不同剂量纳布啡复合依托咪酯在无抽搐电休克中的应用研究  

A study of different does of nalbuphine composite etomidate in the application of modified electroconvulsive therapy

作　　者：徐德毅 周雪莹 方赫 王黔艳 樊晓娜 XU Deyi;ZHOU Xueying;FANG He(Liyuan Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430077,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院,湖北武汉430077

出　　处：《精神医学杂志》2019年第4期245-248,共4页Journal of Psychiatry

基　　金：湖北省自然科学基金重点项目(编号:2015CFA083);中央高校基本科研业务费专项资金资助(编号:2018KFYYXJJ113)。

摘　　要：目的探讨不同剂量纳布啡复合依托咪酯在无抽搐电休克治疗(MECT)中的临床应用价值。方法选取精神科行MECT患者120例,随机分为对照组、低剂量组和高剂量组,每组40例。麻醉诱导时对照组静脉推注等容量生理盐水2 ml,依托咪酯0. 3 mg/kg;低剂量组静脉推注纳布啡0. 05 mg/kg,依托咪酯0. 3 mg/kg;高剂量组静脉推注纳布啡0. 1mg/kg,依托咪酯0. 3 mg/kg。行MECT过程中随时监测循环和呼吸变化,观察并记录三组麻醉前(T0)、麻醉诱导后(T1)、MECT后1 min(T2)、5 min(T3)、10 min(T4)的收缩压(SBP)、舒张压(NBP)、心率(HR)变化及自主呼吸恢复时间、苏醒时间、脑癫痫发作时间、注射琥珀胆碱后肌震颤程度、术后恶心呕吐、躁动、肌痛等不良反应情况。结果 T0、T1、T3、T4时,三组患者的血压、心率组间比较,差异均无统计学意义(P> 0. 05)。T2时,对照组和低剂量组患者的血压、心率均高于T0时(P <0. 05),高剂量组患者的血压、心率与T0时比较,差异无统计学意义(P> 0. 05);高剂量组和低剂量组患者的血压、心率均小于对照组(P <0. 05),高剂量组患者的血压和心率小于低剂量组(P <0. 05)。三组肌颤总发生率比较差异有统计学意义(P <0. 05);其中高剂量组和低剂量组总肌颤发生率均小于对照组(P <0. 05),高剂量组总肌颤发生率小于低剂量组(P <0. 05)。肌颤程度3级,三组比较差异有统计学意义(P <0. 05);其中高剂量组和低剂量组小于对照组(P <0. 05),高剂量组小于低剂量组(P <0. 05)。术后恶心呕吐、躁动、肌痛,高剂量组和低剂量组均小于对照组(P <0. 05),高剂量组小于低剂量组(P <0. 05)。结论纳布啡(0. 1mg/kg)复合依托咪酯在MECT麻醉中,诱导平稳,能够很好地缓解应激导致的血流动力学紊乱,稳定循环,减少琥珀胆碱引起的肌颤搐,并且对癫痫发作质量无明显影响,术后恶心呕吐、躁动、肌痛发生率降低。Objective To explore the value of different doses of nalbuphine composite etomidate in modified electroconvulsive therapy(MECT).Methods A total of 120 patients in psychiatric department treated with MECT were selected and randomly divided into control group(40 cases)injected with equal amount of physiological saline 2 ml and etomidate 0.3 mg/kg,low-dose group(40 cases)injected with nalbuphine 0.05 mg/kg and etomidate 0.3 mg/kg and high-dose group(40 cases)injected with nalbuphine 0.1 mg/kg and etomidate 0.3 mg/kg.During each MECT,SBP,NBP,HR,respiratory recovery times,recovery times,brain epileptic seizure times,and degrees of amyostasia before anesthesia(T0),after anesthesia(T1),1 minute(T2),5 minutes(T3)and 10 minutes(T4)after MECT in all three groups were observed and recorded.Adverse reactions such as nausea,vomiting,dysphoria and myalgia after operation in three groups were observed and recorded.Results There existed no differences in BP and HR at T0,T1,T3,T4 among three groups(P>0.05).At T2,the BP,HR in control group and low-dose group were significantly higher than those at T0(P<0.05),and this difference did not exist in high-dose group(P>0.05).At T2,the BP and HR in high-dose group and low-dose group were significantly lower than those in control group(P<0.05),and BP,HR in high-dose group were significantly lower than those in low-dose group(P<0.05).There existed significant differences in the incidence rates of amyostasia and amyostasia level three among three groups(P<0.05).In terms of amyostasia,amyostasia level three,adverse reactions such as nausea,vomiting,dysphoria and myalgia,high-dose group and low-dose group had lower incidence rates compared with control group(P<0.05)and high-dose group had lower incidence rates compared with low-dose group(P<0.05).Conclusion In the anesthesia of MECT,nalbuphine(0.1mg/kg)composite etomidate can relieve the disturbance of hemodynamics caused by stress,stabilize the circulation,reduce the amyostasia caused by Scoline and has no obvious effect on the quality of epi

关 键 词：纳布啡 依托咪酯 无抽搐电休克 

分 类 号：R749.05[医药卫生—神经病学与精神病学]