Ketamine濫用引發膀胱病變病人之照護

Nursing Care for Patients with Ketamine Abuse-Induced Vesicopathy

Ｋ他命正式名稱為氯胺酮(ketamine)，俗稱卡門、K 粉、k 仔，屬於一種分離性麻醉藥物，由於取得容易，近年來台灣地區濫用K 他命成癮者比例有逐年上升之跡象，該藥物除了對神經功能產生「分離性幻覺」(dissociative hallucination)，導致使用者神志不清外，最常見造成膀胱潰瘍病變、纖維化，甚至導致膀胱容量縮小到僅有50cc，而感到嚴重尿急、小便時疼痛及尿失禁，合併大量血尿和嚴重骨盆腔疼痛，無法正常工作，影響生活品質。對此護理人員必須確知ketamine 所導致的作用、濫用原因、臨床症狀、治療與護理處置，以便在臨床上協助病人及家屬瞭解ketamine 濫用所引發的膀胱病變、治療方向及防止再次藥物濫用，針對此類病人其疼痛、急迫性尿失禁、焦慮及無效性因應能力等健康問題，提供合宜護理措施，有效改善病症，協助即早戒除藥物濫用，恢復優質生活。

Ketamine is commonly known as K powder, and belongs to a class of dissociative anesthetics. Owing to easy acquirement, ketamine addiction has increased in recent years. In addition to impacts on neurologic dysfunction with the generation of "dissociative hallucinations" and confusion, it often produces ulceration and fibrosis in the urinary bladder, which reduces the capacity of the bladder to only 50ml. Furthermore, severe urgency, dysuria, urinary incontinence, massive hematuria, severe pelvic pain and quality of life are all affected. These neurologic and urinary sequelae can distract patients away from work and affect life quality. Therefore, thorough recognition of effect, causes, clinical symptoms and signs, treatments and nursing through ketamine toxicity are critical for nursing care, not only to help patients and their families understand ketamine abuse-induced vesicopathy and treatment but also to prevent further drug abuse. Patients with ketamine abuse-induced vesicopathy often have health problems of pain, urgent incontinence, anxiety, and ineffective coping ability. It is hope that these nursing interventions can persuade users to stay away from illicit drugs and restore the life quality of ketamine-addictive or ketamine-intoxicated patients.