摘要
目的 探讨艾司氯胺酮对电休克治疗(ECT)重度抑郁症患者改善抑郁和术后认知功能的影响.方法 选择接受ECT的重度抑郁症患者115例,男37例,女78例,年龄≥12岁,BMI 18～30 kg/m2,ASA Ⅰ或Ⅱ级,采用随机数字表将患者随机分为两组:艾司氯胺酮组(E组,n=56)和对照组(C组,n=59)o E组在麻醉诱导时使用艾司氯胺酮0.3～0.5 mg/kg、丙泊酚0.3～1.0 mg/kg和琥珀胆碱0.5～1.25 mg/kg,C组在麻醉诱导时使用丙泊酚1～2 mg/kg和琥珀胆碱0.5～1.25 mg/kg.每次ECT过程中记录ECT指标(包括EEG抽搐时间、抽搐时间、刺激强度和抽搐能量指数).在ECT前和ECT疗程结束后采用蒙特利尔认知评估量表(MoCA)和简易认知状态评价量表(MMSE)评价认知功能,使用汉密尔顿抑郁量表(HAMD)进行抑郁评分.记录头疼、恶心、呕吐、头晕、谵妄等不良反应的发生情况.结果 与C组比较,E组EEG抽搐时间明显延长(P＜0.05),ECT疗程结束后MoCA评分下降≥1分和MMSE评分下降≥1分比例明显降低(P＜0.05),恶心、呕吐和头晕发生率明显降低(P＜0.05).结论 艾司氯胺酮用于ECT重度抑郁症患者可改善治疗后的认知功能.
Abstract
Objective To investigate the effect of esketamine on depression and improvement of postoperative cognitive function in patients with major depressive disorder treated by electroconvulsive therapy(ECT).Methods A total of 115 patients with major depressive disorder,37 males and 78 fe-males,aged≥12 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ were selected to receive ECT.The patients were randomly divided into two groups using a random number table:the esketamine group(group E,n=56)and the control group(group C,n=59).Group E received esketamine,propofol,and succincholine during anesthesia induction,and group C received propofol and succincholine during an-esthesia induction.ECT indicators(including EEG twitch time,twitch time,stimulus intensity,and twitch energy index)were recorded during each ECT session.Montreal cognitive assessment(MoCA)and Mini-mental state examination(MMSE)were used to evaluate cognitive function at baseline and after ECT treat-ment.Hamilton depression(HAMD)scale was used to score depression.The occurrence of headache,nau-sea,vomiting,dizziness,delirium,and other adverse reactions were recorded.Results Compared with group C,the EEG convulsion time in group E was significantly prolonged(P＜0.05),the incidence of Mo-CA score decreased by≥1 point and MMSE score decreased by≥1 point in group E after the end of ECT treatment was significantly reduced(P＜0.05),the incidence of nausea,vomiting,and dizziness were sig-nificantly decreased(P＜0.05).Conclusion Using esketamine in ECT for the treatment of major depres-sive disorder can improve cognitive function after ECT.
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