改良电休克治疗后自主意识与自主呼吸恢复时间的临床观察及相关因素研究

Clinical observation and associated factors of the recovery time of consciousness and spontaneous respiration after the treatment of modified electroconvulsive therapy

目的:观察改良电休克治疗(MECT)后患者的自主意识和自主呼吸恢复时间,分析二者恢复时间可能的相关因素。方法:将接受MECT治疗的185例精神疾病患者分为异丙酚和依托咪酯组。治疗准备完毕后,通电并即刻开始计时。根据血氧饱和度及患者胸廓扩张情况观测自主呼吸恢复情况;同时运用格拉斯哥昏迷量表(GCS)判断自主意识恢复,记录恢复时间。结果:自主意识恢复时间的中位数为11.72(四分位间距)(5.07)min,95%可信区间(CI)11.74～12.98min;自主呼吸恢复时间的中位数(四分位间距)为3.47(1.13)min,95%CI:3.48～3.76min。异丙酚组与依托咪酯组自主呼吸恢复时间差异无统计学意义(Z=0.26,P=0.79),而自主意识恢复时间两组间在统计学上差异具有显著性(Z=2.19,P=0.03)。相关分析提示大脑皮质癫疒间样放电时间同自主意识恢复时间呈正相关(r=0.185,P=0.012),治疗次数、治疗前舒张压及大脑皮质癫疒间样放电时间同自主呼吸恢复时间呈正相关(r=0.150,P=0.043;r=0.154,P=0.037;r=0.166,P=0.025)。结论:MECT治疗后患者自主意识恢复时间与麻醉剂类型、大脑皮质癫疒间样放电时间有关。

Objective： To investigate the recovery time of consciousness and the time to first spontaneous respiration among the patients after the administration of MECT,and to explore some related factors on the recovery time of consciousness and spontaneous respiration. Method：185 cases of patients who received modified electraconvulsive therapy（MECT） were randomly divided into propofol group and etomidate group.When the doctor delivered a suprathreshold electrical stimulus,timing was started.Spontaneous respiration was observed and recorded according to the oxygen saturation of blood and the thoracic dilatation.The patients’ consciousness were judged by the psychiatrist with the Glasgow coma scale （GCS）,and the recovery time of consciousness were recorded. Results：The recovery time of consciousness was 11.72（5.07）[Median（ Interquartile range）]minute,95%CI： 11.74~12.98 min;The time to first spontaneous respiration was 3.47（1.13）min,95%CI：3.48~3.76 min.Compared the recovery time of consciousness and the time to first spontaneous respiration between the propofol group and the etomidate group：there was no significant difference of the time to first spontaneous respiration （Z=0.26,P=0.79）;but there was significant difference of the recovery time of consciousness （Z=2.19,P=0.03）.Correlation analysis showed that：the electroencephalogram seizure duration and the recovery time of consciousness were significantly positively correlated （r=0.185,P=0.012）.Times of treatment、diastolic pressure and the electroencephalogram seizure duration showed positive correlation with the time to first spontaneous respiration（r=0.150,P=0.043 ;r=0.154,P=0.037 ;r=0.166,P=0.025）. Conclusion： The electroencephalogram seizure duration and anaesthetic were positively correlated with the recovery time of consciousness.