无抽搐电休克治疗中肌肉松弛药及肌肉松弛拮抗药使用的研究进展

Research Progress in the Use of Muscle Relaxants and Muscle Relaxant Antagonist in the Treatment of Modified Electroconvulsive Therapy

无抽搐电休克治疗(MECT)是一种在静脉麻醉药和肌肉松弛药作用下,通过适当的电流刺激诱发大脑皮质广泛性电发放的一种物理治疗方式,其对重症抑郁、精神分裂症急性发作、躁狂急性发作等药物控制不良的患者有较好的疗效。静脉麻醉药和肌肉松弛药不仅可明显降低骨关节机械性并发症的发生率,还可减少电刺激后交感和副交感神经放电对循环系统的影响,提高呼吸道可控性及治疗过程的安全性,使患者及家属更易于接受。目前,中国MECT肌肉松弛药的使用以去极化肌肉松弛药(琥珀胆碱)为主。随着舒更葡糖钠注射液的出现,罗库溴铵、维库溴铵等非去极化肌肉松弛药在MECT中的适用性正逐步提高。未来,肌肉松弛拮抗药与非去极化肌肉松弛药的配合使用将成为MECT肌肉松弛的主要研究方向。

Modified electroconvulsive therapy(MECT)is a kind of physical therapy to induce the extensive electrical distribution of the cerebral cortex under the action of intravenous anesthetics and muscle relaxants.It has a good effect on the cases of severe depression,acute schizophrenia,manic acute attack and so on.The use of intravenous anesthetics and muscle relaxants can significantly reduce the probability of mechanical complications of bone and joint,reduce the effect of sympathetic and parasympathetic nerve discharge on the circulation after systemelectrical stimulation,and improve respira-tory controllability and the safety of treatment,so that it′s easier for the patients and their families to accept.At present,the use of MECT muscle relaxants is mainly based on depolarizing muscle relaxant-succinylcholine in China.With the emergence of new muscle relaxant antagonistic-Sugammadex sodium,the applicability of rocuronium,vecuronium and other non-depolarizing muscle relaxants in MECT is gradually improving.In the future,the combination of muscle relaxant antagonist and non-depolarizing muscle relaxant will become the main research direction of MECT muscle relaxation.