右美托咪定对无抽搐电休克治疗抑郁症患者疗效的影响

The influence of dexmedetomidine to the treatment effect in depression patients with modifiled electroconvulsive therapy

目的观察不同剂量右美托咪定对改良电休克治疗即无抽搐电休克治疗(modifiled electroconvulsive therapy,MECT)抑郁症患者疗效的影响。方法采用随机双盲设计,将30例汉密尔顿抑郁量表(Hamilton depression scale,HAMD)24项评分总分≥20分的抑郁症患者纳入,均分为三组,每位患者行6次MECT。三组患者于每次麻醉诱导前20min分别静脉匀速泵注右美托咪定1μg/kg(D1组)、0.5μg/kg(D2组)或等容量的生理盐水(D0组),泵注时间为10min。记录每次MECT的抽搐指数(seizure energy index,SEI)、抽搐时间(seizure duration,SD)、丙泊酚、琥珀胆碱用量、苏醒时间和不良反应。第1次MECT前1h及每次MECT后6h对患者进行HAMD、简易智力量表(Mini-mental state examination,MMSE)评分。结果与D0组比较,D1组不良反应明显曾多、苏醒时间明显延长(P<0.05);D1和D2组SEI、SD值明显升高,D1组丙泊酚用量明显减少(P<0.05)。与第1次MECT前1h评分比较,D1、D2组第3、4、5、6次及D0组第4、5、6次MECT后6h的HAMD评分明显降低,MMSE评分明显升高(P<0.05)。结论每次MECT麻醉诱导前20min静脉匀速泵注0.5μg/kg右美托咪定,可提高SEI、SD值以及MMSE评分,降低HAMD评分,提高MECT患者的疗效,且不增加不良反应及苏醒时间,可安全有效地应用于MECT。

Objective To observe the influence of different doses of dexmedetomidine hydrochloride injection on the treatment effect in patients with modifiled electroconvulsive therapy（MECT）.Methods Thirty patients with depression of hamilton depression scale（HAMD≥20）were divided into three groups D1,D2,D0,randomly.Each group received dexmedetomidine intravenously via pump 20 min before anesthesia induction.The dosage was 1μg/kg for group D1,0.5μg/kg for group D2,and group D0 received equal amount of saline as a control.The continuous injection lasted for 10 min.All patients were given the MECT 6times.During each MECT,SEI,SD,the recovery time、the adverse reactions and the dosage of propofol and succinylcholine were recorded.Every patient was evaluated with HAMD and MMSE 1 hbefore the first MECT and 6 hafter each MECT.Results Compared with group D0,the group D1 had significantly more adverse reactions and longer recovery time.（P〈0.05）.The index of SEI,SD was higher in groups D1,D2 than in group D0,the dosage of propofol was also lower in group D1（P〈0.05）.Compared with the value recorded 1hbefore the 1st MECT,6h after the 3rd,4th,5th,6th MECT in groups D1 and D2and the 4th,5th,6th MECT in group D0 showed lower HAMD and higher MMSE（P〈0.05）.Conclusion Dexmedetomidine at the dose of 0.5μg/kg i.v via pump 20 min before anesthesia induction may induce higher SEI,SD,MMSE and lower HAMD,thus improving the therapeutic response of depression patients undergoing MECT,without increasing the side effects and recovery time.Dexmedetomidine can be used safely and effectively in MECT.