用氯胺酮对接受无抽搐电休克治疗的难治性抑郁症患者进行麻醉的效果研究

Effect of ketamine on anesthesia in patients with refractory depression who received no convulsive electroconvulsive therapy

目的:探讨用氯胺酮对接受无抽搐电休克(MECT)治疗的难治性抑郁症(TRD)患者进行麻醉的效果。方法:将近年来在临沂市精神卫生中心接受MECT治疗的60例TRD患者随机分为氯胺酮组、丙泊酚组与联合组。对三组患者进行MECT治疗时,用氯胺酮对氯胺酮组患者进行麻醉,用丙泊酚对丙泊酚组患者进行麻醉,用氯胺酮联合丙泊酚对联合组患者进行麻醉,然后比较三组患者的HAMD评分、MoCA评分及其麻醉相关不良反应的发生率。结果:接受1次、2次、3次、4次、6次和8次MECT治疗后,三组患者的HAMD评分均低于治疗前,P<0.05。接受1次、2次、3次、4次、6次和8次MECT治疗后,三组患者的HAMD评分相比,P>0.05。接受8次MECT治疗后,氯胺酮组患者的MoCA评分高于丙泊酚组患者与联合组患者,P<0.05。接受MECT治疗期间,氯胺酮组患者麻醉相关不良反应的发生率低于丙泊酚组患者与联合组患者,P<0.05。结论:用氯胺酮对接受MECT治疗的TRD患者进行麻醉能在保证其疗效的同时降低其麻醉相关不良反应的发生率,且对其认知功能的影响较小。

objective:to investigate the anesthetic effect of ketamine on patients with treatment-resistant depression(TRD)treated without convulsive electroconvulsive shock(MECT).Methods:60 TRD patients who received MECT in linyi mental health center in recent years were randomly divided into ketamine group,propofol group and combined group.During MECT treatment,patients in the ketamine group were anesthetized with ketamine,patients in the propofol group were anesthetized with propofol,and patients in the combined group were anesthetized with ketamine and propofol.HAMD score,MoCA score and the incidence of anaesthesia related adverse reactions in the three groups were then compared.Results:after 1,2,3,4,6 and 8 MECT treatments,HAMD scores of patients in the three groups were all lower than before treatment,P<0.05.After 1,2,3,4,6 and 8 MECT treatments,the HAMD scores of patients in the three groups were compared(P>0.05).After 8 MECT treatments,the MoCA score of the ketamine group was higher than that of the propofol group and the combined group(P<0.05).During MECT treatment,the incidence of anaesthesia related adverse reactions in the ketamine group was lower than that in the propofol group and the combined group(P<0.05).Conclusion:the administration of ketamine to TRD patients receiving MECT can reduce the incidence of anesthesia-related adverse reactions while ensuring the efficacy,and has little effect on their cognitive function.