镇静剂量用于快速序列输管和输管后低血压:是否存在关联?
Brian E Driver1, Stacy A Trent2, Matthew E Prekker3
1Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Annals of emergency medicine
|June 30, 2023
概括
对于接受快速序列输管的患者,这项研究发现埃托米达或胺剂量与输管后低血压之间没有联系. 降低镇静剂剂量可能不必要,以防止低血压在这些关键情况下.
科学领域:
- 紧急医疗 紧急医疗
- 药理学 药理学是指药理学的学科.
- 关键的护理关键的护理
背景情况:
- 专家经常建议在血液动力学不稳定的患者的快速序列输管过程中减少镇静剂剂量.
- 然而,有限的证据支持这种做法,特别是对于埃托米达和胺.
- 在这种患者群体中,输管后低血压是一个重大问题.
研究的目的:
- 调查以体重为基础的埃托米达或胺剂量与输管后低血压的发生之间的关联.
- 为在接受输管治疗的重症患者中提供基于证据的镇静剂剂量指导.
主要方法:
- 从国家紧急航空航道登记处 (2016-2018) 分析数据.
- 包括成人患者 (≥14岁) 在第一次输管试验中接受埃托米达或胺.
- 多变量逻辑回归用于评估药物剂量 (mg/kg) 与输管后低血压 (静缩血压<100 mm Hg) 之间的独立关联.
主要成果:
- 分析了12175个埃托米达和1849个胺接触.
- 埃托米达剂量 (aOR 0.95,95% CI 0.90-1.01) 和胺剂量 (aOR 0.97,95% CI 0.81-1.17) 都没有独立地与输管后低血压相关.
- 敏感性分析证实了这些发现,即使排除了先前低血压患者或因休克而被直管患者.
结论:
- 在一个大型注册表中,基于体重的埃托米达和胺镇静剂剂量与输管后低血压无关.
- 目前专家建议减少镇静剂剂量以保持血液动力学稳定性,可能需要对这些药物进行重新评估.
- 进一步的研究可以探索其他影响输管后低血压的因素.
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