Department of Emergency Medicine, Orlando Health, Orlando Regional Medical Center, United States of America.
Emergency Physician Chief Medical Officer Department of Emergency Medicine, Orlando Health, Orlando Regional Medical Center, 86 W Underwood St (Suite 200), Orlando, FL 32806, United States of America.
Am J Emerg Med. 2021 May;43:54-58. doi: 10.1016/j.ajem.2020.12.088. Epub 2021 Jan 14.
There are no emergent pharmaceutical interventions for acute suicidal ideation, a common presenting complaint in the ED. Ketamine is a NMDA agonist frequently used by ED physicians for sedation and analgesia. Prior evidence from studies conducted in inpatient psychiatry units suggests that ketamine may have a role in alleviating treatment-resistant depression as well as suicidal ideation.
PubMed, MEDLINE, and Cochrane reviews were queried for articles related to keywords ketamine, suicidality, suicidal ideation, and emergency department/room. Relevant articles were selected and reviewed by two separate authors.
Three relevant, prospective studies were identified with a mean sample size of 25.7. Each was performed using 0.2 mg/kg ketamine for individuals receiving active treatment. Each study reported a decrease in depressive symptoms among those receiving ketamine. One study reported a significant reduction in SI when compared to placebo at 90 min that became non-significant by 230 min. No significant adverse events were reported in any study.
Current evidence suggests that ketamine is a promising, safe potential intervention for acute suicidality in the ED. Convincing evidence for efficacy of ketamine for acute suicidal ideation remains lacking, and this promising potential intervention should be further investigated.
对于急性自杀意念这一常见的急诊就诊症状，目前尚无紧急的药物干预措施。氯胺酮是急诊科医生常用的 NMDA 激动剂，用于镇静和镇痛。先前在住院精神病学病房进行的研究中的证据表明，氯胺酮可能在缓解治疗抵抗性抑郁症以及自杀意念方面发挥作用。
通过 PubMed、MEDLINE 和 Cochrane 综述，检索与关键词氯胺酮、自杀倾向、自杀意念和急诊科/室相关的文章。由两位作者分别选择和审查相关文章。
确定了 3 项具有平均样本量为 25.7 的相关前瞻性研究。每项研究均使用 0.2mg/kg 的氯胺酮对接受积极治疗的个体进行治疗。每项研究都报告了接受氯胺酮治疗的患者抑郁症状有所减轻。一项研究报告称，与安慰剂相比，在 90 分钟时 SI 显著降低，但在 230 分钟时变得不显著。在任何研究中均未报告严重不良事件。
目前的证据表明，氯胺酮是急诊科急性自杀意念的一种很有前途且安全的潜在干预手段。氯胺酮对急性自杀意念的疗效仍缺乏令人信服的证据，这种有前途的潜在干预措施应进一步研究。
