氯胺酮应用于改良性电抽搐治疗的观察和护理

Ketamine as Anesthesia for Modified Electroconvulsive Therapy:Observation and Nursing

目的探讨氯胺酮在改良性电抽搐治疗(MECT)中的不良反应,采取针对性的护理措施,降低风险,提高治疗的安全性。方法将60例需做MECT治疗的难治性抑郁患者随机分为两组。氯胺酮组(30例):使用氯胺酮作为诱导麻醉剂;丙泊酚组(30例):使用丙泊酚作为诱导麻醉剂;比较两组患者在治疗中的生命体征和不良反应。结果丙泊酚组静脉炎、分泌物、肌肉疼痛及记忆障碍显著高于氯胺酮组(P<0.01);氯胺酮组头痛、结束后躁动不安显著高于丙泊酚组(P<0.05),恶心呕吐无明显差异(P>0.05)。抽搐期氯胺酮组血压、心率显著高于丙泊酚组(P<0.05);术后1、2、5分钟血压、心率迅速下降至正常值,两组生命体征无显著差异(P>0.05)。结论做好氯胺酮静脉麻醉下改良电抽搐治疗抑郁患者不良反应的护理,可减少患者术后不适感,提高患者对治疗的依从性、安全性及有效性。

Objective To observe the side effects of ketamine as anesthesia for modified electroconvulsive therapy （MECT） in treatment-resistant depressive （TRD） patients, and to use specific nursing measures to lower the risks and to improve the treatment safety. Methods 60 TRD patients were divided into two groups randomly and equally, one group with ketamine as anesthesia and the other group with propofol. Then the vital signs and all the side effects were observed and compared between the two groups. Results The incidence of phlebitis, secreta, myalgia and dysmnesia in propofol group was significantly higher than that in ketamine group （P〈0.01）, ketamine group had higher incidence of headache and post-treatment restlessness than propofol group （P 〈0.05）, and no difference was found in the incidence of nausea and vomit between the two groups （P 〉0.05）. During the period of convulsion, patients＇ blood pressure and heart rate was significantly higher in ketamine group than that in propofol group （P〈0.05）, patients＇ blood pressure and heart rate was down rapidly to normal on the 1st, 2nd and 5th minute after operation, and vital signs were not significantly different between the two groups （P 〉0.05）. Conclusions Good nursing for side effects of ketamine as anesthesia for MECT in TRD patients will reduce postoperative discomfort, and enhance compliance, safety and effectiveness.