不同波宽刺激下无抽搐电休克治疗抑郁症疗效及对心脏节律性的影响

Efficacy and impact of cardiac rhythm of modified electroconvulsive therapy with different pulse width for major depressive disorder

目的:探讨不同波宽刺激下无抽搐电休克治疗(modified electroconvulsive therapy,MECT)对抑郁症疗效及心脏节律性的影响。方法:选取抑郁症患者120例,随机分为DGX模式组和Low 0.5模式组。给予MECT治疗6次。在治疗前、治疗3次、治疗6次后用汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD-17)评估临床症状。记录MECT刺激时间和抽搐发作时间。监测首次MECT治疗麻醉药注射前至抽搐发作结束后10 min心电图及心律失常发生情况。结果:治疗3次后Low 0.5模式组HAMD-17减分率明显优于DGX模式组(t=2.041,P=0.044)。Low 0.5模式组与DGX模式组相比,心律失常发生率明显增高(χ^(2)=7.350,P=0.007),刺激时间明显延长(t=30.92,P<0.01),首次发作时间明显延长(t=2.098,P=0.038)。刺激时间与心律失常发生率呈正相关(r=0.212,P=0.020)。结论:Low0.5模式与DGX模式相比,治疗抑郁症起效更快,心律失常发生率更高;MECT刺激时间越长,心律失常发生率越高。

Objective:To detect the efficacy of modified electroconvulsive therapy(MECT)with different pulse width on depression and impact on cardiac rhythm.Method:One hundred and twenty inpatients with depression were divided into two groups randomly(Low 0.5 group and DGX group).All patients received MECT treatments for 6 times.Clinical symptoms were assessed using Hamilton Depression Scale(HAMD-17)at baseline,after 3 and 6 treatments.The stimulation time and seizure time were recorded.The electrocardiogram was monitored from the injection of anaesthetics to 10 minutes after seizure at the first MECT treatment.Results:After 3 time treatment,the reduction rate of HAMD-17 in the Low 0.5 group was significantly better than that in the DGX group(t=2.041,P=0.044).There was significantly higher incidence of arrhythmia(χ^(2)=7.350,P=0.007),longer stimulation time(t=30.92,P<0.01),longer first seizure duration(t=2.098,P=0.038)in the Low 0.5 group than that in the DGX group.Long stimulation time was related to high incidence of arrhythmia(r=0.212,P=0.020).Conclusion:Low 0.5 mode has earlier response in treating depression comparing with DGX mode,while with higher incidence of cardiac arrhythmia.Longer stimulation time is related to the higher incidence of arrhythmia.