依托咪酯对无抽搐电休克治疗的影响

Effects of etomidate on modified electroconvulsive therapy

目的：探讨依托咪酯对丙泊酚诱导麻醉后无抽搐电休克（MECT）治疗运动发作时间不良的精神分裂症患者的疗效。方法：将67例行丙泊酚诱导麻醉下MECT治疗3次后，运动发作时间〈20s的精神分裂症患者随机分为两组，丙泊酚组33例，诱导麻醉仍给予丙泊酚，后续治疗电量较上次递增5％-100％；依托咪酯组34例，诱导麻醉换用依托咪酯，后续治疗电量较上次递增5％。两组均隔日治疗1次，共3次，治疗前及治疗2周，以阳性与阴性症状量表（PANSS）和韦氏记忆量表（WMS）评定其精神状况及记忆水平；比较两组患者运动发作时间、躁动谵妄发生率及疼痛发生率指标。结果：治疗后依托咪酯组运动发作时间、WMS评分、PANSS减分及躁动谵妄发生率均高于丙泊酚组，但疼痛发生率及电量指数显著低于丙泊酚组。结论：依托咪酯可提高丙泊酚诱导麻醉后MECT治疗运动发作时间不良患者的发作时间，减少注射疼痛，且较增加电量延长发作时间的方法有更少的认知损害，但须注意躁动谵妄问题。

Objective： To study the effect of etomidate on modified electroconvulsive therapy （MECT） for the patients with schizophrenia after anesthetized by propofol and had the shorter motor seizure duration. Method ：67 inpatients with schizophrenia treated three times with MECT under anesthetization by propofol and having shorter motor serzure duration （20 s） were randomized divided into two groups, propofol group （33 cases） and etomidate group （34 cases）. Propofol group was anesthetized by propofol, and therapeutic electric loadings increased by 5% to 100%. Etomidate group was anesthetized by etomidate and therapeutic electric loadings by 5%. The two groups accepted the treatment for three times with one time every two days. Wechsler memory scale（WMS） and positive and negative symptom scale（PANSS） were used to assess the patients＇memory and mental status before and two weeks after the MECT treatment. The motor seizure duration, phrenitis rate and pain rate were also measured. Results： Etomidate group had more seizure duration, phrenitis rate, scores of WMS and score decrease of PANSS after the treatment, but had less pain rate and therapeutic electric loadings than propofol group. Conclusion：Etomidate can prolong motor seizure duration and decrease pain rate for the patients with schizophrenia who anesthetized by propofol and has the shorter motor seizure duration in the MECT. And etomidate has less cognitive impairment than enlargement of motor seizure duration by adding therapeutic electric loadings. But phrenitis rate should be paid attention.