Goldfine Charlotte E, Tom Jeremiah J, Im Dana D, Yudkoff Benjamin, Anand Amit, Taylor Joseph J, Chai Peter R, Suzuki Joji
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States.
Front Psychiatry. 2023 Apr 27;14:1141836. doi: 10.3389/fpsyt.2023.1141836. eCollection 2023.
Alcohol use disorder (AUD) is the most prevalent substance use disorder (SUD) globally. In 2019, AUD affected 14.5 million Americans and contributed to 95,000 deaths, with an annual cost exceeding 250 billion dollars. Current treatment options for AUD have moderate therapeutic effects and high relapse rates. Recent investigations have demonstrated the potential efficacy of intravenous ketamine infusions to increase alcohol abstinence and may be a safe adjunct to the existing alcohol withdrawal syndrome (AWS) management strategies.
We followed Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines to conduct a scoping review of two databases (PubMed and Google Scholar) for peer-reviewed manuscripts describing the use of ketamine in AUD and AWS. Studies that evaluated the use of ketamine in AUD and AWS in humans were included. We excluded studies that examined laboratory animals, described alternative uses of ketamine, or discussed other treatments of AUD and AWS.
We identified 204 research studies in our database search. Of these, 10 articles demonstrated the use of ketamine in AUD or AWS in humans. Seven studies investigated the use of ketamine in AUD and three studies described its use in AWS. Ketamine used in AUD was beneficial in reducing cravings, alcohol consumption and longer abstinence rates when compared to treatment as usual. In AWS, ketamine was used as an adjunct to standard benzodiazepine therapy during severe refractory AWS and at signs of delirium tremens. Adjunctive use of ketamine demonstrated earlier resolution of delirium tremens and AWS, reduced ICU stay, and lowered likelihood of intubation. Oversedation, headache, hypertension, and euphoria were the documented adverse effects after ketamine administration for AUD and AWS.
The use of sub-dissociative doses of ketamine for the treatment of AUD and AWS is promising but more definitive evidence of its efficacy and safety is required before recommending it for broader clinical use.
酒精使用障碍（AUD）是全球最普遍的物质使用障碍（SUD）。2019年，AUD影响了1450万美国人，导致95000人死亡，年成本超过2500亿美元。目前AUD的治疗方案疗效中等且复发率高。最近的研究表明，静脉注射氯胺酮可能有助于增加戒酒率，并且可能是现有酒精戒断综合征（AWS）管理策略的安全辅助手段。
我们遵循系统评价的首选报告项目（PRISMA）指南，对两个数据库（PubMed和谷歌学术）进行范围审查，以查找描述氯胺酮在AUD和AWS中应用的同行评审手稿。纳入评估氯胺酮在人类AUD和AWS中应用的研究。我们排除了研究实验动物、描述氯胺酮其他用途或讨论AUD和AWS其他治疗方法的研究。
我们在数据库搜索中识别出204项研究。其中，10篇文章展示了氯胺酮在人类AUD或AWS中的应用。7项研究调查了氯胺酮在AUD中的应用，3项研究描述了其在AWS中的应用。与常规治疗相比，AUD中使用氯胺酮有助于减少渴望、饮酒量并提高更长时间的戒酒率。在AWS中，氯胺酮在严重难治性AWS期间及出现震颤谵妄迹象时用作标准苯二氮䓬类药物治疗的辅助药物。氯胺酮的辅助使用显示震颤谵妄和AWS的缓解更早，缩短了重症监护病房住院时间，并降低了插管可能性。氯胺酮用于AUD和AWS后记录的不良反应包括过度镇静、头痛、高血压和欣快感。
使用亚解离剂量的氯胺酮治疗AUD和AWS很有前景，但在推荐其更广泛地用于临床之前，需要更多关于其疗效和安全性的确切证据。
