氯胺酮联合丙泊酚麻醉对抑郁症患者电休克疗效的影响

Effect of low dose of ketamine combined with propofol on efficacy of electroconvulsive therapy in patients with depression

目的探讨氯胺酮联合丙泊酚麻醉对抑郁症患者电休克（ECT）疗效的影响,并评价其安全性。方法纳入2014年6~7月在我院首次接受改良电休克治疗（MECT）患者127例,男44例,女83例,年龄18~65岁,随机分为氯胺酮组（K组,n=63）和对照组（C组,n=64）。麻醉诱导时K组静脉注射丙泊酚1.5mg/kg、氯胺酮0.3mg/kg;C组静脉注射丙泊酚1.5mg/kg、生理盐水[体重（kg）×0.3÷10]ml。记录MECT期间患者生命体征、抽搐发作时间（SD）、抽搐能量指数（SEI）、呼吸恢复时间、苏醒时间和相关不良反应。于首次MECT前24h、每次MECT后24h采用汉密尔顿抑郁评分（HDRS）评价疗效,简易智力状态检查评分（MMSE）评价认知功能。结果两组患者MECT中生命体征平稳,呼吸恢复时间、苏醒时间、恢复期恶心呕吐、幻觉、头痛或肌肉痛发生率差异无统计学意义。K组MECT治疗后有效率和缓解率分别为90.5%和81.0%,明显高于C组的75.0%和65.6%;K组达到有效及缓解标准需要进行的MECT次数明显少于C组,治疗后认知功能障碍发生率（3.2%）明显低于C组（14.1%）（P〈0.05）。结论氯胺酮0.3mg/kg联合丙泊酚麻醉用于MECT治疗,可缩短MECT起效时间,改善疗效,减轻认知功能障碍,反复静脉注射小剂量氯胺酮无明显不良反应。

Objective To investigate the effect of low dose of ketamine combined with propofol on efficacy and safety of electroconvulsive therapy（ECT）in patients with depression.Methods One hundred and twenty-seven patients firstly undergoing modified electroconvulsive therapy（MECT）between June and July of 2014 were included and randomly assigned to either group K or group C.Patients in group K received propofol 1.5 mg/kg and ketamine 0.3 mg/kg in induction of anesthesia,while group C received 1.5 mg/kg and normal saline.Vital signs during MECT,seizure duration（SD）,seizure energy index（SEI）,respiration recovery time,awakening time,as well as the incidence of adverse events were recorded.The 24 hours before,and 24 hours after each MECT,Hamilton Depression Rating Scale（HDRS）was used to evaluate the efficacy,and Mini-Mental State Examination（MMSE）was applied to assess cognitive function in all patients.Results No significant differences were found in vital signs,respiration recovery time,awakening time and the incidence of adverse events including nausea and vomiting,hallucination,headache and myalgia between the groups.In group K,both effective rate and response rate were higher than those in group C（90.5% vs75.0% and 81.0% vs 65.6%,respectively）.Moreover,the required times of MECT to meet the standards of effective and response were significantly fewer in group K than those in group C.When compared with group C,the occurrence of cognitive dysfunction after ECT was lower in group K（P〈0.05）.Conclusion Low dose ketamine combined with propofol anesthesia could improve onset time and efficacy of ECT,as well as attenuate cognitive dysfunction following ECT in patients with depression.There is no evidence of any increase in adverse events occurrence associated with the repeated intravenous injection of low dose ketamine.