氯胺酮麻醉的改良性电抽搐治疗对抑郁症患者心血管系统及认知功能的影响

Effects of ketamine on cardiovascular system and cognitive function in patients with depression receiving MECT

目的对抑郁症患者进行多参数无抽搐电休克治疗(MECT)时,比较氯胺酮与异丙酚麻醉对患者心血管系统及认知功能的影响。方法将纳入研究的抑郁症患者随机分为观察组和对照组,每组各30例,进行MECT治疗时观察组接受氯胺酮麻醉,对照组则接受异丙酚麻醉。在MECT治疗前后对患者的平均动脉压(MAP)进行监测,并在治疗前及治疗8次末使用汉密尔顿抑郁量表(HAMD)评定患者的疗效,以及使用威斯康星卡片(WCST)评定患者的认知功能。结果两组患者在MECT治疗前后的MAP比较差异无统计学意义(P>0.05),两组患者的HAMD分值在治疗后均有所下降(P<0.05),在WCST总错误数与随机错误数方面差异无统计学意义(P>0.05),其中氯胺酮组在WCST完成分类数方面较异丙酚组好(P<0.05)。结论在MECT中使用氯胺酮作为麻醉剂对患者的心血管系统影响较少,认知功能损害较轻,可推荐为MECT治疗抑郁症的麻醉药。

Objective To investigate the effects of ketamine and propofol on cardiovascular system and cognitive function in the patients with depression during the modified electroconvulsive therapy（MECT）.Methods A total of 60 patients with depression treated by MECT were randomly divided into 2 groups.Induced anesthesia with ketamine and propofol were performed respectively during MECT.The course of treatment was 8 times.The mean arterial pressure（MAP）was recorded before therapy and at 5 min after MECT.Depression and the cognitive function were evaluated by using the Hamilton Depression Scale（HAMD）and the Wisconsin Card Sorting Test（WCST）before treatment and 1 day after treatment.Results There was no significant difference in MAP between the two groups after MECT（P〈0.05）.The HAMD scores of the two groups were lower than those before treatment（P〈0.05）.In the total number of errors and the number of random errors,there was no significant difference between two groups（P〈0.05）.But in completing classification of WCST,the ketamine group was better than the propofol group（P〈0.05）.Conclusion Propofol has no obvious influence on the cognition function and little influence on MAP,so it could be the first choice of anaesthetic for the induction of MECT.