李思賢Lee, Szu-Hsien李佳瑾Lee, Jia-Jin2019-08-28不公開2019-08-282018http://etds.lib.ntnu.edu.tw/cgi-bin/gs32/gsweb.cgi?o=dstdcdr&s=id=%22G0002053117%22.&%22.id.&amp;http://rportal.lib.ntnu.edu.tw:80/handle/20.500.12235/87277我國近年來非醫療用途的K他命使用人數大幅攀升，對國人的生理和心理健康造成重大的危害。由於K他命作用在N-methyl d-aspartate (NMDA) receptor，會造成大腦認知功能的下降，其中，包含對工作記憶Working memory的損害。 本研究案於西元2015年至2017年間，在台灣的台北市及台中市毒品危害防制中心其年齡介於20~40歲之間的K他命使用者中共招募到194位(實驗組)並公開招募了77位年齡一樣介於20~40歲之間抽菸且無使用K他命之健康受試者(對照組)，作為本實驗之研究對象。本論文使用到的研究工具有社會人口學背景、成癮嚴重度指標（Addiction Severity Index，ASI, McLellan et al., 1992）、尼古丁成癮度量表(Fagerstrom Tolerance Questionnaire，FTQ)以及針對大腦認知功能中短期記憶(工作記憶)做評估的電腦測試n-back task。 研究結果在人口統計學上，受試者絕大多數是男性，約佔81.9%，平均年齡為25.52歲(標準差為4.72)，平均受過11.65年的教育(標準差為2.30)，大多數的參與者都有完成或接受過高中職以上的教育和有全職或兼職的工作(81.9%)。在本研究中，相較於沒有使用K他命的健康受試者，K他命使用者在測試工作記憶力的電腦執行功能上，有較差的表現結果，且在困難度愈高的測試中，正確率和失誤率的差異與健康受試者愈大 (1-Back測試中，K他命使用者有較低的正確反應率(相差6.17%)，並且當測驗難度上升時(2-Back)，反應正確率又再更低(相差10.16%);在不該反應而反應的失誤率(Mistakes%)方面，0-Back和1-Back測試中K他命使用者不該反應而反應的失誤率均比健康受試者較高(分別相差1.04%及1.29%)，並且在當測驗難度上升至2-Back時，失誤反應率又再更高(相差1.49%))。至於應反應而反應的正確反應時間，則與年齡和性別較為相關;反應正確率和失誤率與多重藥物使用相關，而與第一次使用K他命至今的時間(藥齡)、過去30天使用的天數(使用頻率)和酒精使用不特別相關。 我們期望臨床研究結果能讓已使用藥物之成癮者降低再次使用K他命的頻率和劑量並因此減少他們的危險行為發生率，也期待提供可靠的衛教能使社會的組成狀態更好，是以執行研究計畫並就結果發表論文。In recent ten years, there was dramatically increasing non-medical use of ketamine in Taiwan. Through the action on N-methyl d-aspartate (NMDA) receptor, ketamine was reported to impair the neurocognitive function, and cause deficits in working memory robustly. Between 2015 to 2017, at Taiwan Drug Prevention and Control Center in Taipei and Taichung, we included 194 ketamine users, aged 20-40 and 77 same-aged smokers but not ketamine users (healthy group, H) as control. To validate the impact of ketamine use on neurocognition, we not only presented the demographic data but also use the tools including Addiction Severity Index (ASI, McLellan et al., 1992), Fagerstrom Tolerance Questionnaire (FTQ) and N-back task (Jaeggi, Buschkuehl, Perrig& Meier, 2010) as psychometric measurement. Demographically, of all participants, the gender was male predominant (81.9%), the mean age was 25.52 (±4.72), average years in education was 11.65 (±2.30), and rate of employment was 81.9%. The results demonstrate that ketamine abusers have poorer performance on the higher value N-back tasks. Compared to the control group, the ketamine abusers had significantly decreased rates of accuracy on the 1- and 2-back task (81.4% vs. 87.8%, p < 0.05; 66.3% vs.76.5%, p < 0.01), and increased rates of mistakes on N-back tasks. Reaction times of accuracy, however, were affected solely by age and gender. In this study, we confirmed the negative impact of ketamine on working memory, and the effect was much more profound when involving tasks that are more complex. We expect ketamine users to stop or reduce the frequency, dose and duration of abuse, to avoid performing risk-taking behavior and risk of accidental injury. With established awareness of potential long-term negative effects of ketamine, young people should having a healthier psychosocial life, educational and professional achievement.愷他命短期記憶工作記憶ketamineshort-term memoryworking memorynBack task