Schönenberg Michael, Reichwald Ursula, Domes Gregor, Badke Andreas, Hautzinger Martin
Department of Clinical and Physiological Psychology, Tübingen University, Gartenstr. 29, 72074 Tübingen, Germany.
Psychopharmacology (Berl). 2005 Nov;182(3):420-5. doi: 10.1007/s00213-005-0094-4. Epub 2005 Oct 19.
Ketamine, an N-methyl-D: -aspartate receptor antagonist, produces transient dissociative and psychotic states in healthy humans that resemble symptoms shown by subjects with acute and chronic posttraumatic stress disorder (PTSD). Since ketamine is widely used as an analgesic and sedative in emergency care, it might be one factor triggering, modulating, or exacerbating PTSD in accident victims when given in the acute trauma phase.
The purpose of the present study was to determine whether the peritraumatic administration of ketamine affects acute and sustained PTSD symptoms in accident victims.
A sample of 56 moderately injured accident victims was screened retrospectively for acute (Peritraumatic Dissociative Experiences Questionnaire; Acute Stress Disorder Scale) and for current PTSD symptoms (Impact of Event Scale) approximately 1 year postaccident. All subjects had received a single or fractionated dose of either racemic ketamine (n = 17), (S)-ketamine (n = 12), or opioids (n = 27) during emergency ambulance transportation.
Retrospectively assessed acute symptomatology was strongly increased in (S)-ketamine subjects in terms of dissociation, reexperiencing, and avoidance, and slightly heightened in racemic ketamines. Current PTSD symptoms were substantially elevated in (S)-ketamine subjects, while there was no difference observed between opioids and racemic ketamines. Medication groups did not differ in regard to demographic variables, previous or postaccidental traumatic events, time between accident and investigation, and injury severity.
The data provide first evidence for a modulating effect of a single-dose ketamine on the severity and duration of posttraumatic stress symptoms in accident victims.
氯胺酮是一种N-甲基-D-天冬氨酸受体拮抗剂，可在健康人体内产生短暂的分离性和精神病性状态，类似于急性和慢性创伤后应激障碍（PTSD）患者所表现出的症状。由于氯胺酮在急救中广泛用作镇痛药和镇静剂，在急性创伤期给予时，它可能是引发、调节或加剧事故受害者PTSD的一个因素。
本研究的目的是确定事故受害者围创伤期给予氯胺酮是否会影响急性和持续性PTSD症状。
回顾性筛选了56名中度受伤的事故受害者，以评估事故后约1年时的急性症状（围创伤期分离体验问卷；急性应激障碍量表）和当前的PTSD症状（事件影响量表）。所有受试者在紧急救护车运送期间均接受了单剂量或分次剂量的消旋氯胺酮（n = 17）、（S）-氯胺酮（n = 12）或阿片类药物（n = 27）。
回顾性评估发现，（S）-氯胺酮组受试者在分离、反复体验和回避方面的急性症状显著增加，消旋氯胺酮组略有升高。（S）-氯胺酮组受试者当前的PTSD症状大幅升高，而阿片类药物组和消旋氯胺酮组之间未观察到差异。各药物组在人口统计学变量、事故前或事故后的创伤事件、事故与调查之间的时间以及损伤严重程度方面无差异。
数据首次证明单剂量氯胺酮对事故受害者创伤后应激症状的严重程度和持续时间有调节作用。
