小剂量氯胺酮联合依托咪酯对难治性抑郁症患者改良电休克治疗疗效的影响

Effect of low-dose ketamine combined with etomidate on the curative effect of modified electroconvulsive therapyin patients with refractory depression

目的观察探讨小剂量氯胺酮联合依托咪酯对难治性抑郁症患者改良电休克治疗(MECT)的疗效。方法选取2018年1月至2019年6月该院行MECT的60例难治性抑郁症患者为研究对象,分为氯胺酮组和对照组,每组30例。麻醉诱导时氯胺酮组给予氯胺酮和依托咪酯分别为0.3 mg/kg和0.2 mg/kg,对照组给予依托咪酯0.2 mg/kg。记录两组抽搐能量输出、动作发作时间、呼吸及意识恢复时间、MECT治疗前后心率、平均动脉压及不良反应发生情况。所有患者每次行MECT前行患者健康问卷(PHQ-9)评价疗效。结果两组抽搐能量输出、动作发作时间、呼吸及意识恢复时间、治疗前后心率和平均动脉压比较,差异无统计学意义(P>0.05)。治疗前两组PHQ-9评分比较,差异无统计学意义(P>0.05)。随着MECT次数的增加,两组PHQ-9评分均较前降低,且自第3次治疗后,两组PHQ-9评分比较,差异有统计学意义(P<0.05),且氯胺酮组低于对照组。1例患者出现一过性血压升高,治疗结束后即恢复正常。3例患者出现肌肉疼痛,于治疗后48 h内消失。结论小剂量氯胺酮联合依托咪酯可增强MECT疗效。

Objective To observe the effect of ketamine combined with etomidate on the curative effect of modified electroconvulsive therapy(MECT)in patients with refractory depression.Methods A total of 60 patients with refractory depression who received MECT were selected as the research objects,and divided into the ketamine group(n=30)and the control group(n=30).Ketamine and etomidate were given to the ketamine group 0.3 mg/kg and 0.2 mg/kg respectively,while the control group was given etomidate 0.2 mg/kg during anesthesia induction.The energy output,action attack time,respiratory and consciousness recovery time,heart rate before and after treatment,mean arterial pressure(MAP)and adverse reactions before and after MECT were recorded.The efficacy of all patients were evaluated by patient health questionnaire(PHQ-9)before MECT every time.Results There were no statistical difference in the convulsive energy output,action attack time,respiratory and consciousness recovery time,heart rate,MAP and adverse reactions before and after MECT between the two groups(P>0.05).There was no significant difference in PHQ-9 scores between the two groups before treatment(P>0.05).With the increase of treatment times,PHQ-9 scores in both groups were lower than before.After the third treatment,PHQ-9 scores in the two groups were significantly different(P<0.05),and the ketamine group was lower than the control group.One patient had transient elevated blood pressure,which returned to normal after treatment.Muscle pain occurred in 3 patients and disappeared within 48 h after treatment.Conclusion Low dose ketamine combined with etomidate can enhance the efficacy of MECT.