依托咪酯联合丙泊酚诱导麻醉用于老年患者无抽搐电休克治疗的临床观察

Clinical observation on the application of etomidate and propofol induced anesthesia in the non-convulsion electric shock therapy for senile patient

目的探讨依托咪酯联合丙泊酚诱导麻醉用于老年患者无抽搐电休克治疗(MECT)的安全性及疗效。方法 2009年8月至2010年10月收治的需行MECT的老年患者60例,男42例,女18例,年龄60～85岁。按随机化顺序均分为依托咪酯与丙泊酚联合组(A组)、依托咪酯组(B组)和丙泊酚组(C组)。A组静注依托咪酯0.15mg/kg、丙泊酚1mg/kg;B组静注依托咪酯0.3mg/kg;C组静注丙泊酚2mg/kg。测定三组患者麻醉前、麻醉诱导后和MECT后5、10min的SBP、DBP、HR、SpO2以及麻醉前、MECT10min后的血糖。记录治疗过程中每组患者的脑电癫痫波发作时间及不良反应。结果 B组MECT后5、10minSBP、DBP明显高于、HR明显快于A、C组,B组MECT后10min血糖明显高于麻醉前和A、C组(P<0.05)。A、B组脑电癫痫波发作时间明显长于C组(P<0.01);A组不良反应发生率明显低于B组(P<0.05)。结论依托咪酯联合丙泊酚诱导麻醉用于老年患者MECT安全有效,对血流动力学影响轻微,同时能明显延长脑癫痫波发作时间,减少不良反应的发生。

Objective To explore the curative effect and safety of the etomidate and propofol induced anesthesia in the non-convulsion electric shock therapy （MECT） for senile patient. Methods Sixty senile patients （42 males and 18 females aged 60 to 85 years old） needing MECT from August, 2009 to October, 2010 were randomized into three groups, one group using etomidate and propofol （group A）, one group using etomidate （group B）, and one group using propofol （group C）. Patients in group A are given etomidate fat emulsion injection 0.15 mg/kg and propofol 1 mg/kg in their venae, etomidate 0.3 mg/kg in group B, and propofol 2 mg/kg in group C. SBP, DBP, HR, and SpO2 are measured respectively before these three groups of patients are anesthetized, after anesthesia induction, and 5 min and 10 min after MECT. Blood glucose is also measured before anesthesia and 10 min after MECT. The onset time of epilepsy wave and the side effect of each group are recorded during the therapeutic process. Results Compared with groups A and C, SBP, DBP and blood glucose in group B are obviously increased and HR is significantly faster after electric shock therapy（P〈0. 05） ; the onset time of epilepsy wave in groups A and B are obviously prolonged than that in group C （P〈0.01）; cases of side effect in group A occurs less than that in groUp B （P〈0.05）. Conclusion Etomidate and propofol induced anesthesia can be safely and effectively used in the non-convulsion electric shock therapy for senile patient, and it has slight influence on haemodynamics. Meanwhile, it can obviously prolong the onset time of epilepsy wave and reduce side effects.