergency physicians : Results of an online survey].[德国急诊医生对麻醉剂的不同经验水平：一项在线调查的结果]
Anaesthesist. 2018 Jan;67(1):9-17. doi: 10.1007/s00101-017-0386-1. Epub 2017 Dec 5.
本文引用的文献
1
[Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients].[重大创伤中的急诊麻醉、气道管理与通气。重大创伤患者跨学科S3指南的背景与关键信息]
Anaesthesist. 2011 Nov;60(11):1027-40. doi: 10.1007/s00101-011-1957-1.
2
Pharmacological studies of methoxycarbonyl etomidate's carboxylic acid metabolite.甲氧羰基依托咪酯羧酸代谢物的药理学研究。
Anesth Analg. 2012 Aug;115(2):305-8. doi: 10.1213/ANE.0b013e318239c6ca. Epub 2011 Nov 3.
3
Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia.依托咪酯及其吡咯类似物卡泊依托咪酯对内毒素血症时肾上腺皮质和细胞因子反应的差异作用。
Crit Care Med. 2012 Jan;40(1):187-92. doi: 10.1097/CCM.0b013e31822d7924.
4
Corticosteroid after etomidate in critically ill patients: a randomized controlled trial.依托咪酯后给予皮质类固醇治疗危重症患者：一项随机对照试验。
Crit Care Med. 2012 Jan;40(1):29-35. doi: 10.1097/CCM.0b013e31822d7938.
5
Use of intravenous etomidate to control acute psychosis induced by the hypercortisolaemia in severe paediatric Cushing's disease.静脉注射依托咪酯控制小儿严重库欣病高皮质醇血症诱发的急性精神病。
Horm Res Paediatr. 2011;75(6):441-6. doi: 10.1159/000324419. Epub 2011 Mar 24.
6
The effect of etomidate on adrenal function in critical illness: a systematic review.依托咪酯对危重病患者肾上腺功能的影响：系统评价。
Intensive Care Med. 2011 Jun;37(6):901-10. doi: 10.1007/s00134-011-2160-1. Epub 2011 Mar 4.
7
Clinical and molecular pharmacology of etomidate.依托咪酯的临床与分子药理学。
Anesthesiology. 2011 Mar;114(3):695-707. doi: 10.1097/ALN.0b013e3181ff72b5.
8
Medical treatment of Cushing's syndrome: adrenal-blocking drugs and ketaconazole.库欣综合征的治疗：肾上腺阻断药物和酮康唑。
Neuroendocrinology. 2010;92 Suppl 1:111-5. doi: 10.1159/000314292. Epub 2010 Sep 10.
9
A comparison of the effects of etomidate and midazolam on hospital length of stay in patients with suspected sepsis: a prospective, randomized study.依托咪酯与咪达唑仑对疑似脓毒症患者住院时间影响的比较：一项前瞻性、随机研究。
Ann Emerg Med. 2010 Nov;56(5):481-9. doi: 10.1016/j.annemergmed.2010.05.034. Epub 2010 Sep 15.
10
Cardiac effects of induction agents in the septic rat heart.在脓毒症大鼠心脏中诱导剂的心脏效应。
Crit Care. 2009;13(5):R144. doi: 10.1186/cc8038. Epub 2009 Sep 8.
Zotero 插件