Van Berkel Megan A, Exline Matthew C, Cape Kari M, Ryder Lindsay P, Phillips Gary, Ali Naeem A, Doepker Bruce A
Department of Pharmacy, Methodist LeBohneur Healthcare- University Hospital, 1265 Union Ave., Memphis, TN 38104.
Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, 201 Davis Heart & Lung Research Institute, 473 West 12th Ave, Columbus, OH 43210.
J Crit Care. 2017 Apr;38:209-214. doi: 10.1016/j.jcrc.2016.11.009. Epub 2016 Nov 15.
This study compared the incidence of clinical hypotension between ketamine and etomidate within a 24 hour period following endotracheal intubation.
This single-center, retrospective propensity-matched cohort study included septic patients admitted to our medical intensive care unit who received either etomidate or ketamine for intubation. Clinical hypotension was defined as any one of the following: mean arterial pressure (MAP) decrease >40% compared to baseline and MAP <70 mmHg, MAP <60 mmHg, initiation of a vasopressor, or increase to >30% of the initial vasopressor dose.
Patients were matched based on propensity scores determined by demographics and baseline characteristics. A total of 384 (200 etomidate and 184 ketamine) patients were included for analysis with 230 patients (115 in each group) matched. Clinical hypotension was less prevalent in patients who received ketamine as compared to etomidate [51.3% vs. 73% (odds ratio=0.39, 95% confidence interval=0.22-0.67, P=.001]. The etomidate group experienced significantly lower MAPs at time periods 6.1-12 hours (65.1 mmHg vs. 69.3 mmHg, P=.01) and 12.1-24 hours (63.9 mmHg vs. 68.4 mmHg, P=.003).
Ketamine was associated with a lower incidence of clinical hypotension within the 24 hour period following endotracheal intubation in septic patients.
本研究比较了气管插管后24小时内氯胺酮和依托咪酯引起临床低血压的发生率。
这项单中心回顾性倾向匹配队列研究纳入了入住我院医学重症监护病房、因插管接受依托咪酯或氯胺酮治疗的脓毒症患者。临床低血压定义为以下任何一种情况：平均动脉压（MAP）较基线下降>40%且MAP<70 mmHg，MAP<60 mmHg，开始使用血管升压药，或血管升压药初始剂量增加>30%。
根据人口统计学和基线特征确定的倾向得分对患者进行匹配。共有384例患者（200例使用依托咪酯，184例使用氯胺酮）纳入分析，其中230例患者（每组115例）匹配成功。与依托咪酯相比，接受氯胺酮治疗的患者临床低血压发生率较低[51.3%对73%（优势比=0.39，95%置信区间=0.22-0.67，P=0.001）]。依托咪酯组在6.1-12小时（65.1 mmHg对69.3 mmHg，P=0.01）和12.1-24小时（63.9 mmHg对68.4 mmHg，P=0.003）时的MAP显著较低。
在脓毒症患者气管插管后的24小时内，氯胺酮与较低的临床低血压发生率相关。
