复合氯胺酮麻醉对老年抑郁症患者电休克治疗的认知保护作用:一项随机对照研究

Cognitive protective effect of subanesthetic ketamine anesthesia on elderly patients with depression undergoing electroconvulsive therapy: a prospective controlled clinical study

目的探讨小剂量氯胺酮在老年抑郁症患者电休克治疗(electroconvulsive therapy,ECT)的有效性和安全性。方法将157例老年抑郁症患者随机分为丙泊酚麻醉组(P组)和丙泊酚复合氯胺酮麻醉组(KP组)。KP组每次ECT麻醉前给予小剂量氯胺酮0.3 mg/kg,P组给予等量生理盐水。采用简易智力状态检查量表(mini-mental state examination,MMSE)分别在ECT前1 d、第1、2、4、6次ECT治疗后1 d和ECT结束后1 d评估认知功能,同时记录每次ECT所需要的刺激电量、发作时间及并发症。结果两组在ECT治疗前及每次ECT治疗后的MMSE评分差异无统计学意义(P>0.05),但KP组认知功能损害的发生率(10.4%)低于P组(25.7%)。两组在治疗过程中需要不同的刺激电量和发作时间。两组术后并发症差异无统计学意义(P>0.05)。结论小剂量氯胺酮作为辅助麻醉剂用于老年ECT患者是安全的,并且对认知功能有保护作用。

Objective To investigate the efficacy and safety of low-dose ketamine in the treatment of elderly depressive patients with electroconvulsive therapy(ECT). Methods A total of 157 elderly patients with depression were randomly divided into propofol anesthesia group(P group) and propofol combined with ketamine group(KP group). Beside propofol anesthesia, the patients in the KP group were given ketamine(0.3 mg/kg) before each ECT treatment, while those from the other group same amount of normal saline. Global cognitive functions were assessed using the mini-mental state examination(MMSE), respectively at baseline, 1 d after the 1 st, 2 nd, 4 th and 6 th ECT sessions, and 1 d after the end of the ECT course. The electrical dose and seizure duration of each ECT and incidence of complications were recorded. Results There were no significant differences in MMSE scores between the 2 groups at above time points before and after ECT treatment(P>0.05), but the incidence of cognitive function impairment was lower in the KP group than the P group(10.4% vs 25.7%, P<0.05). The 2 groups need different electrical dose and seizure duration in the course of treatment. There was no significant difference in the incidence of postoperative complications between them(P>0.05). Conclusion Low dose ketamine is safe as an adjuvant anesthetic for elderly patients undergoing ECT and shows a protective effect on cognitive function.