Anaesthesia Department, Cochin Hospital, Paris, France.
French Navy Medical Service, Brest, France.
Anaesthesia. 2017 Dec;72(12):1476-1483. doi: 10.1111/anae.14079. Epub 2017 Oct 3.
The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting.
本研究旨在探讨氯胺酮是否会预防或加重军事创伤患者的急性或创伤后应激障碍。我们对法国军事卫生服务机构的数据库进行了回顾性研究，纳入了所有在阿富汗战争中幸存下来的士兵（2010-2012 年）。创伤后应激障碍的诊断由精神科医生做出，根据患者是否存在这种情况进行分析。分析包括以下协变量：年龄；性别；急性应激障碍；爆炸伤；相关病死率；脑损伤；创伤性截肢；格拉斯哥昏迷量表；创伤严重程度评分；使用的药物；手术次数；身体、神经感觉或美学后遗症；以及慢性疼痛的发生。与创伤后和急性应激障碍相关的 p 值≤0.10 的协变量被纳入多变量逻辑回归模型。确定了 450 名士兵的数据；其中 399 名士兵幸存，其中 274 名士兵被纳入分析。在这些患者中，98 名（36%）患有创伤后应激障碍，89 名（32%）接受了氯胺酮治疗。创伤后应激障碍组中 54 名（55%）患者接受了氯胺酮治疗，而无创伤后应激障碍组中 35 名（20%）患者接受了氯胺酮治疗（p<0.001）。接受氯胺酮治疗的 89 名受伤士兵的创伤严重程度评分中位数（IQR [范围]）为 5（3-13 [1-26]），而未接受氯胺酮治疗的 185 名患者的评分中位数（IQR [范围]）为 3（2-4 [1-6]）（p<0.001）。多变量分析显示，只有急性应激障碍和手术总数与创伤后应激障碍的发生独立相关。在这项回顾性研究中，氯胺酮的使用不是军事创伤环境中创伤后应激障碍发展的危险因素。
