抗精神病药物对精神分裂症无抽搐电休克治疗中出现室性心律失常的影响

Effects of antipsychotics on ventricular arrhythmia in modified electroconvulsive therapy for shizoprenia

目的探讨无抽搐电休克治疗(modified electroconvulsive therapy,MECT)中室性心律失常的发生率及药物的可能影响。方法对625例MECT治疗的精神分裂症患者在MECT中是否出现室性心律失常的病历资料进行回顾性分析,按MECT治疗同时是否应用抗精神病药物分为用药组和未用药组,比较各组间的差异。结果用药组的室性心律失常发生率为14.96%(79/528),未用药组为6.19%(6/97),差异有统计学意义(2=5.37,P=0.02,OR=2.42)。经典和非经典抗精神病药物组室性心律失常发生率分别为22.69%(27/119)和11.65%(41/352),而联合用药组为19.30%(11/57),经典抗精神病药物组和联合用药组的发生率均高于未用药组(2=11.25,P<0.05;2=6.29,P<0.05),经典抗精神病药物组高于非经典抗精神病药物组(2=8.78,P=0.003,OR=1.74)。舒必利组频发室早发生率22%(11/50),联合用药组为10.53%(6/57),两组频发室早发生率均明显高于未用药组的3.09%(3/97),差异均有统计学意义(2=13.69,P<0.05;2=4.03,P<0.05)。结论应用抗精神病药物的精神分裂症患者MECT时出现室性心律失常的风险高于未使用者,且不同种类药物的风险有所不同。

Objective To explore the incidence of ventricular arrhythmia and potential drug effects in modified electroconvulsive therapy （MECT）.Methods Retrospective analyses of who developed ventricular arrhythmia during MECT were conducted in 625 schizophrenics.Patients were divided into medication and non-medication groups according to whether patients were on antipsychotics or not during MECT.Results Incidences of ventricular arrhythmia were 14.96% （79/528） and 6.19%（6/97） in medication and non-medication group,respectively.The incidence of ventricular arrhythmia was significantly higher in medication than in non-medication group （2=5.37,P=0.02,OR=2.42）.Incidences of ventricular arrhythmia were 22.69%（27/119）and 19.30%（11/57） in typical antipsychotic group and drug combination group,respectively.The incidences of both of those groups were significantly higher than that of the non-medication group （2=11.25,P0.05,2=6.29,P0.05）.Incidences of ventricular arrhythmia were 22.69%（27/119）and 11.65%（41/352） in the classic and non-classic antipsychotic group,respectively.The incidence was significantly higher in the classic than in the non-classic groups （2=8.78,P=0.003,OR=1.74）.Incidences of frequent ventricular premature beat were 22%（11/50） and 10.53%（6/57） in sulpiride and the drug combination group,respectively.The incidence of frequent ventricular premature of both of those groups were significantly higher while compared with 3.09%（3/97） of the non-medication group （2=13.69,P0.05;2=4.03,P0.05）.Conclusions The risk of ventricular arrhythmia during MECT is higher in patients on antipsychotics than in those not on medication,and different kinds of drugs have different risk.