Objective To compare the incidence of hypotension after intubation induced by etomidate or ketamine in ICU patients with sepsis. Methods A retrospective study was conducted in this study. The clinical data of 464 patients with sepsis treated with ICU in our hospital were selected. All patients were intubated for the first time and induced with ketamine or etomidate. According to the difference inducer,the patients were divided into the etomidate group and the ketamine group. Tendency scores were used to adjust baseline differences between the two groups. The mean arterial pressure (MAP) values of the patients were recorded before intubation,0~1 h,1~6 h,6~12 h and 12~24 h after intubation. The incidence of clinical hypotension was compared between the two groups after 24 hours of intubation. Results After adjustment,135 patients were enrolled in the etomidate group and the ketamine group. Compared with the ketamine group, the incidence of hypotension in the etomidate group was significantly higher[72.6% (98/135) vs. 51.1% (69/135), χ2=13.201, P<0.001]. The MAP values of 6~12 h[(65.98 ± 13.26) mm Hg vs. (69.34 ± 16.95) mm Hg, t=2.246, P=0.026] and 12~24 h[(63.90 ± 13.35) mm Hg vs. (68.47 ± 15.71)mm Hg,t=2.576,P=0.011] in the etomidate group were significantly lower than those in the ketamine group, the difference was statistically significant. Conclusion Inoculation with etomidate can significantly increase the incidence of clinical hypotension in patients with sepsis compared with ketamine. And ketamine has a positive effect on hemodynamics,is a substitute for etomidate for sepsis patients with tracheal intubation agent.%目的 评价ICU治疗的脓毒症患者进行依托咪酯或氯胺酮麻醉诱导插管后低血压的发生率.方法 本研究为回顾性研究,收集2012-06~2017-05在我院ICU治疗的464例脓毒症患者临床资料,所有患者均为第一次插管并使用氯胺酮或依托咪酯诱导.根据患者使用麻醉药物的不同,将患者分为依托咪酯组与氯胺酮组,采用倾向评分以调整两组患者基线差异.记录插管前,插管后0~1 h、1~6 h、6~12 h和12~24 h时患者的MAP值,比较插管24 h后两组患者临床低血压发生率.结果 调整后依托咪酯组与氯胺酮组各纳入135例患者,与氯胺酮组比较,依托咪酯组在插管后24 h低血压发生率明显提高[72.6%(98/135) vs.51.1%(69/135), χ2=13.201,P<0.001].依托咪酯组患者6~12 h[(65.18 ± 13.26) mm Hg vs.(69.34 ± 16.95) mm Hg,t=2.246,P=0.026]与12~24 h[(63.90 ± 13.35) mm Hg vs. (68.47 ± 15.71) mm Hg,t=2.576,P=0.011] MAP值均较氯胺酮组明显降低,差异有统计学意义.结论 与氯胺酮比较,依托咪酯诱导插管可明显提高患者临床低血压发生率.而氯胺酮对血流动力学有积极的影响,是一种可以代替依托咪酯用于脓毒症患者的气管插管诱导剂.
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