艾司氯胺酮联合丙泊酚在无抽搐电休克治疗重度抑郁障碍患者中的应用

Application of esketamine combine with propofol in modified electro-convulsive therapy in patients with major depressive disorder

目的探讨艾司氯胺酮联合丙泊酚在无抽搐电休克(modified electro-convulsive therapy,MECT)治疗重度抑郁障碍(major depressive disorder,MDD)患者中的应用效果。方法选择2021年4月至2022年7月丽水市第二人民医院收治的64例MDD患者为研究对象,根据治疗方法不同分为对照组(n=32)与试验组(n=32)。对照组采用丙泊酚作为MECT麻醉剂,试验组在对照组基础上联合艾司氯胺酮作为麻醉剂,采用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分观察记录两组临床疗效,采用简易智力精神状态检查量表(mini-mental state examination,MMSE)比较两组的认知功能,比较两组麻醉效果、呼吸循环功能,以及麻醉前(T1)、麻醉中(T2)、麻醉后(T3)的心率(heart rate,HR)、血氧饱和度(pulse oxygen saturation,SpO_(2))、平均动脉压(mean arterial pressure,MAP)、不良反应发生情况。结果治疗前,两组HAMD评分比较,差异无统计学意义(P>0.05),治疗后试验组HAMD评分显著低于对照组(P<0.05),治疗总有效率显著高于对照组(P<0.05);试验组麻醉诱导时间、苏醒时间、定向力恢复时间均显著短于对照组(P<0.05);两组T1、T3时HR、SpO_(2)、MAP比较,差异均无统计学意义(P>0.05),T2时两组HR、SpO_(2)、MAP水平均显著低于T1,且试验组显著高于对照组(P<0.05);麻醉前,两组MMSE评分比较,差异均无统计学意义(P>0.05),麻醉后2h、8h,试验组MMSE评分显著高于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论艾司氯胺酮联合丙泊酚作为MECT麻醉剂在治疗MDD患者有较好的临床效果,可提升麻醉效果,对呼吸循环功能、认知功能影响较小。

Objective To investigate the effect of esketamine combined with propofol in modified electro-convulsive therapy(MECT)in patients with major depressive disorder(MDD).Methods A total of 64 patients with MDD admitted to Lishui Second People’s Hospital from April 2021 to July 2022 were selected and divided into control group(n=32)and test group(n=32)according to different treatment methods.The control group was treated with propofol combined with MECT,and the test group was treated with esketamine on the basis of the control group.The Hamilton depression scale(HAMD)was used to observe the clinical outcome of the two groups,and the mini-mental state examination(MMSE)was used to compare the cognitive function of the two groups.Heart rate(HR),pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP)and adverse reactions were compared between the two groups at the time before(T1),during(T2)and after(T3)anaesthesia.Results Before treatment,there was no statistically significant difference between the HAMD scores of the two groups(P>0.05),and after treatment,the HAMD scores of the test group were significantly lower than those of the control group(P<0.05),and the total effective rate of treatment was significantly higher than that of the control group(P<0.05).The induction time of anesthesia,awakening time and recovery time of orientation were significantly shorter in the test group than those in the control group(P<0.05);the differences in HR,SpO_(2)and MAP at T1 and T3 between the two groups were not statistically significant(P>0.05),while the levels of HR,SpO_(2)and MAP at T2 were significantly lower in both groups than those at T1,and significantly higher in the test group than in the control group(P<0.05).Before anesthesia,there was no statistically significant difference between the MMSE scores of the two groups(P>0.05),and 2h and 8h after anesthesia,the MMSE scores of the test group were significantly higher than those of the control group(P<0.05),there was no statistically significant difference between the incidence of adverse reactions of the two groups(P>0.05).Conclusion Esketamine combine with propofol has better application effect in MECT patients with MDD,can improving the anesthesia effect,and has little effect on respiratory circulatory function and cognitive function.