氯胺酮快速抗抑郁作用与围术期应用
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摘要
氯胺酮是一种NMDA受体拮抗剂。因其副作用和其他静脉麻醉药的发展,而逐渐减少了临床使用。近年来研究发现氯胺酮具有快速、有效、持久的抗抑郁作用,使得医学界对它的热情重新升温。本文重点回顾近年来氯胺酮的快速抗抑郁作用以及围术期应用研究进展,旨在拓宽麻醉医生参与围术期管理的范围。
Ketamine is a NMDA receptor antagonist. Due to its side effects and improvements of other intravenous anesthetics,the clinical application of ketamine has gradually been reduced. Recently,rapid,effective and permanent anti-depression effects of ketamine were discovered and drew the renewed interests of many clinicians. To broaden the perioperative scopes of anesthesiologists,this review focus on the research progress on rapid antidepressant effects and perioperative application of ketamine.
Ketamine is a NMDA receptor antagonist. Due to its side effects and improvements of other intravenous anesthetics,the clinical application of ketamine has gradually been reduced. Recently,rapid,effective and permanent anti-depression effects of ketamine were discovered and drew the renewed interests of many clinicians. To broaden the perioperative scopes of anesthesiologists,this review focus on the research progress on rapid antidepressant effects and perioperative application of ketamine.
引文
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[2]SWIATEK K M,JORDAN K,COFFMAN J.New use for an old drug:oral ketamine for treatment-resistant depression[J].BMJ Case Rep,2016,pii:bcr2016216088.DOI:10.1136/bcr-2016-216088.
[3]ANDRADE C.Ketamine for depression,2:diagnostic and contextual indications[J].J Clin Psychiatry,2017,78(5):e555-e558.DOI:10.4088/JCP.17f11629.
[4]OKAMOTO N,NAKAI T,SAKAMOTO K,et al.Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression:comparing ketamine and propofol anesthesia[J].J ECT,2010,26(3):223-227.DOI:10.1097/YCT.0b013e3181c3b0aa.
[5]ZAVOROTNYY M,KLUGE I,AHRENS K,et al.S-ketamine compared to etomidate during electroconvulsive therapy in major depression[J].Eur Arch Psychiatry Clin Neurosci,2017.DOI:10.1007/s00406-017-0800-3.
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[7]WANG X,CHEN Y,ZHOU X,et al.Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder[J].J ECT,2012,28(2):128-132.DOI:10.1097/YCT.0b013e31824d1d02.
[8]KARA N Z,AGAM G,ANDERSON G W,et al.Lack of effect of chronic ketamine administration on depression-like behavior and frontal cortex autophagy in female and male ICR mice[J].Behav Brain Res,2017,317:576-580.DOI:10.1016/j.bbr.2016.09.056.
[9]AUTRY A E,ADACHI M,NOSYREVA E,et al.NMDA receptor blockade at rest triggers rapid behavioural antidepressant responses[J].Nature,2011,475(7354):91-95.DOI:10.1038/nature10130.
[10]SOUMIER A,CARTER R M,SCHOENFELD T J,et al.New hippocampal neurons mature rapidly in response to ketamine but are not required for its acute antidepressant effects on neophagia in rats[J].e Neuro,2016,3(2).pii:ENEURO.0116-15.2016.DOI:10.1523/ENEURO.0116-15.2016.
[11]WANG N,YU H Y,SHEN X F,et al.The rapid antidepressant effect of ketamine in rats is associated with down-regulation of pro-inflammatory cytokines in the hippocampus[J].Ups J Med Sci,2015,120(4):241-248.DOI:10.3109/03009734.2015.1060281.
[12]ZHANG G F,WANG J,HAN J F,et al.Acute single dose of ketamine relieves mechanical allodynia and consequent depression-like behaviors in a rat model[J].Neurosci Lett,2016,631:7-12.DOI:10.1016/j.neulet.2016.08.006.
[13]FEDER A,PARIDES M K,MURROUGH J W,et al.Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder:a randomized clinical trial[J].JAMA Psychiatry,2014,71(6):681-688.DOI:10.1001/jamapsychiatry.2014.62.
[14]SCAGGS T R,GLASS D M,HUTCHCRAFT M G,et al.Prehospital ketamine is a safe and effective treatment for excited delirium in a community hospital based EMS system[J].Prehosp Disaster Med,2016,31(5):563-569.DOI:10.1017/S1049023X16000662.
[15]MCANDREW A,LAWN W,STEVENS T,et al.A proof-of-concept investigation into ketamine as a pharmacological treatment for alcohol dependence:study protocol for a randomised controlled trial[J].Trials,2017,18(1):159.DOI:10.1186/s13063-017-1895-6.
[16]WONG A,BENEDICT N J,ARMAHIZER M J,et al.Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome[J].Ann Pharmacother,2015,49(1):14-19.DOI:10.1177/1060028014555859.
[17]BELUGON P,JAKOBOWSKI N L,DOLLISH H K,et al.Withdrawal from acute amphetamine induces an amygdala-driven attenuation of dopamine neuron activity:reversal by ketamine[J].Neuropsychopharmacology,2016,41(2):619-627.DOI:10.1038/npp.2015.191.
[18]FULLER J J,MURRAY R C,HORNER K A.D-Amphetamine withdrawal-induced decreases in brain-derived neurotrophic factor in sprague-dawley rats are reversed by treatment with ketamine[J].Neuropharmacology,2015,97:7-17.DOI:10.1016/j.neuropharm.2015.04.023
[19]LALANNE L,NICOT C,LANG J P,et al.Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman:a case report[J].BMC Psychiatry,2016,16(1):395.DOI:10.1186/s12888-016-1112-2.
[20]JIANG M,WANG M H,WANG X B,et al.Effect of intraoperative application of ketamine on postoperative depressed mood in patients undergoing elective orthopedic surgery[J].J Anesth,2016,30(2):232-237.DOI:10.1007/s00540-015-2096-7.
[21]XU N,TANG X H,PAN W,et al.Spared nerve injury increases the expression of microglia M1 markers in the prefrontal cortex of rats and provokes depression-like behaviors[J].Front Neurosci,2017,11:209.DOI:10.3389/fnins.2017.00209.
[22]LI Y,WANG Y,XUAN C,et al.Role of the lateral habenula in pain-associated depression[J].Front Behav Neurosci,2017,11:31.DOI:10.3389/fnbeh.2017.00031.
[23]XIE Z M,WANG X M,XU N,et al.Alterations in the inflammatory cytokines and brain-derived neurotrophic factor contribute to depression-like phenotype after spared nerve injury:improvement by ketamine[J].Sci Rep,2017,7(1):3124.DOI:10.1038/s41598-017-03590-3.
[24]RINCON-CORTES M,GRACE A A.Sex-dependent effects of stress on immobility behavior and VTA dopamine neuron activity:modulation by ketamine[J].Int J Neuropsychopharmacol,2017.DOI:10.1093/ijnp/pyx048.
[25]HUDETZ J A,IQBAL Z,GANDHI S D,et al.Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery[J].Acta Anaesthesiol Scand,2009,53(7):864-872.DOI:10.1111/j.1399-6576.2009.01978.x.
[26]LEE K H,KIM J Y,KIM J W,et al.Influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients[J/OL].Anesth Pain Med,2015,5(5):e28844.DOI:10.5812/aapm.28844.
[27]AUBRUN F,GAILLAT C,ROSENTHAL D,et al.Effect of a lowdose ketamine regimen on pain,mood,cognitive function and memory after major gynaecological surgery:a randomized,double-blind,placebo-controlled trial[J].Eur J Anaesthesiol,2008,25(2):97-105.DOI:10.1017/S0265021507002566.
[28]尤杰,张焰,张邓新.氯胺酮全麻对患儿术后早期认知功能的影响[J].临床麻醉学杂志,2008,24(11):947-948.
[2]SWIATEK K M,JORDAN K,COFFMAN J.New use for an old drug:oral ketamine for treatment-resistant depression[J].BMJ Case Rep,2016,pii:bcr2016216088.DOI:10.1136/bcr-2016-216088.
[3]ANDRADE C.Ketamine for depression,2:diagnostic and contextual indications[J].J Clin Psychiatry,2017,78(5):e555-e558.DOI:10.4088/JCP.17f11629.
[4]OKAMOTO N,NAKAI T,SAKAMOTO K,et al.Rapid antidepressant effect of ketamine anesthesia during electroconvulsive therapy of treatment-resistant depression:comparing ketamine and propofol anesthesia[J].J ECT,2010,26(3):223-227.DOI:10.1097/YCT.0b013e3181c3b0aa.
[5]ZAVOROTNYY M,KLUGE I,AHRENS K,et al.S-ketamine compared to etomidate during electroconvulsive therapy in major depression[J].Eur Arch Psychiatry Clin Neurosci,2017.DOI:10.1007/s00406-017-0800-3.
[6]ANDERSON I M,BLAMIRE A,BRANTON T,et al.Ketamine augmentation of electroconvulsive therapy to improve neuropsychological and clinical outcomes in depression(Ketamine-ECT):a multicentre,double-blind,randomised,parallel-group,superiority trial[J].Lancet Psychiatry,2017,4(5):365-377.DOI:10.1016/S2215-0366(17)30077-9.
[7]WANG X,CHEN Y,ZHOU X,et al.Effects of propofol and ketamine as combined anesthesia for electroconvulsive therapy in patients with depressive disorder[J].J ECT,2012,28(2):128-132.DOI:10.1097/YCT.0b013e31824d1d02.
[8]KARA N Z,AGAM G,ANDERSON G W,et al.Lack of effect of chronic ketamine administration on depression-like behavior and frontal cortex autophagy in female and male ICR mice[J].Behav Brain Res,2017,317:576-580.DOI:10.1016/j.bbr.2016.09.056.
[9]AUTRY A E,ADACHI M,NOSYREVA E,et al.NMDA receptor blockade at rest triggers rapid behavioural antidepressant responses[J].Nature,2011,475(7354):91-95.DOI:10.1038/nature10130.
[10]SOUMIER A,CARTER R M,SCHOENFELD T J,et al.New hippocampal neurons mature rapidly in response to ketamine but are not required for its acute antidepressant effects on neophagia in rats[J].e Neuro,2016,3(2).pii:ENEURO.0116-15.2016.DOI:10.1523/ENEURO.0116-15.2016.
[11]WANG N,YU H Y,SHEN X F,et al.The rapid antidepressant effect of ketamine in rats is associated with down-regulation of pro-inflammatory cytokines in the hippocampus[J].Ups J Med Sci,2015,120(4):241-248.DOI:10.3109/03009734.2015.1060281.
[12]ZHANG G F,WANG J,HAN J F,et al.Acute single dose of ketamine relieves mechanical allodynia and consequent depression-like behaviors in a rat model[J].Neurosci Lett,2016,631:7-12.DOI:10.1016/j.neulet.2016.08.006.
[13]FEDER A,PARIDES M K,MURROUGH J W,et al.Efficacy of intravenous ketamine for treatment of chronic posttraumatic stress disorder:a randomized clinical trial[J].JAMA Psychiatry,2014,71(6):681-688.DOI:10.1001/jamapsychiatry.2014.62.
[14]SCAGGS T R,GLASS D M,HUTCHCRAFT M G,et al.Prehospital ketamine is a safe and effective treatment for excited delirium in a community hospital based EMS system[J].Prehosp Disaster Med,2016,31(5):563-569.DOI:10.1017/S1049023X16000662.
[15]MCANDREW A,LAWN W,STEVENS T,et al.A proof-of-concept investigation into ketamine as a pharmacological treatment for alcohol dependence:study protocol for a randomised controlled trial[J].Trials,2017,18(1):159.DOI:10.1186/s13063-017-1895-6.
[16]WONG A,BENEDICT N J,ARMAHIZER M J,et al.Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome[J].Ann Pharmacother,2015,49(1):14-19.DOI:10.1177/1060028014555859.
[17]BELUGON P,JAKOBOWSKI N L,DOLLISH H K,et al.Withdrawal from acute amphetamine induces an amygdala-driven attenuation of dopamine neuron activity:reversal by ketamine[J].Neuropsychopharmacology,2016,41(2):619-627.DOI:10.1038/npp.2015.191.
[18]FULLER J J,MURRAY R C,HORNER K A.D-Amphetamine withdrawal-induced decreases in brain-derived neurotrophic factor in sprague-dawley rats are reversed by treatment with ketamine[J].Neuropharmacology,2015,97:7-17.DOI:10.1016/j.neuropharm.2015.04.023
[19]LALANNE L,NICOT C,LANG J P,et al.Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman:a case report[J].BMC Psychiatry,2016,16(1):395.DOI:10.1186/s12888-016-1112-2.
[20]JIANG M,WANG M H,WANG X B,et al.Effect of intraoperative application of ketamine on postoperative depressed mood in patients undergoing elective orthopedic surgery[J].J Anesth,2016,30(2):232-237.DOI:10.1007/s00540-015-2096-7.
[21]XU N,TANG X H,PAN W,et al.Spared nerve injury increases the expression of microglia M1 markers in the prefrontal cortex of rats and provokes depression-like behaviors[J].Front Neurosci,2017,11:209.DOI:10.3389/fnins.2017.00209.
[22]LI Y,WANG Y,XUAN C,et al.Role of the lateral habenula in pain-associated depression[J].Front Behav Neurosci,2017,11:31.DOI:10.3389/fnbeh.2017.00031.
[23]XIE Z M,WANG X M,XU N,et al.Alterations in the inflammatory cytokines and brain-derived neurotrophic factor contribute to depression-like phenotype after spared nerve injury:improvement by ketamine[J].Sci Rep,2017,7(1):3124.DOI:10.1038/s41598-017-03590-3.
[24]RINCON-CORTES M,GRACE A A.Sex-dependent effects of stress on immobility behavior and VTA dopamine neuron activity:modulation by ketamine[J].Int J Neuropsychopharmacol,2017.DOI:10.1093/ijnp/pyx048.
[25]HUDETZ J A,IQBAL Z,GANDHI S D,et al.Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery[J].Acta Anaesthesiol Scand,2009,53(7):864-872.DOI:10.1111/j.1399-6576.2009.01978.x.
[26]LEE K H,KIM J Y,KIM J W,et al.Influence of ketamine on early postoperative cognitive function after orthopedic surgery in elderly patients[J/OL].Anesth Pain Med,2015,5(5):e28844.DOI:10.5812/aapm.28844.
[27]AUBRUN F,GAILLAT C,ROSENTHAL D,et al.Effect of a lowdose ketamine regimen on pain,mood,cognitive function and memory after major gynaecological surgery:a randomized,double-blind,placebo-controlled trial[J].Eur J Anaesthesiol,2008,25(2):97-105.DOI:10.1017/S0265021507002566.
[28]尤杰,张焰,张邓新.氯胺酮全麻对患儿术后早期认知功能的影响[J].临床麻醉学杂志,2008,24(11):947-948.