不同麻醉深度对抑郁症电休克治疗后学习记忆的影响

Effects of different anesthesia depth on learning memory in depressed patients undergoing electroconvulsive therapy

目的观察抑郁症在不同麻醉深度下行电休克治疗的疗效及对学习记忆的影响。方法75例初次接受电休克治疗的抑郁症患者,随机分为A、B、C三组,每组25例。A组:单次静脉推注丙泊酚1.5 mg/kg后实施电休克;B组:丙泊酚泵注维持深麻醉(脑电双频指数<45)下电休克;C组:丙泊酚泵注维持临床麻醉深度(脑电双频指数=45～60)下电休克。于电休克治疗前、治疗后24 h和1周末以17项汉密尔顿抑郁量表和韦氏记忆量表评估抑郁症状及学习记忆功能。结果与C组比较,A组、B组呼吸恢复时间、意识恢复时间、治疗室观察时间均延长(P<0.05)。三组患者电休克治疗后24 h(F=5.04,P<0.01)及1周末(F=4.05,P<0.05)汉密尔顿抑郁量表评分较治疗前均降低,而在各时间点评分三组之间差异无统计学意义。与治疗前比较,三组患者ECT后24 h长时记忆均降低(P<0.05),而ECT后24 h和1周后患者短时记忆、即刻记忆均升高(P<0.05),且B组、C组短时记忆、即刻记忆高于A组(P<0.05)。结论临床麻醉深度下实施电休克治疗可有效缓解抑郁症状,且患者的短期记忆在治疗后可得到早期改善,有利于患者早期康复,更适于电休克的麻醉。

Objective To examine the learning memory in patients receiving electroconvulsive therapy（ECT） under different anesthesia depth.Methods Seventy-five depressed patients receiving electroconvulsive therapy for the first time were divided into three groups（n = 25）： group A,group B and group C.The patients in group A were executed electroconvulsive therapy following treatment with intravenous injection of propofol 1.5mg / kg;the patients in group B were executed electroconvulsive therapy in deep anesthesia depth and the patients in group C were executed electroconvulsive therapy in clinical anesthesia depth.Depressed symptoms and learning memory were evaluated before and 24 h,one week after ECT by the Hamilton Depession Scale and the Wechsler Memory Scale.Results The respiration recovery time,consciousness recovery time and therapeutic room detain time were longer in group A and B than in group C（P 0.05）.The Hamilton Depression scale in all three groups were lower after ECT than before ECT（P 0.05）.However,the difference was not significant at each time point after ECT among different groups（P 0.05）.Compared with before ECT,the long term memory at 24 h after ECT significantly decreased in three groups（P 0.05） whereas the short term memory and immediate memory at 24 h and one week after ECT significantly increased（P 0.05）.The short term memory and immediate memory were higher in group B and group C than in group A（P 0.05）.Conclusion The depressed symptoms can be effectively treated by ECT therapy under depth of clinic anesthesia and anesthesia can improve the short term memory and immediate memory of patients undergoing ECT.