I-Ketamine yinto eyahlukileyo yoxinzelelo.
I-Ketamine inegama elibi kakhulu njengeziyobisi ezingekho mthethweni, kwaye oku kuyaqondakala. I-Ketamine ifana ne-PCP, enye i-agent ye-anesthetic agent. Xa kuthathwa kwi-doses ezinetyhefu, i-ketamine ingabangela ukunyanzelisa, kuquka ukunyuka kwengcinezelo yegazi, ukunyuka kwenani lentliziyo, ukujuluka, kunye nokuqina komzimba. I-Ketamine overdose inokubangela ukuba i-psychosis.
Nangona libizwa ngokuba yiziyobisi zokusetyenziswa gadalala, i-ketamine inokusetyenziswa kwezempilo ngokusemthethweni. Kuyi-antiesthetic ephezulu kunye neendawo zayo ezizodwa, kwaye isetyenziswe kwiindawo ezininzi zelizwe elikhulayo ngenxa yesi sizathu. Ukongezelela, i-ketamine isetyenziselwa ukuphatha iintlobo ezithile zeentlungu ezinzima. Ngoku kutshanje, i-ketamine ibonakalise ngempumelelo ekunciphiseni iingcinga zokuzibulala.
Ketamine ichazwe
I-Ketamine yi-arylcylohexylamine i-dissociative anesthetic agent esebenzisa iilwimi zenyama kunye nezilwanyana (ngoko ke, igama layo "njenge-tranquilizer yehashe"). I-Ketamine iqulethwe ngamanzi kunye neepidids (oko kukuthi, i-fat fat), oko kuthetha ukuba inokulawulwa ngale ndlela elandelayo:
- Ngaphandle (IV)
- Intramuscularly (IM)
- Ngaphantsi
- Ngomlomo
- Ngokubanzi
- Transnasally
- Transdermally
Ingqalelo, i-ketamine iyona nto ifakwe kwisithuthi seendlela. I-Ketamine iza kwiinkalo ezintathu: 10 mg / mL, 50 mg / mL kunye ne-100 mg / mL.
I-Ketamine ineendlela ezininzi zokwenza izinto kwaye ichaphazela amaqela angama-neurotransmitter kwi-system ye-nervous central. Ezi mpembelelo zenza inxaxheba kwintsebenzo yayo ebanzi, kubandakanywa nokwandisa inkqubo yokutya ye-nervous "yokulwa okanye indiza", echaphazela inkqubo ye-cardiovascular, kunye neempendulo zentlungu. Nazi ezinye zeentlobo ezinzima zesifo se-neuropathic (umonakalo onobungozi) enxulumene neetamine:
- Postherpetic neuralgia
- Intlungu ye postamputation
- Umqolo wesisu
- I-Brachial plexopathy
- HIV neuropathies
- I-cancer neuropathies
I-Ketamine ifanelekile ekuphatheni ubuhlungu be-nociceptive, obuvela ekuvuseleleni kwamathambo. Imizekelo yeentlungu zesikhombiso zibandakanya intlungu ye-myofascial kunye ne-ischemic.
Kwicatshulwa lonyango Utywala kunye nokugqithiswa kwezidakamizwa , u-Olson kunye nabalobi babambisene babhale oku kulandelayo malunga neketamine:
Ezinye iziphumo ze-pharmogologic mediated by modulation epigenetic kunye nokubonakaliswa kwe-microRNA, abalamli abavuthayo kunye ne-nitric oxide synthase banokudityaniswa nemiphumo eqhubekayo yokuthintela ukulawulwa kweengxaki zengqondo kunye nemizwelo, izenzo ezinxamnye nokuvuvukala, kunye nonyango lwe-asthmaticus.
Nazi iindlela ezizodwa zokuthi i-ketamine ichaphazela njani umzimba:
- Ukongeza kwenani lentliziyo
- Ukunyuswa kwengcinezelo yegazi
- Uxinzelelo oluphambili lwentlungu
- Ukwandisa izinga lokuphefumula
- Bronchodilation
- Ukunyuka kwegazi kwiqondo
- Ukwandisa izinga lokunciphisa umzimba
- Uxinzelelo lwe-intraocular (iso)
- Ukuncatshiswa okunokwenzeka kunye nokuhlanza
- Ikhefu e likhoyo
- Itheyibhile yonyumba
- Iinjongo ezifana nephupha
- Iingcamango ezinokwenzeka
Kukho iipropati ezikhethekileyo ze-ketamine njenge-anesthetic. Akuqhelekanga ukuphefumula ukuphefumula nokuphazamisa indlela yokuhamba njengendlela enye eyenziwa yi-anesthetics.
Ukongezelela, ukuba i-ketamine ayichithisi ukunyanzelisa uxinzelelo lwegazi yenza kube yinto efanelekileyo yokuxiliswa kwezi zigulane ezisengozini yokuxinzelelwa kwegazi (oko kukuthi, uxinzelelo lwegazi oluphantsi), izigulane ezonakalisa amanzi kunye nezigulane.
I-Ketamine yokuDandatheka kunye ne-Bipolar Disorder
Abaphandi baye bafumana ixesha elinzima ukuphuhlisa iiklasi zamachiza ezintsha ukuphatha uxinzelelo . Kwiminyaka emashumi eyadlulayo, izifo zengqondo zaphatha ukudakumba kwezidakamizwa ezivimbela abagibeli be-monoamine kunye ne-monoamine receptors; Nangona kunjalo, ezi ziyobisi zineempembelelo ezingalunganga. Ukuvela kwe-serotonin-reuptake inhibitors (i-SRIs) yatshintshile inkalo yesifo sengqondo, kwaye yanikela iingqondo zempilo, kunye noogqirha bokunakekelwa kwinqununu, iinketho ezikhuselekileyo kunye ezikhethiweyo zokunyanga koxinzelelo.
I-Ketamine yi-NMDA ye-glutamate receptor antagonist, kwaye ngoko ke i-agutamatergic agent. Kwizifundo zonyango, i-agutamatergic yokuqala esebenziselwe ukuphathwa kwengcinezelo yayisifo sesifo sofuba esibizwa ngokuba yi-D-cycloserine. Le ngxube yavavanywa kwizigulane zesifo sofuba ngexinzelelo ngowe-1959, kwaye ukuphucula imizwa kwabonakala ngokukhawuleza. Ngama-1960, enye i-agutamatergic ebizwa ngokuthi i-amantadine ibonise isithembiso ekuphatheni isifo se-Parkinson, esoloko sihamba nexinzelelo. Ngenxa yoko, le nkunkuma yayisetyenziselwa ukuphatha ukudakumba kwisifundo somqhubi.
Ngasekupheleni kweminyaka yama-1980, abaphandi bavavanya imiphumo ye-ketamine ekudakaleni. Abaphandi bamangaliswa yindlela i-ketamine eyenziwa ngayo ngokukhawuleza ukuphatha iimpawu zokudandatheka. Kwiiyure ezingama-24 zonyango kunye nesinye isifo se-intanvenous intravenous, ezinye izigulane ezinexinzelelo ziye zagcinwa ukuba zixolelwe.
Ukuvela kwe-ketamine ukuphatha uxinzelelo olucaciswe kwinqanaba lomgaqo-nkqubo kunye neendlela ezintsha zokwenza. Ngokuqhelekileyo iintsholongwane zokudambisa iingxaki zithatha iiveki ezimbalwa ukuze zifikeleleke. Nangona kunjalo, i-ketamine isebenza ngokukhawuleza kwaye iphumela ekuphuculeni kliniki enkulu kwiiyure nje.
Kwinqaku le-2013 kwi- Biological Psychiatry , uKrystal kunye nababhali-mbhali babhale oku kulandelayo:
Iziphumo zokuxhatshazwa kwe-ketamine zazingekho kuze kube yilapho emva kwe-psychologenic and effects of ketamine. Ukwahlukana okwethutyana kuqala kwaphakanyiswa ukuba iziphumo ezichasene nokuxhatshazwayo zavela njengento yokukhawuleza ngokukhawuleza kwiimpembelelo ze-ketamine kwingqondo. Kuyo yonke iingxelo ezibikwe ukuza kube yimini, iziphumo ezixhatshazelisayo zivela kuma-2-4 iiyure. Ngeeyure ezingama-24, uphando lubonisa ukuphucuka okukhulu kunye nokuphendula kweempawu zoxinzelelo kwi-50% -80% yezigulane. Zonke iimpawu zokudakumba ziphucula, kuquka nokuzibulala. Iintlawulo zekliniki emva kokuba umthamo omnye we-ketamine ungadlulela ngokufutshane nje ngeentsuku ezingama-1-2 kwaye ihlale ixesha elide kuneentsuku ezimbini.
Iziphumo ezivela kuhlalutyo lwe-meta ye-2014 ezipapashwe kwi- Psychopharmacology zixhasa inkxaso-futshane yeeketamine ekuphatheni ukudakumba kunye neengxaki ze- bipolar . Ngokuchanekileyo, kule meta-analysis, iFond kunye noogxa baxhaswe kunye nokuhlalutya iziphumo kwizifundo ezihlola ukusetyenziswa kwe-ketamine kwisifo esixinzelelekileyo (MDD), ukuxinezeleka kwengqondo, nokuxinezeleka okuxhatshazelisayo, kunye ne-agent ye-anesthetic kwi- anti-electroconvulsive therapy (ECT). ukudandatheka . Abaphandi bafumanisa ukuba i-ketamine yayisebenzisekile ekuphatheni iimpawu ezixinezelekileyo kwezi ziimeko.
Nangona amandla esi sifundo aphelelweyo ngobukhulu beesampula, ama-Fond kunye nabalobi babambisene bancome ukuba iziphumo zetamamine zahlala phakathi kweentsuku ezimbini neentsuku. Ukongezelela, ubungqina bokuba ubungqina bokuthi ayenzi nje iimpawu ezixinezelekileyo kodwa ukucinga okuzibulala kunokunciphisa, nangona-nangona iinjongo zokuzibulala zalinganiswa zisetyenziselwa ukusebenzisa into eyodwa kuphela kwizicwangciso zokudandatheka.
Okubalulekileyo, isiqabane kunye noogxa baqaphele ukuba kwezinye izigulane kukho ukuphakama okwexeshana kwixinzelelo legazi. Ngenxa yemiphumo ye-ketamine entliziyweni, abaphandi baxwayisa ngokusetyenziswa kwabo kubantu abaneentliziyo zesifo.
Nangona uphando olusakhulayo oluxhasa ukusetyenziswa kwe-ketamine ekwenzeni unyango nokuphazamiseka kwe-bipolar, kufuneka kwenziwe uphando olungakumbi. Okokuqala, akucaci ukuba yiyiphi imilinganiselo ye-ketamine ekufuneka isetyenziswe ekuphatheni izifo zengqondo. Kubaluleke kakhulu, iimpawu ezingenayo i-dissociative zingabonakala kubantu abathatha amanani aphantsi kakhulu e-ketamine. Okwesibini, ukuxhatshazwa kweengxaki kunokunciphisa i-mania kulabo abaneengxaki ze-bipolar, kwaye nangona kungenakwenzeka, akucaci ukuba i-ketamine ingakwazi ukunqumla imania kulezi zi gulane. Okwesithathu, akucaci ukuba kaninzi kangakanani i-ketamine kufuneka ilawulwe kubantu abanezifo zengqondo. Ngaba kufuneka ilawulwe rhoqo iintsuku ezimbini okanye ezintathu? Okwesine, asiyazi ukuba i-ketamine inayo nayiphi na imiphumo emibi yesikhathi eside.
Ekugqibeleni, ukuba i-ketamine yayisetyenziswe ngokubanzi ekuphatheni ukudakumba okanye ukuphazamiseka kwengqondo, kuya kuba yinkqubo yokwenza isigqibo. Ngamanye amazwi, i-ketamine yayiza kusetyenziswa ukongeza kwimiba yokuxhatshazwayo okanye yokunyaniseka kwemizwa. Ngeli xesha, akucaci ukuba i-ketamine iyakufuneka ilawulwe yi-anesthesiologist. Umthamo we-intramuscular of ketamine awungadingi ukulawulwa ngu-anesthesiologist kwaye unokufanelekile ukusetyenziswa kwezonyango zonyango.
I-Ketamine yeengcinga zokuzibulala
Kwiminyaka yakutshanje, umphumo we-ketamine kwiingcamango zokuzibulala (Wena, iinjongo zokuzibulala) awuhloliswanga ngokupheleleyo. Izihlandlo ezivame ukuhlola imiphumo ye-ketamine kwi-mood zijonge nje ukucinga okuzibulala njengento enye kwi-scale scale depress.
Kwinqaku le-Disemba 2017 elibizwa ngokuthi "I-Ketamine yokuNcitshiswa okuKhuselekileyo kweengxaki zokuzibulala ekudakaleni okukhulu: i-Midazolam-Elawulwayo i-Randomized Clinical Trial," I-Grunebaum kunye noogxa bafundela imiphumo ye-ketamine kwizigulane ezinokukhathazeka okukhulu kunye nokuzibulala.
Kulo vavanyo lokulawulwa ngokungahleliwe, abathathi-nxaxheba abangama-80 babelwe ukuba bafumane i-ketamine okanye ulawulo, imidazolam. Ngenxa yemiphumo ye-dissociative, akukho nanye i-anesthetic ifaniswa ne-ketamine. Ngaloo ndlela, abaphandi bakhetha i-midazolam ukulawula ngenxa yokuba i-ketamine, le nkunkuma inezakhiwo ezinengqondo. Ngaphezulu, isiqingatha-sobomi sezo zombini iziyobisi zifaniswa, kwaye imidazolam ayinayo impembelelo yokulwa ne-anti-depressant okanye i-antisuicidal. Zomibini izidakamizwa zilawulwa nguthambo lwezengqondo njengenye ye dose ngokulandelana.
Nazi ezinye zeziphumo zabaphandi:
- Ngomhla wokulawula, umlinganiselo ophakathi kweSikicidal Ideation (SSI) wawungamanqaku angamahlanu aphantsi kulabo bathatha i-ketamine, emele ukuhla kwexabiso lokuzibulala.
- Iinjongo zokuzibulala zancipha ngaphakathi kwee-230 imizuzu yokungeniswa.
- Iimpawu ezixakekayo ziphucule kakhulu kulabo bathatha i-ketamine.
- I-Ketamine ibangele ukunyuka kwexesha elide, ukunyuka kokulinganisela kwixinzelelo legazi.
- I-Ketamine yabangela imiphumo yokuxhatshazwa efana neyo yabonwa kwezinye iifundo.
- Ukuphuculwa kwinjongo yokuzibulala kwaqhubeka iiveki ezintandathu emva kokungeniswa kokuqala.
Olu phofu luneemingalo. Ngokomzekelo, olu pho nonongo luhlolisise abantu abaneengcinga zokuzibulala, kwaye iinjongo zokuzibulala zihluke kwiinjongo zokuzibulala okanye ukuziphatha. Ngenxa yokuba abaninzi abantu baneengcinga zokuzibulala, kwaye abantu abambalwa bayazibulala, ubuninzi bezampuli zesampula (okt, izigulane ezininzi) ziza kufuneka zifakwe ukuba ukuziphatha ngokuzibulala kuhlolwe. Ukongezelela, xa kuthelekiswa neqela lolawulo, izigulane ezininzi kwiqela lokuhlola le-ketamine lalinomngcipheko wobuntu obumda.
ILizwi
Phakathi kuka-1999 no-2015, kukho ukunyusa kwama-26.5 ekhulwini kumazinga okuzibulala e-United States. Okwangoku, akukho nonyango olululo lweengcinga zokuzibulala. I-American Psychiatric Association ithi "ubungqina bokunciphisa amazinga okuzibulala kunye noxinzelelo oluxinzelelekileyo luyinto engahambelaniyo." Kucacile ukuba iindlela ezifanelekileyo zokujongana nale ngxaki. Ngenxa yokuqalisa kwayo ngokukhawuleza, i-ketamine inokuba luncedo gqitha ekunciphiseni iingcinga zokuzibulala.
Ngokuqhelekileyo, ngokubhekiselele kwizifo zengqondo, i-ketamine ibonisa isithembiso ekuphatheni ukudakumba nokuphazamiseka kwengqondo-ngakumbi xa ezi zigulo zinganyangekiyo.
> Imithombo:
> I-Fond G, et al. Ulawulo lweCetamine kwiintlungu zokudandatheka: ukuhlolwa ngokucwangcisiweyo kunye nokuhlaziywa kwemeta. Psychopharmacology. 2014; 231: 3663-3676.
> Grunebaum MF, et al. I-Ketamine yokunciphisa ngokukhawuleza kweengcinga zokuzibulala ekudakaleni okukhulu: i-Midazolam-elawulwayo elawulwayo i-Clinical Trial Trial. I-American Journal ye-Psychiatry. 2017.
> Krystal JH, Sanacora G, Duman RS. I-agitamatergic anti-depressants esebenza ngokukhawuleza: indlela eya kwi ketamine nangaphezulu. Psychiatry. 2013; 73 (12): 1133-1141.
> Iziyobisi kunye neAntidotes. Ku: Olson KR, Anderson IB, uBenowitz NL, i-Blanc PD, u-Clark RF, uKearney TE, uKim-Katz SY, i-Wu AB. eds. Ukutyhefuza nokugqithiswa kweDrug, 7e eNew York, NY: McGraw-Hill.