不同刺激电量无抽搐电痉挛治疗抑郁发作的疗效及不良反应比较

Efficacy and adverse reactions of different stimulus dosage of modified electroconvulsive therapy for depressive episode

目的：比较低、中、高3种不同刺激电量无抽搐电痉挛治疗（ modified electroconvulsive therapy，MECT）对抑郁发作的疗效及术后不良反应。方法接受MECT治疗的抑郁发作患者120例，随机分为低电量组、中等电量组、高电量组共3组，每组40例。低电量组刺激电量为年龄x50％，中等电量组刺激电量为年龄x70％，高电量组刺激电量为年龄x80％。患者共接受MECT治疗6次。采用汉密尔顿抑郁量表（ HAMD-17）评估患者临床症状，并观察记录患者不良反应发生情况。结果治疗6次后，3组患者HAMD-17评分与治疗前相比均显著改善（ t＝24．026， P＝0．000；t＝26．541， P＝0．000；t＝25．904， P＝0．000），组间差异无统计学意义（F＝0．409， P＝0．665）；治疗3次后，中等电量组[（34．3±6．8）％]和高电量组[（33．9±6．9）％]患者的HAMD-17减分率显著高于低电量组[（27．2±5．4）％]（ t＝－5．513， P＝0．000；t＝－4．785， P＝0．000）。高电量组患者的头痛、恶心呕吐、急性谵妄的发生率显著高于低电量组（头痛：χ2＝14．532， P＝0．000；恶心呕吐：χ2＝13．333， P＝0．000；急性谵妄：χ2＝14．907， P＝0．000）；中等电量组[（10．5±1．6）min]和高电量组[（11．2±1．8）min]患者的平均意识恢复时间显著长于低电量组[（8．8±1．2）min]（ t＝－5．144， P＝0．000；t＝－6．889， P＝0．000）。结论不同刺激电量MECT治疗抑郁发作6次时疗效相当，中、高刺激电量起效快，但不良反应发生率高。

Objective To evaluate the antidepressant efficacy and adverse reactions of 3 different stimulus dosage of modified electroconvulsive therapy （ MECT） in patients with depressive episode. Methods 120 patients with depressive episode were randomized into low dosage group （ n=40） ,medium dosage group （ n=40） and high dosage group （ n=40） . Low dosage were 50% x age,medium dosage was 70%xage,high dosage was 80%xage . All patients received 6 treatments. Hamilton depression scale-17（HAMD-17） was used to evaluate the clinical symptoms at baseline,3 and 6 treatments. Effects and adverse reactions were compared among three groups.Results Compared with baseline the HAMD-17 scores of the 3 groups were significantly improved after 6 treatments（ t=24.026, P=0.000;t=26.541, P=0.000;t=25.904, P=0.000） , but there were no statistically significant differences among the three dosage groups（F=0.409, P=0.665）. Compared with low dosage group（（27.2±5.4）%）,the HAMD-17 scores reductive ratio of medium dosage group（（34.3±6.8）%） and high dosage group（（33.9±6.9）%）） were significantly improved after 3 treat-ments （ t=-5.513, P=0.000;t=-4.785, P=0.000）. Compared with the low dosage group,the incidence rate of headache,nausea and vomiting,delirium were significantly higher in high dosage groups（ headache：χ2=14.532, P=0.000;nausea and vomiting：χ2=13.333, P=0.000;delirium：χ2=14.907, P=0.000） . The re-covery time was significantly longer in medium dosage group （ （ 10. 5 ± 1. 6 ） min ） and high dosage group＆amp;nbsp;（（11.2±1.8）min） than that in low dosage group（（8.8±1.2）min）（ t=-5.144,=0.000;t=-6.889, P=0.000）.Conclusion Different stimulus dosage of MECT for depressive episode has equivalent curative effect after 6 treatment . Medium dosage and high dosage treatments appear to have an early onset of efficacy,but may also be associated with more adverse reactions.