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氯胺酮为苯环己哌啶的衍生物,属于N-甲基-D-天门冬氨酸(N-methyl-D-aspartic acid,NMDA)受体拮抗剂。从上世纪60年代问世开始,由于其具有镇痛作用强、作用迅速、苏醒快、给药方便、麻醉后吞咽及咳嗽反射仍然存在及血流动力学稳定等诸多优点而广泛应用于临床麻醉。随着氯胺酮滥用、慢性病患者的镇痛及抗抑郁治疗,将有越来越多的人群应用氯胺酮。短期应用,其急性毒性主要是产生情绪上的快感、精神病样症状;长期应用,目前焦点集中在对心血管和神经病变上。近5年来,越来越多的文献聚焦于其对泌尿系统的损害。本文综合2007～2012年3月所有氯胺酮相关性泌尿系统损害的文献,并对其相关流行病学、损害机制、诊断、治疗及其他问题进行综述。
Ketamine is a derivative of phencyclidine, belonging to the N-methyl-D-aspartic acid (NMDA) receptor antagonist. Since its introduction in the 1960s, it has been widely used in clinical anesthesia because of its many advantages such as strong analgesic effect, rapid action, fast recovery, convenient administration, swallowing and cough reflex after anesthesia and hemodynamic stability. With the abuse of ketamine, chronic pain patients with anti-depression treatment, there will be more and more people use ketamine. Short-term application, the main acute toxicity is to produce emotional pleasure, mental illness-like symptoms; long-term application, the current focus on cardiovascular and neuropathy. In the recent 5 years, more and more literature has focused on its damage to the urinary system. This article summarizes all ketamine-related urinary tract damage from March 2007 through March 2012 and reviews the related epidemiology, mechanisms of damage, diagnosis, treatment, and other issues.