无抽搐电休克治疗老年难治性抑郁症临床研究

Clinical study of modified electroconvulsive therapy for refractory late-life depression

目的探讨无抽搐电休克(MECT)治疗老年难治性抑郁症的临床疗效和安全性。方法对43例老年难治性抑郁症患者予以无抽搐电休克(MECT)治疗,治疗前后采用汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评定临床疗效,用韦氏记忆量表(WMS)和简易精神状态检查表(MMSE)评定认知功能。结果治疗后第4周末临床总有效率为69.7%。治疗后第2周末HAMD总分及焦虑躯体化、睡眠障碍因子分较治疗前降低(P<0.05),治疗后第3周末HAMD除体质量外其他各因子分及总分均较治疗前降低(P<0.05),治疗后第4周末HAMD总分及各因子分均较治疗前降低(P<0.05)。治疗后第2、3周末HAMA总分及精神性焦虑较治疗前降低(P<0.05),治疗后第4周末HAMA总分及各因子分均较治疗前降低(P<0.05)。治疗后第1周末WMS中记忆商数、瞬间记忆较治疗前下降(P<0.05),治疗后第2周末瞬间记忆较治疗前下降(P<0.05);治疗后第4周末MMSE评分较治疗前升高(P<0.05)。所有患者均未发生严重心脑血管等事件。结论 MECT对老年难治性抑郁症有较好疗效和良好的安全性,其对认知功能的影响是短期和可逆的。

Objective To explore the clinical efficacy and safety of modified electroconvulsive therapy（ MECT） for the refractory late-life depression. Methods 43 patients with refractory late-life depression were treated with MECT. All patients were assessed with Hamilton Depression Scale（ HAMD） and Hamilton Anxiety Scale（ HAMA） at baseline and at the endpoint to evaluate the efficacy,and were assessed with Wechsler Memory Scale（ WMS） and Mini Mental Status Examination（ MMSE） at baseline and endpoint to evaluate the cognitive function. Results The total effective rate was 69. 7% at the end of the 4^（th）week of the treatment. Compared with the baseline,total score of HAMD and factor scores of anxiety / somatization,sleep disturbance decreased significantly at the end of the 2^ndweek（ P〈0. 05）; total score of HAMD and all factor scores except body mass decreased significantly at the end of the 3^（rd）week（ P〈0. 05）; and total score of HAMD and all factor scores decreased significantly at the end of the 4^（th）week（ P〈0. 05）. Compared with the baseline,total score of HAMA and factor score of psychic anxiety decreased significantly at the end of the 2^ndand 3^（rd）week of the treatment（ P〈0. 05）,and total score of HAMA and all factor scores decreased significantly at the end of the 4^（th）week（ P〈0. 05）. Compared with the baseline,factor scores of memory quotient and immediate memory in WMS decreased significantly at the end of the 1^（st）week of the treatment（ P〈0. 05）,and the factor score of immediate memory decreased significantly at the end of the 2^ndweek（ P〈0. 05）. Score of MMSE was significantly higher at the end of the 4^（th）week of the treatment than the baseline（ P〈0. 05）. No serious cardiovascular and cerebrovascular events were observed during the treatment. Conclusion MECT is effective and safe for refractory late-life depression. Cognitive impairment induced by MECT is transient and reversible.