丙泊酚与依托咪酯在无抽搐电休克治疗中的疗效对比

Comparison of the clinical effects between propofol and etomidate on modified electroconvulsive therapy

目的:对比丙泊酚与依托咪酯在无抽搐电休克(modified electroconvulsive therapy,MECT)中的疗效。方法:选取接受MECT治疗的精神病患者500例,每例患者首次MECT治疗前随机使用丙泊酚或依托咪酯,下一次治疗使用另一种麻醉药物,使用丙泊酚计为观察组,依托咪酯计为对照组。对比两次治疗的效果。结果:麻醉前收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)比较,差异无统计学意义(P>0.05);MECT后对照组SBP、DBP和HR均高于麻醉前(P<0.05);观察组SBP、DBP和HR与麻醉前比较,差异无统计学意义(P>0.05),且观察组SBP、DBP和HR均显著低于对照组(P<0.05)。观察组脑电癫痫波发作时间显著短于对照组(P<0.05)。两组抽搐能量指数(seizure energy index,SEI)、呼吸恢复时间和意识恢复时间比较,差异无统计学意义(P>0.05)。观察组不良反应发生率显著低于对照组(P<0.05)。结论:丙泊酚在MECT中对脑电癫痫波发作抑制作用强于依托咪酯,且对血压和心率影响较小,安全性好,临床可优先选用。

Objective：To compare the clinical effects of propofol and etomidate in modified electroconvulsive therapy （MECT）. Methods： 500 psychiatric patients who had received MECT were chosen and treated by MECT with either propofol （ the observation group） or etomidate （ the con- trol group） randomly for the first time and another anesthetic drug for the next time, the effects of the two groups compared. Results： There was no significant difference in systolic blood pressure （SBP） , diastolic blood pressure （DBP） and heart rate （HR） between the two groups before anes- thesia （ P 〉 0.05 ）. After MECT, the SBP, DBP and HR in the control group were significantly higher than those before anesthesia （ P 〈 0.05 ）. There was no significant difference in SBP, DBP and HR between the observation group and before anesthesia （ P 〉0.05 ） , and the SBP, DBP and HR in the observation group were significantly lower than those in the control group （ P 〈0.05 ）. The onset time of EEG seizures in the obser- vation group was significantly shorter than that in the control group （ P 〈 0.05 ）. There was no significant difference in seizure energy index （SEI）, respiratory recovery time and consciousness recovery time between the two groups （ P 〉 0.05 ）. The incidence of adverse reactions in the observation group was lower than that in the control group （ P 〈 0.05 ）. Conclusion ： Propofol in MECT is more effective and safer than etomidate in inhibiting EEG seizures but has less effect on blood pressure the heart rate , which is preference to etomidate .