Ubuvuzi bwa Ketamine ni ugukoresha ketamine ku rugero ruto rwo munsi ya anesthesia, bugenzuwe n'abaganga, akenshi ku ndwara yo kwiheba yari idakize ku miti isanzwe ikoreshwa mu kuvura kwiheba. Urugo rushobora kuza mu masaha aho kuba mu cyumweru, ariko rugashira mu gihe cy'iminsi 10-12, ku buryo ubuvuzi bukomeza ku rutonde rwo gufata imiti igenze.

Nk'igicapo: Ibintu by'ingenzi ugomba kwibuka

  • Urugo rumwe ruhagije rwakora vuba rugashira. Tegereza urukurikirane rw'imiti ndetse n'imyitozo yo kubungabunga, aho kuba gahunda imwe.
  • Spravato (esketamine) ni yo yonyine yemewe na FDA, kandi ni yo ishobora kwishyurwa n'ubwishingizi bwawe.
  • Imiti ya ketamine itunganywa mu rugo hamwe n'itumanaho rya telehealth ifite impuruza y'ibyago by'umuryango wa FDA yo muri Ukwakira 2023.
  • Ntabwo ushobora gutwara imodoka nyuma y'urugero. Shyiraho gutwara mbere yo kwiyandikisha.
  • Baza ku bikoresho byo gukurikirana, uwaba muri icyumba, hamwe n'urplan yo gukurikirana mbere yo kwishyura na gato.

Ubuvuzi bwa Ketamine bukora mu masaha, aho kuba mu cyumweru, ariko urugero rumwe ntirubikora

Ubuvuzi bwa Ketamine ni ugukoreshwa kwa ketamine ya subanesthetic igenzura, itangwa m'urubaho rw'umuntu, inshinge, cyangwa nk'isunzu ry'imiti yo mu mazuru ya esketamine, cyane cyane ku kwiheba kwakumiriwe n'imiti. Bitandukanye na imiti yo mu kanwa, isanzwe yaka ibyumweru bine kugeza kuri bitandatu kugira ngo igaragare, ketamine irashobora guhindura imitekerereze mu gihe cy'amasaha imwe. Urwego ni ruto, gukurikirana ni ubudahwema, kandi ubuvuzi butangwa nk'urugendo rwo gutegura aho kuba urugendo rumwe.

Imibare iri munsi ya "urugero ruto" irakenewe. Urugo rwo muri buri gihugu no mu buryo bwa klinik rwa 0.5 mg/kg, rwo munsi cyane y'urugero rwa 1-3 mg/kg rugabanywa kugira ngo rubyare ububazi. Mu isesengura rimwe, ingaruka zo kuvura kwiheba ziboneka hafi inshuro 40 za mbere inshuro, zikagera ku masaha 24, kandi zigacika intege ugereranyije na placebo mu gihe cy'iminsi 10-12.

Soma iki gice cyo nyuma ukongera. Bivuze ko akamaro k'ubuvuzi bumwe kaba gato, bityo urukurikirane rw'imiti ndetse n'imyitozo yo kubungabunga bikaba ari urugero rw'ubuvuzi bwa ketamine ku kwiheba, aho kuba kwiyongera. Bivuze kandi ko ketamine intravenous na intramuscular racemic ikoreshwa mu buryo bwo kumenya abaganga, mugihe esketamine intranasal ari yo yemejwe na FDA. Ibikurikira birakomeza kuri iyo ngengano.

Ketuamine nyinshi zigurishwa kuri interineti ku kwiheba ntabwo zigeze zigenzurwa na FDA

Bici n'ibyo bikoreshwa nk'ikicuruzwa cya ketamine ku kwiheba kuri interineti, harimo imiti y'ibipfubyi n'imisosi yo mu kanwa iyoborwa na telehealth, ntabwo byigeze bigenzurwa na FDA kuri iyo ntego. Ku ya 10 Ukwakira 2023, iyi nzego zahaye impuruza yo gutunganya ibyago yari ikubiyemo ibyo bicuruza byose. Ikibazo cyayo cyihariye: nta muntu ufite ubumenyi ufite kugira ngo akurikirane ububare, gutandukana, umuvuduko w'amaraso, n'ubuhumeka, abaguzi bafite akaga gakomeye cyane. FDA ntabwo yahagaritse ketamine nk'uwizewe kandi ufite ingaruka nyinshi mu ndwara z'ubwenge uretse ibicuruzwa by'esketamine byemewe.

Mu kurwanya, Spravato ntabwo iriryo ku rugo na gato. Ibyo si impanuka y'isoko. Ni urwego rw'amategeko rugomba gutsinda ku bicuruzwa byemewe.

Dore ibyo kenshi abantu batakubwirira: impuruza si nshya, kandi ntiva ku bayobozi gusa. Inama yo muri 2017 y'Ishami ry'Ubushakashatsi bwa Leta ya Amerika yo muri Burama mu rubuga rwa JAMA Psychiatry yasabye kwitonda no kwerekana mu gukoresha ketamine mu buryo budateguye mu buvuzi bw'ubwenge, ivuga iby'ibizamini bito na data nke k'ubuhanga n'umutekano w'igihe kirekire. Nta n'imwe muri ibi ikora ko gukoresha mu buryo budateguye ko bidashoboka. Bivuze ko ibibazo ubibaza bigaragara. Ni nde umukurikirana, akoresheje ibiki, kandi bibaho bite niba umuvuduko w'amaraso wawe uzamuka wari wenyine mu rugo?

Spravato cyangwa urupfubye? Ubwishingizi bwawe burakora

Spravato (esketamine) ni yo yonyine ifata ketamine FDA yemeje ku kwiheba kwakumiriwe n'imiti, yakozwe mu 2019. S-enantiomer ni ikomeye kurushaho ku rubyavu rwa NMDA kurenza ketamine ya racemic, bityo ikagera ku ngaruka zo kuvura kwiheba ku rugero ruto.

Kwemezwa kwaje guherekejwe na gahunda y'ihame ya REMS, kandi ibibazo byayo bisobanura hafi byose kubijyanye n'uburenganzira. Mu buryo bwa FDA yo kwandika imiti, urugero rwose rutangwa ku gukoresha wenyine mu kigo cy'ubuzima cyemejwe cyugururiwe ku maso, hamwe no gukurikirana amasaha nibura abiri nyuma, kwitaho ubuhumeka harimo gufata umwuka n'umuvuduko w'amaraso, no kwemeza ko uri mu mwanya mwiza mbere yo kugenda. Urutonde rwanditswe ni kabiri mu cyumweru ku 56 mg cyangwa 84 mg mu cyumwe cy'iminsi umunani, rimwe mu cyumweru mu cyumweru cya 5 kugeza ku cyumweru cya 8, hanyuma rimwe mu cyumweru cyangwa rimwe mu byumweru bibiri kuva ku cyumweru cya 9 ku rugero ruto rushyigikira uko wibona.

Ibyo biro ni bwo buhanga bwo kwishyurwa. Kwemezwa na FDA hamwe n'ubuyobozi bwa REMS ni impamvu Spravato isanzwe yishyurwa n'ubwishingizi, harimo ibibazo kubijyanye n'uko Medicare yishura ubuvuzi bwo mu mutwe, mugihe ketamine intravenous na intramuscular zidateguye zidafite ubuyobozi bwa leta bwa leta, kubera ko igihangano kimwe kidafite umuyobozi wo mu rwego rwa leta, bigaha ubwihindurirwamo bushobora gutuma ugabanya, kandi bikaguha igihamya: urugero rw'ubuyobozi ruhinduka ku rugo, bityo uburemere bwo kumenya bugushyira.

Guhitamo gahunda bifite akamaro kuruta guhitamo molecule

Niba uhisemo gufata imiti idafite akamaro cyangwa ubuvuzi bwa ketamine, inzira z'ibigo byo gusesengura no gukurikirana zishobora kurengera ubuzima bwawe kuruta uko inzira yo gutanga ibikora.

Kwemeza ko uri umukandida. Izi gahunda zihabwa abafite kwiheba kwakumiriwe n'imiti, bisanzwe bivuga ko imiti ibiri cyangwa irenga idafite ingaruka yari yasabye igenda ibyo. Uzane amakuru y'imiti wanditswe hamwe n'urugero n'igihe byafashwe. Gahunda itabaza ni yo ikubwira.

Hitamo uburyo. Ugereye ku imiti idafite akamaro, nta muvuzi uri muri icyumba. Ubuvuzi bwa ketamine burimo imiti na psychotherapy yo gutegura no kwishyira hamwe. Hitamo ku ntego: guhumuriza ibimenyetso cyangwa gusesengura ibigaragara mugihe no nyuma yo gufata imiti. Niba wifuza bwa kabiri, soma kubijyanye n'uburyo bw'ubuvuzi na ibyo uzitega mu rugero rwa mbere rwa psychotherapy mbere yo kwemera.

Kwemeza impamyabumenyi n'ibikoresho. Ukeneye umuganga wanditse, zazwi cyane nk'umuganga wo mu mutwe cyangwa umuganga wo mu bitaro, gukurikirana ubuzima burambye n'umwuka, ibikoresho by'ubuhumeka no gusubiza ubuzima, gahunda y'ikimenyetso cyihutirwa, no guhuza neza n'umuntu ugukoresha ibindi. Inzira zigari ni ndende: nta gusesengura kw'ibitaro cyangwa ubwenge, nta gukurikirana ubuzima, nta muntu uhari mugihe cyo gufata imiti, ibicuruzwa byoherejwe ku rugo rwawe, nta gahunda yo gukurikirana.

Shyiraho intego igenzura mbere y'urugero rwa mbere. "Kwirara" bisanzwe bivuga ko kugabanuka 50% cyangwa hejuru ku rwego rwo kwiheba nka PHQ-9 cyangwa MADRS, kandi kwiyakira bivuga amanota hafi y'ibisanzwe. Shira amakuru ku rwego rukoreshwa no igihe ruzapimwa. Noneho basabe gahunda yo kubungabunga n'ikomeza mu nyandiko mbere yo kwishyura urukerera rwo gutangira.

Hagati y'insimburana, porogaramu ngufasha y'ubuzima nka August AI irashobora kugufasha kwandika uko wifuzaga n'umwuka, kugira ngo umuganga wawe akurikirane amakuru nyayo aho kuba ibyo wibuka by'ibihe bibi.

Umubare w'amasaha 40 y'urubaho n'amasaha atatu yo kwirinda

Urugero rusanzwe rwa ketamine rutanga 0.5 mg/kg intravenous mu gihe cy'amasaha 40. Gutandukana kwiyongera hagati muri urugero kandi bishira mu gihe cy'iminota 15-30 nyuma yo guhagarika urubaho. Ubuvuzi bukomeza nyuma y'icyo.

"Kwitegereza neza" bigomba bivuga imibare. Ketamine yongera umuvuduko w'umutima n'amaraso, kandi mu rubanza rumwe rwa kimwe cya gatatu rw'urubaho rwagaragaje impinduka z'umuvuduko w'amaraso zikomeye cyane: umuvuduko w'amaraso hejuru ya 180/100 mmHg cyangwa kwiyongera kwa 20% cyangwa hejuru ku rugero, cyangwa umuvuduko w'umutima hejuru ya 110 bpm. Ni yo mpamvu imibare y'ubuzima ikurikiranwa mu gihe cy'iminota 200 izengurutse buri rubaho. Baza niba urugo rwawe rukora ibyo.

Mbere yo kugenda, fata umurongo wo kwirinda amafunguro, akenshi nta biryo mu masaha menshi hamwe n'ibinyobwa bisukuye bikaba byararangiye mbere. Shyiraho gutwara, kuko utashobora gutwara imodoka igihe cyose cy'umunsi. Kwemeza imiti n'ibiribwa byo kwirinda. Kwirinda inzoga n'igikoma. Kwambara imyenda yoroshye, kandi uzane mask yo kwiryamira cyangwa playlist niba urugo rubikwemereye.

Niba uri gukoresha Spravato, urya umuti mu rugo hanyuma ugahagarara nibura amasaha abiri kugira ngo witegerezwe, ufite umuvuduko w'amaraso ku isaha ya 40. Byaba gutya cyangwa gutya, nta muganga uri muri icyumba keretse niba wari wariyandikishije muri gahunda ya psychotherapy ifite ketamine.

Akaga gakomeye ntikaba mu ngaruka, ni ukureka urugendo mbere y'igihe

Inzara zisanzwe za ketamine ni gutandukana, kwiruka, umutwe, kubona nabi, ububare, no kwiyongera kw'umuvuduko w'umutima n'amaraso, hafi yose ikanguka mu gihe cy'amasaha nyuma y'urugero. Igice cy'umutima ni umubiri: ketamine irongera umuvuduko w'umutima, amaraso, n'ibitero by'umutima mugihe no gusa nyuma yo gufata imiti, hanyuma igacya.

Akaga kamwe kagera. Kurema amabuye m'umubiri kubera ketamine, byanditswe kera mu gukoresha ibyishimo, ubu byagaragaye ku muntu ufata ketamine ku rugero rwo kuvura kwiheba, kuboneka n'ububare, kwihutirwa, kubona nijoro, no kwihutira kwihagarika mu musarani. Uburemere bugaragaza urugero rusange, kandi guhagarara kare ku ntangiriro y'ibimenyetso byakumaza indwara.

Ikibazo: urugero rugaragaza ko 41% by'abafashe urugero rwa ketamine intravenous barahagarika. Fata ko ari urugero rumwe rugaragaza ibyo bikorwa, ariko impamvu zabyo zizwi. Kwishyura amafaranga. Gusubiramo amasaha atatu kugeza kuri ane yo kugera mu rugo. Gutandukana byagaragaye nk'ikibazo kuruta kwishimisha. Gutakaza urumuri hagati y'urugero. Nta bufasha bwo mu bwenge ku byagaragaye. Burimwe bufite igisubizo: imiti yo kwirinda ibyo kuruka, urugero ruto cyangwa igipfubye cyihuta, inshuro zihujwe, kwiyongera kwa psychotherapy yo guhuza, no gusubiramo gahunda aho kuba uguhagarika ako kanya. Porogaramu ngufasha y'ubuzima nka August AI irashobora kugufasha kwandika ingaruka n'ibimenyetso by'umubiri wawe ku ruhande rwa buri rugero kugira ngo urugero rugaragare ku muganga wawe mbere y'urugero rukurikira aho kuba nyuma ya gatandatu.

Igihe cyo guhamagara 911, n'igihe cyo guhamagara umuganga mbere

Hagara 911 cyangwa ugende ku cyumba cyihutirwa none niba:

  • Ufite ububabare mu gatuza, umutwe mubi, cyangwa umuvuduko w'amaraso hejuru cyane ku rugero rwawe (sisito hejuru ya 180)
  • Uhumura bwirirwa bucye, bucece, cyangwa buhagarara, cyangwa umuntu atagisubiza nyuma ya ketamine, cyane cyane ibicuruzwa byakorewe mu rugo
  • Habayeho kwiyahura
  • Ufite ibimenyetso by'ibyakubaho bikomeye cyane: kwibagirwa mu maso cyangwa mu muhogo, guhumeka nabi, cyangwa uruhu ruzenguruka

Kubijyanye n'ibitekerezo byo kwiyahura cyangwa ubwiyumvishijwe byiyongera cyangwa bikomeye, hamagara cyangwa wohereze SMS ku rubuga rwa 988 Suicide and Crisis Lifeline.

Shyiramo urugero mu cyumweru gitaha niba:

  • Ubona amaraso mu musarani wawe, ububabare bwo mu kibuno, cyangwa kwihutirwa kw'umusarani cyangwa kwihutirwa nyuma yo gutangira ubuvuzi
  • Ibimenyetso by'ubwenge nka hallucination, paranoia, cyangwa ibitekerezo bidashira kare nyuma yo guhagarika urugero
  • Kwiruka cyangwa gutakara amakuru bikomeza hagati y'insimburana
  • Ibisomwa by'umuvuduko w'amaraso mu rugo birajya hejuru ku rugero rwawe

Kubijyanye n'icyo gice cyo hagati, urugero rw'ibitaro rusange kuri 39 $ hamwe n'umuganga wemewe muri Leta Zunze Ubumwe z'Amerika ni inzira nziza yo gupima vuba ibibazo bishya by'umubiri, kwiruka kudasiba, cyangwa ibibazo by'umuvuduko w'amaraso. Umuganga ni we ugena ibizami cyangwa ubuvuzi. Urugero ntirushobora gutanga cyangwa kwandika ubuvuzi bwa ketamine, kandi ikintu icyo ari cyo cyose mu gice cya mbere gikeneye ubuvuzi bwo mu bwihutirwa.

Vugana n'umuganga mbere yo gutangira niba:

  • Ufite umuvuduko udasanzwe w'amaraso cyangwa indwara zikomeye z'umutima
  • Ufite indwara z'umubiri zitwarwa n'amaraso cyangwa amateka yo kwihagarika mu mutwe
  • Ufite amateka yo kwibagirwa cyangwa schizophrenia
  • Urasa cyangwa uri kunononsa
  • Ufite kwishora mu bikoresho by'ububabare, harimo inzoga
  • Ufite hyperthyroidism idakijijwe, indwara zikomeye z'umwijima, cyangwa amateka y'ibimenyetso byo mu ruhu byerekeranye na ketamine

Inzigo z'ibibazo bikunze kubazwa

Nshobora gukomeza gufata imiti yanjye yo kuvura kwiheba n'indi miti yo mu mutwe mugihe cy'ubu runzi bwa ketamine?

Akenshi. Abantu benshi bakomeza gufata imiti yo mu kanwa yo kuvura kwiheba mugihe cyose, kandi esketamine yanditswe kugira ngo ikoreshwe hamwe na yo. Iki kintu cyihari ni benzodiazepines: gukoresha buri gihe bishobora kugabanura ingaruka zo kwirara kuri ketamine. Niba ukeneye kugabanya, gutegereza, cyangwa gukomeza benzodiazepine ni icyemezo cy'umuganga cyakozwe hamwe n'urutonde rwawe rwose rw'imiti, aho kuba ikintu ugomba kwihindurira wenyine.

Ubuvuzi bwa Ketamine buraterwa ubwonko?

Birashoboka. Ketamine ni igikoresho cyugururwa gifite ibyago byo kwishimira, ni yo mpamvu gufata imiti bugenzuwe, urugero rufatwe, kandi nta kijyo cyo hanze ni ibikenewe muri gahunda y'ubuhanga. Kwishimira ibikoresho by'ububabare ni ikintu cyiza cyo kwiga mbere yo gutangira. Kwiyongera urugero rwawe cyangwa gushaka ketamine hanze y'urugo ni inzira yo kwirinda.

Ubuvuzi bwa Ketamine bukora ku bwoba, PTSD, cyangwa ububabare bukomeye?

Rimwe na rimwe. Ibice by'ibitaro bikoresha mu buryo budateguye ku bwoba, indwara ya stress nyuma yo guhura n'ikibazo, indwara yo kwisizanya, n'ibibazo bimwe by'ububabare bikomeye, kandi ibyemezo bito birashimishije. Umubare w'ibihamya ni muto cyane ugereranyije n'ubuvuzi bwo kwiheba kwakumiriwe n'imiti, kandi nta n'imwe yujuje ibyo FDA yemeje kuri ibyo bikoresho. Baza buri gice icyemezo kivuga ko gishyigikira gahunda yacyo ku ndwara yawe.

Nkeneye icyemezo cy'umuganga wo mu mutwe kugira ngo ntangire ubuvuzi bwa ketamine?

Akenshi si ko bimeze. Ibice byinshi bikirwa n'abiyandikishije bonyine kandi bigafata amakuru yabo. Kwemeza biragufasha, kuko bigeraho amakuru y'imiti yo kuvura kwiheba yahawe, igaragaza ko uri umukandida kandi igashyigikira isabwa ry'ubwishingizi kuri esketamine. Gahunda zirekura gusesengura ubwenge ni zo zikura mu gihe cyo kwirinda.

Ni iyihe mishani mfite niba ubuvuzi bwa ketamine butankoreye?

Nibura. Kwihindurira inzira cyangwa uburyo rimwe na rimwe bifasha, kuko abantu bakira ketamine intravenous na esketamine intranasal batandukanye. Kurenza aho, uburyo bwo gukoresha ubwonko nka transcranial magnetic stimulation na electroconvulsive therapy byombi bifite ibihamya bihamye by'igihe kirekire mu kuvura kwiheba kwakumiriwe n'imiti, n'uburyo bwo kongera ibindi bivuye ku ngufu bikomeza kuba ibisanzwe. Umuganga wo mu mutwe ashobora kubikubaza.

Ibisobanuro by'ubu runzi bwa ketamine

Ubuvuzi bwa ketamine ni ugusubiramo, gukwirakwiza ku rugero rwo kwirinda, aho kuba urugendo rumwe rutuma uwihagije. Hitamo ubwoko bwawe ku kwishyura no gukurikirana aho kuba ingufu. Genzura gahunda yo gusesengura, gukurikirana, no gukurikirana. Mvura ibisubizo byawe ku rwego rw'ubwiherero rwemejwe. Icyo ukora gikurikira ni ugushiramo isesengura ry'ubwenge rishyira mu nyandiko imiti yawe yo kuvura kwiheba yahawe.

Inyungu: Inyandiko iyi ni impamvu gusa kandi ntibishobora kuba inama y'abaganga. Komeza kugisha inama umuganga ufite ubuhanga kugira ngo uhitemo uburyo bwo gukiza no kuvura. Niba ufite impanuka y'ibitaro, hamagara 911 cyangwa ugende ku cyumba cyihutirwa cyegereye ako kanya.