不同剂量氯化琥珀胆碱复合丙泊酚对无抽搐电休克治疗患者肌痛及不良反应的影响

Effect of different doses of succincholine chloride combined with propofol on myalgia and adverse reactions in patients treated with modified electroconvulsive therapy

目的探讨不同剂量氯化琥珀胆碱复合丙泊酚对无抽搐电休克治疗(MECT)患者肌痛及不良反应的影响。方法选取2020年5月至2021年1月于本院治疗的90例精神病患者作为研究对象,根据氯化琥珀胆碱剂量不同分为高剂量组(n=28)、中剂量组(n=32)与低剂量组(n=30)。3组均麻醉后行MECT,给予2.0 mg/kg丙泊酚乳状注射液,高剂量组给予1.4 mg/kg氯化琥珀胆碱,中剂量组给予1.2 mg/kg氯化琥珀胆碱,低剂量组给予1.0 mg/kg氯化琥珀胆碱。比较3组不同时间点血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SaO_(2))]、血钾浓度及肌肉震颤程度、术后肌痛情况、恢复自主呼吸时间、麻醉后苏醒时间、不良反应发生情况。结果3组HR组间、时间、交互比较差异有统计学意义(P<0.05);3组MAP组间、时间比较差异有统计学意义(P<0.05);3组MAP交互比较差异无统计学意义;3组SaO_(2)组间、时间、交互比较差异无统计学意义。组内比较:3组电击后各时间点HR、MAP均低于前一时间点,差异有统计学意义(P<0.05);3组电击后各时间点SaO_(2)比较差异无统计学意义。组间比较:3组电击后各时间点HR、MAP比较差异有统计学意义(P<0.05),SaO_(2)比较差异无统计学意义;电击1、3、5 min,高剂量组HR、MAP均低于中、低剂量组,且中剂量组低于低剂量组,差异有统计学意义(P<0.05)。3组血钾浓度组间、时间、交互比较有统计学意义(P<0.05)。组内比较:3组电击各时间点血钾浓度高于前一时间点,差异有统计学意义(P<0.05)。组间比较:3组诱导前即刻血钾浓度比较差异无统计学意义;电击前即刻、电击后5 min,高剂量组血钾浓度均高于中、低剂量组,且中剂量组高于低剂量组,差异有统计学意义(P<0.05)。高剂量组肌肉震颤程度、视觉模拟评分法(VAS)评分均低于中、低剂量组,中剂量组低于低剂量组,差异有统计学意义(P<0.05)。高剂量组恢复自主呼吸时间、麻醉后苏醒时间均长于中、低剂量组,且中剂量组长于低剂量组,差异有统计学意义(P<0.05)。3组不良反应发生率比较差异无统计学意义。结论1.2 mg/kg氯化琥珀胆碱复合异丙酚可较好稳定MECT患者血流动力学指标,可避免血钾浓度过高,有效降低肌震颤及术后疼痛程度,值得临床推广应用。

Objective To explore the effect of different doses of succincholine chloride combined with propofol on myalgia and adverse reactions in patients treated with modified electroconvulsive therapy(MECT).Methods 90 psychiatric patients treated in our hospital from May 2020 to January 2021 were selected as the research subjects,and they were divided into the high-dose group(n=28),the medium-dose group(n=32)and the lowdose group(n=30)according to different doses of succincholine chloride.All three groups were given MECT after anesthesia,given 2.0 mg/kg propofol emulsion injection,the high-dose group was given 1.4 mg/kg succincholine chloride,the medium-dose group was given 1.2 mg/kg succincholine chloride,and the low-dose group was given 1.0 mg/kg succincholine chloride.The hemodynamic indexes(heart rate[HR],mean arterial pressure[MAP],oxygen saturation[SaO_(2)]),serum potassium concentration at different time points and degree of muscle tremor,postoperative myalgia,recovery time of spontaneous breathing,recovery time after anesthesia,and adverse reactions were compared among the three groups.Results There were significant differences of HR among the three group of group,time points and interaction(P<0.05);there were significant differences of MAP among the three groups of group,time points(P<0.05);there was no significant difference in MAP interaction among the three groups;there was no significant difference in SaO_(2)among the three group of group,time points and interaction.Comparison within the group:HR and MAP of the three groups were lower than those of the previous time point after electric shock,and the differences were statistically significant(P<0.05);there was no significant difference in SaO_(2)among the three groups at each time point after electric shock.Comparison between groups:there were significant differences in HR and MAP among the three groups at each time point after electric shock(P<0.05),but there was no significant difference in SaO_(2)among the three groups.After 1,3 and 5 min of electric shock,HR and MAP in the high-dose group were lower than those in the medium-dose group and slow-dose,and the medium-dose group was lower than that in low-dose group,the differences were statistically significant(P<0.05).There were significant differences in serum potassium concentration among the three group of group,time points and interaction(P<0.05).Comparison within the group:the serum potassium concentration at each time point of electric shock of the three groups was higher than that at the previous time point,and the difference was statistically significant(P<0.05).Comparison between groups:there was no significant difference in serum potassium concentration among the three groups immediately before and after electric shock,but the serum potassium concentration in the high-dose group was higher than that in the middle-dose group and low-dose group immediately before and after electric shock,and the difference was statistically significant in the middle-dose group than in the low dose group(P<0.05).The degree of muscle tremor and visual analogue scale(VAS)score in the high-dose group were lower than those in medium-dose group and low-dose group,and the medium-dose group was lower than that in the low-dose group,the differences were statistically significant(P<0.05).The recovery time of spontaneous breathing and recovery time after anesthesia in the high-dose group were longer than those in the medium-dose group and low-dose group,and the medium-dose group was longer than that in low-dose group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions among the three groups.Conclusion 1.2 mg/kg succinylcholine chloride combined with propofol can better stabilize the hemodynamic indexes of patients with MECT,avoid excessive blood potassium concentration,and effectively reduce the degree of muscle tremor and postoperative pain,which is worthy of clinical promotion and application.