Ketamine rudzi rwakasiyana rwekudzivirira mwoyo.
Ketamine ine mukurumbira unonyadzisa sechirwere chisina kukodzera, uye izvi zvinonzwisisika. Ketamine yakafanana neCPP, imwezve dissociative anesthetic agent. Kana ikatorwa mumatokisi anotyisa, ketamine inogona kukonzera kusagadzikana, kusanganisira kuwedzerwa kweropa, kuwedzerwa kwemwoyo, kusuruvara, uye kusagadzikana kwemasisita. Ketamine kudengenyeka kunogona kukonzerawo psychosis.
Pasinei nehuwandu hwekushandisa zvinodhaka, ketamine ine kushandiswa kwehutano kwepamutemo. Iyo inyanzvi yekushongedza yakawanda ine maitiro ayo akasiyana, uye inoshandiswa mumativi mazhinji enyika inosimudzira nokuda kwechikonzero ichi. Uyezve, ketamine inoshandiswa kubata mamwe marudzi ekutambudzika kwakanyanya. Munguva ichangopfuura, ketamine yakaratidza kubudirira pakudzikisa kuzviuraya.
Ketamine Inotsanangurwa
Ketamine inonzi arylcylohexylamine dissociative anesthetic agent inoshandiswa muvanhu uye muchirwere chezvokurapa (saka, mukurumbira wayo se "mutsigeri wemabhiza"). Ketamine inogadziriswa mumvura uye nemapidhi (kureva kuti, mafuta omuviri), zvinoreva kuti inogona kutarisirwa nenzira dzinotevera:
- Intravenously (IV)
- Intramuscularly (IM)
- Subcutaneously
- Orally
- Rectally
- Transnasally
- Transdermally
Nenzira, ketamine inonyanya kupindira kuburikidza nemugwagwa wepramuscular. Ketamine inouya muzvikamu zvitatu: 10 mg / mL, 50 mg / mL, uye 100 mg / mL.
Ketamine ine nzira dzakawanda dzekuita uye inokanganisa maurotransmitter anoverengeka mumutambo mukuru wemagetsi. Izvi zvinokonzera kuwanda kwezviito, kusanganisira kuwedzera kunzwira tsitsi "kurwisana kana kutiza" nheyo yenheyo, kukonzera mwoyo yemagetsi, uye marwadzo anonzwa. Heano mamwe emhando dzakanyanya dzeuropatic (nerve-kuipa) marwadzo akafanana ayo ketamine anobata:
- Postherpetic neuralgia
- Postamputation kurwadziwa
- Mutsara ischemia
- Brachial plexopathy
- HIV neuropathies
- Cancer neuropathies
Ketamine inobatsirawo pakuchengeta marwadzo emusanaciceptive, anokonzerwa nekukurudzirwa kwemitsipa. Mienzaniso yemarwadzo echeciceptive inosanganisira myofascial uye ischemic kurwadziwa.
Muchirapa text Poisoning & Drug Overdose , Olson uye vanyori vanyori vanyore zvinotevera pamusoro peketamine:
Zvimwe zvinoshandiswa nemapiriniologic zvinoshandiswa kuburikidza ne epigenetic modulation uye kuratidza kwe microRNA, kuvhiringidzika kwevhiringidzi, uye nitric oxide synthase inogona kupindirana nemigumisiro yechirwere yakasimba yehutano hwehupfungwa uye hwepfungwa, zvinopesana nezvirwere, uye kurapa kwehupenyu asthmaticus.
Heano nzira dzakananga iyo ketamine inobata muviri:
- Kuwedzera kwenhamba yemwoyo
- Kuwedzerwa kweropa
- Kuwedzera kwepakati mukati mevhunduka yemhepo
- Kuwedzerwa kupera kwepamusoro
- Bronchodilation
- Kuwedzerwa ropa kunopfuurira kuuropi
- Kuwedzera kwemaitiro emagetsi
- Kuwedzerwa kwepraocular (ziso) kudzvinyirira
- Zvinokonzerwa nekunyunyutira uye kurutsa
- Zvichida delirium
- Kuwedzerwa uterine tone
- Hope-like inotaura
- Zvinogona kuitika
Pane zvimwe zvakasiyana-siyana zve ketamine seanesesthetic. Izvo hazviwanzopedza kufema uye kuparadza mweya wepamhepo sezvinongoita mamwe anesthetics.
Uyezve, chokwadi chokuti ketamine haisi kuderedza kushanda kweropa inoita kuti ive yakanakisisa yehutano hwevaya avo vari pangozi ye hypotension (kureva, kuderera kwemuviri weropa), varwere vanoshaya mvura, nevarwere vanotya.
Ketamine yeApression and Bipolar Disorder
Vatsvakurudzi vakave nenguva yakaoma yekugadzira makirasi matsva emishonga ekurapa kuora mwoyo . Makumi emakore akapfuura, masayendisiti aibata kuora mwoyo nemishonga yakavhara monoamine vatengesi uye monoamine receptors; zvisinei, mishonga iyi yaiva nemigumisiro yakaipa. Kubuda kwe serotonin-reuptake inhibitors (SRIs) kwakashandura munda wepfungwa, uye akapa vakwegura, pamwe chete navanachiremba vekuchengetedza vana, nzira dzakachengeteka dzakachengetwa uye nyore nyore pakurapa kuora mwoyo.
Ketamine inonzi NMDA glutamate receptor anopikisana, uye naizvozvo ine glutamatergic agent. Mune zvidzidzo zvemakiriniki, yekutanga glutamatergic agent anoshandiswa kugadzirisa kuora mwoyo yaiva tuberculosis antibiotic inonzi D-cycloserine. Uyu mujeri akaedzwa pachirwere chechirwere vane chirwere chokuora mwoyo muna 1959, uye kuvandudza mafungiro kwakakurumidza kuonekwa. Pakazosvika makumi ma1960, imwe nhengo ye glutamatergic inonzi amantadine yakanga yakaratidza chivimbiso mukurapa chirwere chePasinsin, chinowanzosangana nekuora mwoyo. Somugumisiro, ichi chinodhaka chakashandiswa kurapa kuora mwoyo mune chidzidzo chekufambisa.
Pakazosvika makore makumi mapfumbamwe, vatsvakurudzi vakanga vachiongorora migumisiro ye ketamine pakuora mwoyo. Vatsvakurudzi vakashamiswa nekukurumidza kwekotamine yakashanda kubata zviratidzo zvekuora mwoyo. Mukati maawa makumi maviri nemasere ekurapa kune imwe subanesthetic inoratidzira dose, vamwe varwere vane kuora mwoyo vakacherechedza kuti vapinde mukuregererwa.
Kubudirira kwe ketamine kuporesa kuora mwoyo kunonzwisiswa nhaurirano yeruzivo rutsva nemaitiro matsva ekuita. Maitiro evanhu vanorwara anowanzopedza vhiki dzinoverengeka kuti vasvike zvakanaka. Zvisinei, ketamine inoshanda zvikuru nekukurumidza uye inoguma mukugadzirisa kwechirongwa chechipatara mumaawa mashoma.
Muchikamu che2013 kubva kuBioological Psychiatry , Krystal uye vanyori vanyori vanyora zvinotevera:
Izvozvo zvinokonzera kusuruvara kwe ketamine zvakanga zvisipo kusvikira mushure mokunge psychotigenic uye euphoric yakaipa ye ketamine yakanga yanyangarika. Uku kukanganisika kwepakutanga kwakaratidza kuti zvinokonzera kuora mwoyo zvinokonzerwa nekukasika kwekutsvaga kwepamusoro kune zvinokonzerwa ne ketamine muuropi. Pakati pezvidzidzo zvakasimbiswa kusvikira zvino, zvinokonzera zvinodhaka zvinokonzera maawa maviri nemaawa mana. Pakazosvika maawa makumi maviri nemasere, zvidzidzo zvehupfumi zvinoshandiswa pakugadzirisa uye kupindura kwekuora mwoyo kwezviratidzo mune anenge 50% -80% yevarwere. Zvose zviratidzo zvekuora mwoyo zvinowedzera, kusanganisira kuzviuraya. Zviriniki zvekubatsira mushure mekunge imwe ketamine inotora inogona kupfupika seyemazuva maviri uye inogona kuramba kwenguva refu kupfuura masvondo maviri.
Migumisiro inobva muna 2014 meta-analysis yakabudiswa muna Psychopharmacology inotsigira kushandiswa kwenguva pfupi kweketamine mukurapa zvose zvakadzama uye bipolar disorder . Kunyanya, mune iyi meta-analysis, Fond uye vashandi pamwe chete vakaburitswa uye vakaongororwa mhinduro kubva kuongororo yekuongorora kushandiswa kweketamine mune chikuru chekuora mwoyo chirwere (MDD), kuora mwoyo kwepipolar, uye kusagadzikana kusuruvara, uyewo anesthetic agent mu electroconvulsive therapy (ECT) ye kusagadzikana kuora mwoyo . Vatsvakurudzi vakawana kuti ketamine yakashanda mukurapa zviratidzo zvinodzvinyirira mune chimwe nechimwe chezviitiko izvi.
Kunyange zvazvo simba rekudzidza uku rakanga rakagadziriswa nemazana mashoma ekuenzanisa, Fond uye vanyori-vanyori vanoratidza kuti migumisiro ye ketamine yakagara pakati pemazuva maviri nematatu. Uyezve, humwe uchapupu hwakaratidza kuti kwete chete kuora mwoyo zviratidzo zvinenge zvisingabatsiri asi pfungwa dzekuzviuraya dzakaderedzwa, zvakare-kunyange kuzviuraya kwakatarwa kushandiswa uchishandisa chinhu chimwe chete pane zvinokonzera kushushikana.
Zvinonyanya kukosha, Fond uye vashandi pamwe chete vanocherechedza kuti kune vamwe varwere pakanga pane zvikwereti zvisinganzwisisiki muropa. Nemhaka yekateamine migumisiro pamwoyo, vatsvakurudzi vakanyevera nezvekushandiswa kwayo kune vanhu vane chirwere chemoyo.
Pasinei nekukura kwekutsvakurudza kunotsigira kushandiswa kwe ketamine yekurapa kuora mwoyo uye kuora mwoyo kwebipolar, kunyanya kutsvakurudza kunofanira kuitwa. Chokutanga, hazvisi pachena pane ketamine inokwana inofanira kushandiswa kurapa chirwere chepfungwa. Zvinonyanya kukosha, zviratidzo zvekudzivirirana zvinogona kuonekwa kune vanhu vanotora kunyange kutsika zvakanyanya kweketamine. Chechipiri, kuora mwoyo kunogona kukonzera mania kune avo vane bipolar disorder, uye kunyange zvisingaiti, hazvizivikanwe kana ketamine inogona kukonzera mania mune varwere. Chechitatu, hazvisi pachena kuti ketamine inofanira kupiwa sei kuvanhu vane chirwere chepfungwa. Inofanira kupiwa mazuva maviri kana matatu here? Chechina, hatizivi kana ketamine ine chero nguva yakaipa.
Pakupedzisira, kana ketamine yakambonyanya kushandiswa kurapa kuora mwoyo kana chirwere cheBipolar, inogona kunge ichigadzirisa. Mune mamwe mazwi, ketamine yaizoshandiswa mukuwedzera kune zvinodhaka zvinopesana nemanzwiro kana maitiro. Panguva ino, hazvisi pachena kana ketamine yaizofanira kutarisirwa neanesthesiologist. Nhamba yakagadziriswa ye ketamine inogona kunge isingafaniri kutarisirwa neanesthesiologist uye ingave yakakodzera yekurapa kwechipatara chirwere.
Ketamine yekuzviuraya pfungwa
Mumakore achangobva kupfuura, chiitiko che ketamine pamusoro pekuzviuraya (Ie, kuzviuraya) hachina kunyatsodzidza. Kazhinji zvidzidzo kuongororwa nemigumisiro ye ketamine nemafungiro chete inongotarisa kuzviuraya sechinhu chimwe chete pane kuora mwoyo kwezinga.
Mune imwe nyaya yaDecember 2017 yakanzi "Ketamine yeRepid Reduction yeAkuzvifungidzira Mafungiro Mukukudarika Kukuru: A Midazolam-Inodzorwa Rakashandiswa Kuongororwa Kwechipatara," Grunebaum nevamwe vaishanda navo vakaongorora migumisiro ye ketamine mune varwere vane chirwere chikuru chekuora mwoyo uye kuzviuraya.
Muchirevo ichi-kutonga, vatori vechikamu 80 vakagoverwa kugamuchira ketamine kana kutonga, midazolam. Nemhaka yekuvhiringidzika kwayo, hakuna imwe inopikisa inofananidzwa ne ketamine. Nokudaro, vanotsvakurudza vakasarudza midazolam nokuda kwekutonga nokuti se ketamine, ichi chirwere chine maitiro epfungwa. Uyezve, hafu yehupenyu hwemishonga yose inofananidzwa, uye midazolam haina antidipressant kana antisuicidal migumisiro. Mishonga iyi yose yaitungamirirwa nechiremba chepfungwa semumwe murairo mukati mega.
Heano zvimwe zvevatsvakurudzi 'zvakawanikwa:
- Pazuva rehutungamiri, chiyero cheScale for Suicidal Ideation (SSI) chikwata chaiva nechokuita nharo shanu kune avo vanotora ketamine, iyo inomiririra kuderera kukuru mukuzviuraya.
- Kuda kuzviuraya kwakaderera mukati memaminitsi makumi maviri ekuderedzwa.
- Zviratidzo zvinoshungurudza zvakavandudzwa zvikuru kune avo vanotora ketamine.
- Ketamine yakaguma mukuwedzera kwenguva pfupi, kunyoro-ku-kuenzanisa kuwedzerwa kweropa.
- Ketamine yakaguma nemagumisiro ezvisiyanano zvakafanana neaya akaonekwa mune dzimwe dzidzo.
- Kuvandudzwa kwekuzviuraya kwakaramba kwakapera vhiki nhanhatu mushure mekudzivirira kwekutanga.
Ichi chidzidzo chakange chine zvishoma. Semuenzaniso, chidzidzo ichi chakaongorora vanhu vane pfungwa yekuzviuraya, uye kuzvipira kune zvakasiyana nekuzviuraya kana chinangwa. Nokuti vanhu vazhinji vanozviuraya, uye vanhu vashomanana vanozviuraya, mienzaniso yakawanda yakawanda (kureva, vakawanda varwere vakawanda) inoda kuiswa pamwe kana kuzviuraya kuchiongororwa. Uyezve, kana ichienzaniswa neboka rinodzora, vamwe varwere mu ketamine yekuongorora boka vaiva nemuganhu wehutano hwehutano.
Shoko Rinobva
Pakati pe1999 na2015, pakanga paine kuwedzera kwe 26.5 muzana yehuwandu hwekuzviuraya muUnited States. Parizvino, hapana hutano hwakanaka hwekuzviuraya. IAmerican Psychiatric Association inoti "uchapupu hwekuderedzwa kwehuwandu hwekuzviuraya nehutachiona hwehutachiona husinganzwisisiki." Zviri pachena, nzira dzakanakisisa dzekugadzirisa nyaya iyi inokurudzira inodiwa. Nemhaka yekukwira kwayo nokukurumidza, ketamine inogona kubatsira zvikuru pakudzikisa kuzviuraya.
Kunyanya kakawanda, maererano nehutano hwepfungwa, ketamine inoratidza chivimbiso mukurapa kuora mwoyo uye kuora mwoyo kwepipolar-kunyanya kana zvirwere izvi zvisingagoni kurapwa.
> Sources:
> Fond G, et al. Ketamine hutungamiri mukudzvinyirira kushungurudzika: kugadziriswa kwekuongorora uye meta-analysis. Psychopharmacology. 2014; 231: 3663-3676.
> Grunebaum MF, et al. Ketamine yeRupid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Inodzorwa Randomised Clinical Trial. The American Journal of Psychiatry. 2017.
> Krystal JH, Sanacora G, Duman RS. Kukurumidza-kuita glutamatergic anti-depressants: nzira ye ketamine uye kupfuura. Biological Psychiatry. 2013; 73 (12): 1133-1141.
> Kurapa Zvinodhaka uye Antidotes. Mu: Olson KR, Anderson IB, Benowitz NL, Blanc PD, Clark RF, Kearney TE, Kim-Katz SY, Wu AB. eds. Kutyisa uye Kuderedza Zvinodhaka, 7e New York, NY: McGraw-Hill.