依托咪酯联合丙泊酚在精神障碍共患高血压患者无抽搐电休克治疗的应用

Application of etomidate mixed with propofol during modified electroconvulsive therapy (MECT) in schizophrenics with hypertension

目的:比较依托咪酯与丙泊酚联用或单用对精神障碍共患高血压患者无抽搐电休克(MECT)围术期治疗效果及不良反应。方法:90例入组患者随机分为:EP组(依托咪酯0.3 mg/kg联合丙泊酚1.0 mg/kg)、E组(依托咪酯0.7 mg/kg)和P组(丙泊酚2.0 mg/kg),依次静脉诱导后行电休克治疗。记录麻醉前、诱导后即刻、电击后即刻及电击后5 min血压、心率、末梢脉搏血氧饱和度,监测心电图、首次MECT治疗的抽搐能量抑制指数、运动发作时间、自主呼吸恢复及苏醒时间及麻醉不良反应的发生情况。结果:EP组和E组运动发作时间较P组长(P<0.05),能量抑制指数较P组高(P<0.05);EP组在诱导前后、电击前后血压心率维持平稳;E组在电击后血压较麻醉前明显升高(P<0.05);P组诱导后即刻血压较麻醉前明显下降(P<0.05)。EP组与E组注射痛发生率明显低于P组(P<0.05),恶心、呕吐、呃逆、躁动等不良反应3组患者无明显差异。结论:精神障碍共患高血压病患者行MECT治疗以依托咪酯联合丙泊酚复合麻醉MECT治疗效果好,围术期心血管事件风险较低,且麻醉不良反应少,临床可考虑推广应用。

Objective To compare the treatment accomplishmentsand adverse effects of the mixedor single-application of etomidate and propofol during modified eleetroconvulsive therapy （MECT） in schizophrenics with hypertension. Methods Ninety hospitalized schizophrenics with hypertension undergoing MECT were randomly assigned to 3 groups： Group EP（etomidate = 0.3 mg/kg and propofol = 1.0 mg/kg）, Group E （etomi- date = 0.7 mg/kg） and Group P （propofol = 2.0 mg/kg）. Changes of SBP, DBP and HR were recorded before anesthesia, after induction, electrical stimulation instantly and 5 min after electrical stimulation. The average periods of epileptic seizure （ESD）, postictal suppression index （PSI） and the adverse reactions were also recorded. Results The ESD and PSI scores were significantly higher in Group EP and Group E than those in Group P （P 〈 0.05）. SBP and DBP in Group E were significantly higher at the electrical stimulation instant than those after induction （P 〈 0.05）. SBP and DBP in Group P were significantly lower after induction than those before anesthesia（P 〈 0.05）. The injection pain of Group EP and Group E were lower than that of Group P（P 〈 0.05）. No significant differences were found among 3 groups in the adverse reactions such as nausea/vomiting anddysphoria.Conclusion The mixed liquor of etomidate and propofol can extend the time of seizure, reduce the negative reaction of cardiovascular system and adverse reactions during MECT in schizophrenics with hypertension.