Schönenberg M, Reichwald U, Domes G, Badke A, Hautzinger M
Department of Clinical and Developmental Psychology, University of Tübingen, Tübingen, Germany.
J Psychopharmacol. 2008 Jul;22(5):493-7. doi: 10.1177/0269881107082481. Epub 2008 Jan 21.
The glutamatergic N-methyl-D-aspartate receptor antagonist ketamine produces transient dissociative states and alters cognitive functioning in healthy humans, thus resembling the core symptoms of acute and chronic post-traumatic stress disorder (PTSD). First evidence exists that the common use of the analgesic and sedative properties of ketamine during emergency care correlates with sustained symptoms of PTSD in accident victims. The aim of the present study was to examine whether ketamine administration after moderate accidental trauma modulates dissociation and other symptoms of acute stress disorder (ASD) in the direct aftermath of the event. Accident victims were screened within the third day after admission to hospital for symptoms of ASD (Peritraumatic Dissociative Experiences Questionnaire, ASD Scale) and prior stressful life events (Traumatic Life Events Questionnaire). Subjects had received a single or fractionated dose of either racemic ketamine (n=13), opioids (n=24) or non-opioid analgesics (n=13) during initial emergency treatment. There were no significant differences between medication groups in demographic and clinical characteristics such as injury severity or prior traumatization. With respect to ASD symptomatology three days post-event there were significant associations between ketamine analgosedation and increased symptoms of dissociation, reexperiencing, hyperarousal and avoidance relative to the comparison groups.Growing evidence exists that ketamine might modulate or aggravate early post-traumatic stress reactions when given in the acute trauma phase, which in turn might contribute to long-lasting symptomatology.
谷氨酸能 N-甲基-D-天冬氨酸受体拮抗剂氯胺酮会在健康人体内产生短暂的分离状态并改变认知功能，因此类似于急性和慢性创伤后应激障碍（PTSD）的核心症状。已有初步证据表明，在急诊护理期间常用氯胺酮的镇痛和镇静特性与事故受害者持续存在的PTSD症状相关。本研究的目的是检查在中度意外创伤后给予氯胺酮是否会在事件刚发生后调节急性应激障碍（ASD）的分离及其他症状。在入院后第三天对事故受害者进行ASD症状筛查（创伤解离经历问卷，ASD量表）以及既往应激性生活事件筛查（创伤性生活事件问卷）。受试者在初始急诊治疗期间接受了单剂量或分次剂量的消旋氯胺酮（n = 13）、阿片类药物（n = 24）或非阿片类镇痛药（n = 13）。用药组在人口统计学和临床特征（如损伤严重程度或既往创伤史）方面没有显著差异。关于事件发生三天后的ASD症状学，相对于对照组，氯胺酮镇痛镇静与分离、重现、过度觉醒和回避症状增加之间存在显著关联。越来越多的证据表明，在急性创伤期给予氯胺酮可能会调节或加重创伤后早期应激反应，这反过来可能导致长期症状。
