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依托咪酯联合丙泊酚用于改良电休克发作不良患者的疗效和安全性
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DOI:
作者:
贾玉萍,沈曙光,王晓敏,肖文斌,庄心良,徐一峰,苏亮
jiayuping,shenshuguang,wangxiaomin,xiaowenbin,zhuangxinliang,xuyifeng,suliang
作者单位:
上海交通大学医学院附属精神卫生中心 上海交通大学医学院附属第一人民医院 复旦大学附属华山医院
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine
关键词:
改良电休克;发作不良;依托咪酯;丙泊酚
Modified electroconvulsive therapy;Shorter motor seizure duration;Etomidate;Propofol
摘要:
目的 探讨依托咪联合丙泊酚对丙泊酚麻醉诱导后改良电休克(Modified electric convulsive therapy,MECT)治疗脑电发作不良患者的影响。方法 将336例丙泊酚麻醉诱导下MECT连续3次脑电波发作不良(时间<25s)的精神疾病患者,随机分为三组:丙泊酚组麻醉诱导仍给予丙泊酚;依托咪酯组麻醉诱导换用依托咪酯;联合用药组(依托咪酯+丙泊酚),每组均为112例。三组患者后续治疗电量根据脑癫痫波发作时间较上次递增5﹪,均隔日治疗1次,共治疗6次。记录初始阈值电量、最终阈值电量、治疗总电量、发作不良次数;分别记录麻醉诱导前、麻醉诱导后、MECT即刻、MECT10分钟心率和平均动脉压;比较三组患者不良反应的发生率。结果 依托咪酯组MECT即刻、10min心率和平均动脉压均明显高于丙泊酚组和联合用药组(P<0.05),丙泊酚组最终阈值电量、治疗总电量等明显高于依托咪酯组和联合用药组(P<0.01),联合用药组的不良反应发生率明显低于依托咪酯组和丙泊酚组。结论 依托咪酯联合丙泊酚诱导麻醉可提高丙泊酚麻醉诱导后MECT发作时间不良患者的脑癫痫发作时间,对血液动力学影响轻微,减少不良反应发生率,安全有效。
Objective To explore the effect of the etomidate and propofol induced anesthesia in the modified electric shock therapy (MECT) for patients with bad brain wave. Methods 336 psychiatric disorders patients who had treated by MECT after propofol induced anesthesia(the onset time of epilepsy wave < 25s in former three times) were selected and randomly divided into 3 groups, propofol group, etomidate group and combined group (propofol and etomidate), every group had 112 patients. The following quantity of therapeutic electricity that makes the onset time of epilepsy wave increase by 5% was used, and all patients treated by MECT once every other day (six times in all).The initial threshold value of quantity of electricity, final threshold value of quantity of electricity, total quantity of therapeutic electricity, times of bad seizures were recorded respectively. In addition, the heart rate (HR) and mean arterial blood pressure (MAP) in before and after anesthesia, and in immediate and 10min after MECT were also recorded. Moreover, the ratios of side effects in these three groups were compared. Results Compared with propofol group and combined group, the HR and MAP in group etomidate are significantly increased immediately and 10min after MECT (P<0.05). Compared with etomidate group and combined group, the ratio of side effects in combined group is obviously decreased (P<0.01). Conclusion Application of combination etomidate and propofol in anesthesia can increase the onset time of epilepsy wave in patients who have bad onset time of epilepsy wave after propofol induced anesthesia. It has slight influence on haemodynamics and can reduce the ratio of side effects. In a word, combined etomidate and propofol induced anesthesia can be safely and effectively used in MECT.
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