精神科住院患者无抽搐电休克治疗应用状况

Clinical application of modified electroconvulsive therapy in psychiatric inpatients

目的了解无抽搐电休克疗法(MECT)的临床应用状况,为更加规范合理地使用MECT提供参考。方法采用回顾性分析方法,分层随机抽样,分析河南省精神病院2006年1月至2015年12月共1 330份精神科住院患者的病历资料,了解MECT应用情况,主要包括各种精神疾病患者接受MECT的比例、MECT合并抗精神病药物使用状况和MECT前后常规检查结果。结果各种精神疾病中接受MECT比例最高的是精神分裂症,为11.36%(81/713),其次为抑郁发作(5.61%,12/214),分离(转换)性障碍、双相情感障碍、器质性精神障碍及其他精神疾病接受MECT的比例分别为5.56%(2/36)、5.34%(7/131)、3.23%(1/31)和2.93%(6/205);非电休克组患者各种精神疾病分布与电休克组比较差异有统计学意义(χ~2=21.728,P<0.05)。电休克组患者未用药、单一用药、二联用药、三联用药和四联用药的比例分别为0.92%、17.43%、56.88%、21.10%和3.67%,电休克组联合使用2种或2种以上抗精神病药物的比例为81.65%;电休克组患者抗精神病药物使用频率较高的分别是奥氮平28.44%、氯氮平27.52%、喹硫平26.61%和利培酮24.77%。电休克组患者治疗前与治疗过程中第1、2、3周和MECT结束后1周的血常规检查结果比较后发现,仅白细胞计数差异有统计学意义(F=2.570,P<0.05),血小板、血红蛋白和红细胞水平在MECT前后不同时间比较差异均无统计学意义(P>0.05),其中93.33%的白细胞计数升高患者于2周内恢复正常。患者MECT治疗期间和治疗后心肌酶、肝功能等检查不够完善,未发现针对电休克患者认知功能、生活质量的长期系统的评估。结论精神分裂症患者选用MECT概率高于抑郁症患者;MECT多在联合使用2种及以上抗精神病药物的情况下使用;MECT可能引起白细胞短暂升高,大多数经治疗后可恢复正常水平;MECT患者治疗和预后情况的临床数据不够充分,有必要进一步完善临床病历资料。

Objective To investigate the clinical application of modified electroconvulsive therapy（ MECT）,and provide the references for more standardized and rational use of MECT. Methods A retrospective study was performed by stratified random sampling method. The clinical data of 1 330 psychiatric inpatients from January 2006 to December 2015 in Henan Psychiatric Hospital were analyzed retrospectively,and the clinical application of MECT was investigated,including the proportion of psychiatric inpatients receiving MECT,the situation of combined use of MECT and antipsychotic drugs,and the routine examination results before and after MECT. Results The proportion of receiving MECT in schizophrenic patients was the highest,it is 11. 36%（ 81/713）,the second was depressive episode（ 5. 61%,12/214）,followed by dissociative conversion disorder（ 5. 56%,2/36）,bipolar disorder（ 5. 34%,7/131）,organic mental disorder（ 3. 23%,1/31） and other mental disorders（ 2. 93%,6/205）. There were significant differences in the distribution of various mental disorders between the non electroshock group and the electroshock group（ χ^2= 21. 728,P〈0. 05）. The proportion of the patients without electric shock and the patients with single drug,two drugs,triple therapy or quadruple therapy was 0. 92%,17. 43%,56. 88%,21. 10% and 3. 67%,respectively. The proportion of the patients with two or more antipsychotic drugs was 81. 65% in the electroshock group. The antipsychotics were olanzapine（ 28. 44%）,clozapine（ 27. 52%）,quetiapine（ 26. 61%） and risperidone（ 24. 77%） according to the drugs used frequently in the electroshock group. The results of routine blood test were compared among the time points of before treatment,the 1 st,2 nd,3 rdweek of MECT and 1 week after MECT in the shock group,which showed that there was significant difference in white blood cell count（ F = 2. 570,P〈0. 05）; but there was no significant difference in the levels of platelet,hemoglobin and red blood cell（ P〈0. 05）; the level of white blood cell returned to normal within two weeks in93. 33% patients with increased white blood count. The myocardial enzymes and liver function tests were not perfect during the treatment of MECT and after treatment. There was no long-term systematic evaluation of cognitive function and quality of life in patients with electroconvulsive shock. Conclusions The probability of using MECT in the patients with schizophrenia is more than that in the patients with depression. MECT is used in combination with two or more antipsychotic drugs. MECT may cause a short increase in white blood cells,but the white blood cell level in most patients can recover to normal levels after symptomatic treatment. The clinical data for treatment and prognosis in patients with MECT are inadequate,so it is necessary to improve the medical record.