依托咪酯与硫喷妥钠用于惊厥性癫痫持续状态患者快速序贯诱导气管插管的比较：回顾性、单中心研究
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Comparison of etomidate and sodium thiopental for induction during rapid sequence intubation in convulsive status epilepticus: A retrospective single-center study
背景与目的
与伴有惊厥性癫痫持续状态的危重患者和气管内插管方式相关的实验数据是极少的。本研究旨在探究依托咪酯与硫喷妥钠分别作为诱导剂用于院外惊厥性癫痫持续状态患者快速序贯诱导气管插管的比较。
方 法
对2006-2015年我院重症监护病房住院病人进行回顾性研究。本实验的主要观察指标为快速序贯诱导气管插管后12h内癫痫发作和/或癫痫持续状态复发情况。
结 果
本研究共纳入97例患者【男性占60%，平均年龄59岁，（IQR,48-70)】。从癫痫发作到首次抗癫痫药物使用的平均时间为60min（IQR，35–90）。插管原因分别为昏迷95例(98%)，急性呼吸窘迫18例(19%)，难治性惊厥性癫痫持续状态9例(9%)，休克6例(6%)，多原因50例(52%)。使用依托咪酯作为镇静催眠的有54例(56%)，硫喷妥钠43例(44%)。依托咪酯组有13例（56%）出现癫痫发作和/或发生癫痫持续状态复发，硫喷妥钠组有11例（44%）（调整后优势比 [AR]，0.98；95%CI，0.36-2.63；p=0.97）。两实验组插管后血流动力学紊乱 (AOR，0.60；95%CI，0.23-1.58；p=0.30)或困难气管插管(1.28；95%CI 0.23~7.21；p=0.77)病人所占比例无统计学意义(P>0.05)。
结 论
实验结果显示，对惊厥性癫痫持续状态的危重患者分别使用依托咪酯与硫喷妥钠作为紧急气管插管诱导剂时对癫痫发作和/或癫痫持续状态复发率的影响无明显差异。
原始文献摘要
Perier F, Chateauneuf AL, Jacq G, et al. Comparison of etomidate and sodium thiopental for induction during rapid sequence intubation in convulsive status epilepticus: A retrospective single-center study. [J] Seizure 2018 Aug 28 ;61DOI：10.1016/j.seizure.2018.08.022
Purpose: Few outcome data are available about morbidity associated with endotracheal intubation modalities in critically ill patients with convulsive status epilepticus. We compared etomidate versus sodium thiopental for emergency rapid sequence intubation in patients with out-of-hospital convulsive status epilepticus.
Methods: Patients admitted to our intensive care unit in 2006–2015 were studied retrospectively. The main outcome measure was seizure and/or status epilepticus recurrence within 12 h after rapid sequence intubation.
Results: We included 97 patients (60% male; median age, 59 years IQR, 48–70]). Median time from seizure onset to first antiepileptic drug was 60 min [IQR, 35–90]. Reasons for intubation were coma in 95 (98%), acute respiratory distress in 18 (19%), refractory convulsive status epilepticus in 9 (9%), and shock in 6 (6%) patients; 50 (52%) patients had more than one reason. The hypnotic drugs used were etomidate in 54 (56%) and sodium thiopental in 43 (44%) patients. Seizure and/or status epilepticus recurred in 13 (56%) patients in the etomidate group and 11 patients (44%) in the sodium thiopental group (adjusted common odds ratio [aOR], 0.98; 95%CI, 0.36–2.63; P = 0.97). The two groups were not significantly different for proportions of patients with hemodynamic instability after intubation (aOR, 0.60; 95%CI, 0.23–1.58; P = 0.30) or with difficult endotracheal intubation (OR, 1.28; 95% CI 0.23 to 7.21; P=0.77).
Conclusions: Our findings argue against a difference in seizure and/or status epilepticus recurrences rates between critically ill patients with convulsive status epilepticus given etomidate vs. sodium thiopental as the induction agent for emergency intubation.
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