原文摘要（供参考）

病例报告：艾氯胺酮治疗后横纹肌溶解症 2 例

重度抑郁症是一种影响全球数百万人的精神障碍。相当一部分患者表现出对常规治疗缺乏反应。随着最近艾司氯胺酮的引入，一种新的治疗选择已被批准用于治疗难治性抑郁症。尽管该药物对很大一部分病例有效，但可能会出现罕见但可能严重的不良反应。本病例系列显示了两例横纹肌溶解症，即在艾氯胺酮给药后肌酸激酶水平升高的肌肉组织破坏。

介绍的第一个案例是关于一名患有严重抑郁症的 33 岁男性患者。他接受了鼻腔艾司氯胺酮作为紧急治疗。虽然抑郁症状初步改善，但患者在第四剂给药后出现肌肉疼痛和疲劳，肌酸激酶 （CK） 水平超过 22,000 U/L，表明横纹肌溶解症。在停用艾司氯胺酮并实施支持性治疗后，CK 水平恢复正常，抑郁症状减轻。

第二个案例是关于一名 22 岁的男性患者，他也患有严重的抑郁发作，并接受了艾司氯胺酮作为紧急治疗。第 10 次给药后，患者表现出肌肉无力和 CK 水平升高 （8,032 U/L），即使在剂量减少后仍持续存在。停止艾司氯胺酮给药，随后的监测显示 CK 和肝酶缓慢恢复到正常水平。

在这两种情况下，都没有已知的病史，并且两名患者在服用艾司氯胺酮后都出现了横纹肌溶解症。时间联系表明可能存在因果关系。我们没有发现关于鼻腔艾司氯胺酮给药后艾氯胺酮诱导的横纹肌溶解症的文献。然而，这两个病例强调了监测实验室变化的必要性，例如接受艾司氯胺酮的患者的 CK 水平升高，特别是考虑到它在难治性抑郁症中的使用越来越多。

关键字： ADR;药物不良反应;病例报告;艾司氯胺酮;横纹肌溶解症;难治性抑郁症。

Case report: two cases of rhabdomyolysis following esketamine treatment

Major depressive disorder is a mental disorder affecting millions of people worldwide. A considerable proportion of patients demonstrate a lack of response to conventional treatment. With the recent introduction of esketamine, a new treatment option has been approved for treatment-resistant depression. Although the medication is efficacious in a substantial portion of cases, rare, but possibly serious, adverse effects may occur. This case series shows two cases of rhabdomyolysis, a destruction of muscle tissue with elevated creatine kinase levels, after administration of esketamine. The first case presented is about a 33 year old male patient who suffered from a severe episode of a depressive disorder. He got nasal esketamine as an emergency treatment. While there was an initial improvement regarding the depressive symptoms, the patient developed muscle pain and fatigue after the administration of the fourth dose, with creatine kinase (CK) levels above 22,000 U/L, indicating rhabdomyolysis. Following the discontinuation of esketamine and the implementation of supportive care, the CK levels returned to normal and the depressive symptoms abated. The second case is about a 22-year-old male patient who also suffered from a severe depressive episode and got eketamine as an emergency treatment. Following the tenth dose, the patient exhibited muscle weakness and elevated CK levels (8,032 U/L), which persisted even after dose reduction. Esketamine administration was stopped, and the following monitoring demonstrated a slow return to normal levels of CK and liver enzymes. In both cases, there was no known medical history and both patients developed rhabdomyolysis after administration of esketamine. The temporal connection suggests a possible causal relationship. We found no literature on esketamine-induced rhabdomyolysis following the administration of nasal esketamine. However, these two cases emphasize the need of monitoring for laboratory changes like elevated CK-levels in patients receiving esketamine, especially considering its growing use in treatment-resistant depression.

Keywords: ADR; adverse drug reaction; case report; esketamine; rhabdomyolysis; treatment-resistant depression.