氯胺酮和芬太尼在院前急诊插管中对血流动力学的影响

本文由“罂粟花”授权转载   氯胺酮和芬太尼在院前急诊插管中对血流动力学的影响  

贵州医科大学    麻醉与心脏电生理课题组

翻译：马艳燕

编辑：宋雨婷

审校：曹莹

背景

氯胺酮用于快速序贯插管(RSI)在院前急诊插管(PHARM)中很常见，并且与潜在的血流动力学不良改变有关，这种不良反应可以通过同时使用芬太尼来改善。

目的

描述芬太尼与氯胺酮在可随意使用时联合使用的频率，并探索其使用过程中观察到的血流动力学变化。

方法

这是一项回顾性观察研究，纳入了2015年至2019年间在PHARM下应用氯胺酮±芬太尼进行RSI的800多名患者。主要结局指标是每组患者在麻醉诱导后10分钟内，经基础血压调整后收缩压(SBP)超出预先指定目标范围患者的比率。

结果

876名患者用氯胺酮麻醉，纳入其中804人进行分析。669例(83%，95%CI 80%-86%)单用氯胺酮，135例(17%，95%CI 14%-20%)同时应用芬太尼和氯胺酮。芬太尼的平均剂量为1.1 mcg/kg(IQR 0.75-1.5 mcg/kg)。多因素Logistic回归分析显示，使用芬太尼与麻醉诱导时和插管后SBP一致相关，但与主要结局指标(OR 1.08；95%CI 0.72-1.60)、高血压(OR 1.35；95%CI 0.88-2.07)或低血压(OR 0.76；95%CI 0.47-1.21)无关。

结论

在氯胺酮中加入芬太尼用于RSI并不会改变麻醉诱导后血流动力学稳定的几率，然而芬太尼使用的剂量很低。这些发现证明有必要进一步研究在院前急诊中RSI期间芬太尼使用的最佳剂量。

原始文献来源：

Ferguson IMC, Miller MR, Partyka C, Bliss J, Aneman A, Harris IA. The effect of ketamine and fentanyl on haemodynamics during intubation in prehospital and retrieval medicine. Acta Anaesthesiol Scand. 2022 Dec 10. doi: 10.1111/aas.14177.

英文原文：

The effect of ketamine and fentanyl on haemodynamics during intubation in prehospital and retrieval medicine

Background: Ketamine use for rapid sequence intubation (RSI) is frequent in pre-hospital and retrieval medicine (PHARM) and is associated with potentially deleterious hemodynamic changes, which may be ameliorated by concurrent use of fentanyl. 

Objectives: To describe the frequency with which fentanyl is used in conjunction with ketamine in a system where its use is discretionary, and to explore any observed changes in hemodynamics with its use. 

Methods: A retrospective observational study of over 800 patients undergoing RSI with ketamine ± fentanyl in the PHARM setting between 2015 and 2019. The primary outcome was the proportion of patients in each group who had a systolic blood pressure (SBP) outside a pre-specified target range, with adjustment for baseline abnormality, within 10 minutes of anaesthetic induction. 

Results: 876 patients were anaesthetised with ketamine, of whom 804 were included in the analysis. 669 (83%, 95% CI 80-86%) received ketamine alone, and 135 (17%, 95% CI 14-20%) received both fentanyl and ketamine. Median fentanyl dose was 1.1 mcg/kg (IQR 0.75 - 1.5 mcg/kg). Systolic blood pressure (SBP) at induction was consistently associated with SBP after intubation in multivariable logistic regression, but fentanyl use was not associated with a change in odds of meeting the primary outcome (OR 1.08; 95% CI 0.72-1.60), becoming hypertensive (OR 1.35; 95% CI 0.88-2.07) or hypotensive (OR 0.76; 95% CI 0.47-1.21). 

Conclusions: The addition of fentanyl to ketamine for RSI was not associated with an alteration of the odds of post-induction hemodynamic stability, although the doses used were low. These findings justify further study into the optimal dosing of fentanyl during RSI in pre-hospital and retrieval medicine. 

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编辑：MiSuper.米超

校对：Michel.米萱

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