依托咪酯联合丙泊酚应用于改良电休克治疗脑癫波发作不良患者的疗效和安全性  

Efficacy and safety of etomidate combined propofol in modified electroshock therapy for poor seizure

作　　者：贾玉萍[1] 沈曙光[1] 王晓敏[1] 肖文斌[1] 庄心良[2] 徐一峰[3] 苏亮[4] 

机构地区：[1]上海交通大学医学院附属精神卫生中心麻醉科,上海200030 [2]上海交通大学医学院附属第一人民医院麻醉科 [3]上海交通大学医学院附属精神卫生中心精神科,上海200030 [4]复旦大学附属华山医院精神科

出　　处：《上海医学》2013年第12期1002-1005,共4页Shanghai Medical Journal

基　　金：上海市级医院新兴前沿技术联合攻关项目(SHDC12012109);上海市精神卫生中心院级基金(2012-YJ-14);上海市卫生局项目(20134295)资助

摘　　要：目的探讨依托咪联合丙泊酚应用于丙泊酚麻醉诱导下行改良电休克治疗(MECT)的脑癫波发作不良(发作时间<25s)患者的疗效和安全性。方法将336例在丙泊酚麻醉诱导下行MECT连续3次脑癫波发作不良的精神疾病患者,随机分入丙泊酚组、依托咪酯组、依托咪酯联合丙泊酚(联合用药)组,每组各112例。所有患者治疗前常规禁食、禁饮6h,无术前用药,入手术室后建立静脉通道,静脉注射阿托品0.5mg。丙泊酚组麻醉诱导:继续静脉注射丙泊酚2mg/kg,依托咪酯组麻醉诱导改静脉注射依托咪酯乳剂0.3mg/kg,联合用药组麻醉诱导静脉注射依托咪酯0.15mg/kg和丙泊酚1mg/kg。待患者入睡、睫毛反射消失后,3组患者均静脉注射琥珀胆碱1mg/kg,面罩加压辅助通气,全身肌肉松弛后行MECT。丙泊酚组、依托咪酯组和联合用药组的首次治疗电量分别较同组初始阈值电量增量5%、递减5%、等同初始阈值电量。3组患者后5次治疗电量根据脑癫波发作时间较同组上次治疗电量递增5%,均隔日治疗1次,共治疗6次。分别记录麻醉前、麻醉诱导后、MECT即刻、MECT 10min的心率(HR)、平均动脉压(MAP),初始阈值电量、最终阈值电量、治疗总电量和发作不良次数等,并记录治疗后不良反应(如躁动/谵妄、肌阵挛、注射痛等)的发生率,使用韦氏记忆量表记忆商数(WMS-MQ)评估患者记忆功能。结果依托咪酯组在MECT即刻、10min的HR均较同组麻醉前、丙泊酚组和联合用药组同时间点显著增快(P值均<0.05),MAP显著升高(P值均<0.05)。3组患者麻醉诱导后的Sp O2均有一过性下降,但组内各时间点间和组间同时间点的差异无统计学意义(P值均>0.05)。3组间初始阈值电量、发作不良次数的差异均无统计学意义(P值均>0.05),丙泊酚组的最终阈值电量、治疗总电量均显著高于依托咪酯组和联合用药组(P值均<0.01)。依托咪酯组躁动/谵妄、肌阵挛Objective To explore the efficacy and safety of etomidate combined with propofol induced anesthesia in modified electric shock therapy （MECT） for patients with bad brain wave （seizure length〈25 s）. Methods A total of 336 mental disorder patients treated by MECT after propofol induced anesthesia （the onset time of epilepsy wave〈25 s in former three times） were randomly divided into 3 groups= propofol group, etomidate group and combined group （propofol and etomidate）, With 112 patients in each group. Beforetreatment, all patients were fasted for 6 h and no medicine was administrated. Atropine （0.5 rag） was applied on bolus after establishment of venous channel. Propofol （2 mg/kg）, etomidate （0. 3 mg/kg） and etomidate （0.15 mg/kg） plus propofol （1 mg/kg） were given in the propofol group, etomidate group and combined group, respectively, after induction of anesthesia. Succinylcholine （1 mg/kg） was intravenously injected in all patients after abolition of lash reflex. Compared with the initial threshold value of quantity of electricity, the quantity of therapeutic electricity increased by 5% in propofol group and decreased by 5% in etomidate group in the first treatment~ the quantity of therapeutic electricity was the same with the initial threshold value of quantity of electricity in the combined group. The following quantity of therapeutic electricity increased by 5% according to seizure length. All patients were treated by MECT every other day （six times in all）. The initial threshold value of quantity of electricity, final threshold value of quantity of electricity, total quantity of therapeutic electricity, and times of bad seizures were recorded. In addition, the heart rate （HR） and mean arterial blood pressure （MAP） before and after anesthesia, at immediate MEOT and 10 min after MECT were measured. Adverse reaction, such as restlessness, delirium, myoclonus and injection pain were also recorded. Wechsler memory scale-memory quotient （WMS-MQ） was used t

关 键 词：改良电休克 发作不良 依托咪酯 丙泊酚 

分 类 号：R614[医药卫生—麻醉学]