Ahern Terence L, Herring Andrew A, Anderson Erik S, Madia Virat A, Fahimi Jahan, Frazee Bradley W
Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland CA.
Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland CA; Department of Emergency Medicine, University of California, San Francisco, San Francisco CA.
Am J Emerg Med. 2015 Feb;33(2):197-201. doi: 10.1016/j.ajem.2014.11.010. Epub 2014 Nov 15.
The objective of this study is to describe the clinical use and safety profile of low-dose ketamine (LDK) (0.1-0.3 mg/kg) for pain management in the emergency department (ED).
This was a retrospective case series of consecutive patients given LDK for pain at a single urban ED between 2012 and 2013. Using a standardized data abstraction form, 2 physicians reviewed patient records to determine demographics, indication, dose, route, disposition, and occurrence of adverse events. Adverse events were categorized as minor (emesis, psychomimetic or dysphoric reaction, and transient hypoxia) and serious (apnea, laryngospasm, hypertensive emergency, and cardiac arrest). Additional parameters measured were heart rate and systolic blood pressure.
Five hundred thirty patients received LDK in the ED over a 2-year period. Indications for LDK were diverse. Median patient age was 41 years, 55% were women, and 63% were discharged. Route of administration was intravenous in 93% and intramuscular in 7%. Most patients (92%) received a dose of 10 to 15 mg. Comorbid diseases included hypertension (26%), psychiatric disorder (12%), obstructive airway disease (11%), and coronary artery disease (4%). There was no significant change in heart rate or systolic blood pressure. Thirty patients (6%) met our criteria for adverse events. Eighteen patients (3.5%) experienced psychomimetic or dysphoric reactions. Seven patients (1.5%) developed transient hypoxia. Five patients (1%) had emesis. There were no cases of serious adverse events. Agreement between abstractors was almost perfect.
Use of LDK as an analgesic in a diverse ED patient population appears to be safe and feasible for the treatment of many types of pain.
本研究的目的是描述低剂量氯胺酮（LDK）（0.1 - 0.3毫克/千克）在急诊科（ED）用于疼痛管理的临床应用及安全性概况。
这是一项回顾性病例系列研究，研究对象为2012年至2013年期间在某城市单一急诊科接受LDK治疗疼痛的连续患者。两名医生使用标准化数据提取表查阅患者记录，以确定人口统计学信息、用药指征、剂量、给药途径、处置方式及不良事件的发生情况。不良事件分为轻微（呕吐、拟精神病反应或烦躁反应、短暂性低氧血症）和严重（呼吸暂停、喉痉挛、高血压急症、心脏骤停）两类。还测量了心率和收缩压等其他参数。
在两年期间，有530名患者在急诊科接受了LDK治疗。LDK的用药指征多种多样。患者年龄中位数为41岁，55%为女性，63%已出院。给药途径93%为静脉注射，7%为肌肉注射。大多数患者（92%）接受的剂量为10至15毫克。合并疾病包括高血压（26%）、精神疾病（12%）、阻塞性气道疾病（11%）和冠状动脉疾病（4%）。心率和收缩压无显著变化。30名患者（6%）符合我们的不良事件标准。18名患者（3.5%）出现拟精神病反应或烦躁反应。7名患者（1.5%）出现短暂性低氧血症。5名患者（1%）出现呕吐。无严重不良事件病例。提取人员之间的一致性几乎完美。
在急诊科不同患者群体中使用LDK作为镇痛药，对于治疗多种类型的疼痛似乎是安全可行的。
