改良电休克治疗后不同亚型谵妄的相关因素分析

The prognostic factors of post-ECT delirium and its subtypes

目的 分析不同亚型改良电休克治疗后谵妄（post-ECT delirium,PECTD）患者的风险因素.方法 收集改良电休克治疗（modified electroconvulsive therapy,MECT）患者一般人口学资料及经MECT治疗的相关资料以及治疗前患者服药情况;采用单因素分析可能导致PECTD的相关因素,多因素Logistic回归分析发生不同亚型PECTD的相关因素.结果共收集335例MECT患者,158例（47.2％）未发生PECTD,177例（52.8％）发生PECTD,其中活动增多型PECTD 118例（66.7％）,活动减少型PECTD 59例（33.3％）.单因素分析显示,活动增多型PECTD患者与未发生PECTD患者比较,治疗前服用碳酸锂（16/31,x2=5.239）、苯二氮（艹卓）类药（30/75,Z=1 3.927）、抗精神病药（107/132,xz=12.214）及抗抑郁药（16/37,x2=4.470）差异有统计学意义（均P＜0.05）;Logistic分析显示仅碳酸锂进入回归方程（OR=2.058,P=0.016）,与年龄≤60岁患者相比,年龄＞60岁患者发生PECTD的风险显著增高（OR=3.884,P=0.014）;首次治疗的患者较非首次治疗患者更易发生活动减少型PECTD（OR=4.891,P＜0.01）.结论活动增多型PECTD的危险因素为治疗前使用碳酸锂.年龄＞60岁患者发生活动减少型PECTD的风险显著增加;而活动减少型PECTD与首次MECT显著相关.

Objective To analyze the prognostic factors associated with each subtype of post-ECT delirium （PECTD）.Methods Enrolled patients who received electroconvulsive therapy.Data collected included the demographic data,modified electroconvulsive therapy （MECT） treatment parameters and pre-MECT medications.Logistic regression analysis was used to examine the prognostic factors for hyperactive and hypoactive PECTD.Results 177 （52.8％） out of 335 patients enrolled in this study developed post-ECT delirium,118/177 （66.7％） were classified as hyperactive subtype and 59/177（33.3％）hypoactive subtype.Single factor analysis showed that,pre-ECT use of lithium （16/31,x2=5.239）,benzodiazepines （30/75,Z=13.927）,antipsychotic （107/132,x212.214） or antidepressants（16/37,x5=4.470）were significantly associated with hyperactive PECTD,but only pre-ECT lithium remained significant （OR=2.058,P=0.016） in logistic analysis.For active PECTD,logistic analysis showed that,comparing with younger age group,patients aged older than 60 years had a higher risk to develop hypoactive PECTD （OR=3.884,P=0.014）,and those who received the first ECT had a higher risk to develop hypoactive PECTD （OR=4.891,P＜0.01）.Conclusions Pre-ECT lithium may be the prognostic factor for hyperactive PECTD,while the prognostic factors for hypoactive ECT include age greater than 60 years old and after first ECT treatment.