老年精神分裂患者无抽搐电休克治疗中运用丙泊酚复合依托咪酯进行全麻诱导的安全性分析  

Safety Analysis of Propofol Combined with Etomidate for Induction of General Anesthesia in Elderly Schizophrenic Patients Treated with Modified Electroconvulsive Therapy

作　　者：金红 江春燕 周珏 Jin Hong;Jiang Chunyan;Zhou Jue(Mental Health Centre,Medical College of Shanghai Jiaotong University,Shanghai,201108,P.R.China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海201108

出　　处：《老年医学与保健》2020年第6期991-994,999,共5页Geriatrics & Health Care

摘　　要：目的探讨老年精神分裂患者无抽搐电休克治疗(MECT)中运用丙泊酚复合依托咪酯进行全麻诱导的安全性。方法选取2019年1月-2020年6月于上海交通大学医学院附属精神卫生中心住院部收治的96例需行MECT的老年精神分裂症患者为研究对象,根据Excel表格随机分组为A、B、C 3组,每组各32例,A组给予丙泊酚进行全麻诱导,B组给予依托咪酯进行全麻诱导,C组给予丙泊酚联合依托咪酯进行全麻诱导。在麻醉前、麻醉诱导后即刻、MECT后即刻和5 min,比较各组血压、心率、血糖变化情况,观察比较各组MECT治疗后呼吸抑制次数、脑电癫痫波运动发作时间、苏醒时间、琥珀胆碱用量、认知功能(WAIS-RC)、不良反应等情况。结果A组与C组不同时间段SBP、DBP、HR、血糖组间比较差异均无统计学意义(P>0.05)。B组MECT后即刻和MECT后5 min的SBP、DBP、血糖高于麻醉前即刻和麻醉诱导后即刻,HR快于麻醉前即刻和麻醉诱导后即刻,且B组MECT后即刻和MECT后5 min的SBP、DBP、血糖高于A组、C组,HR快于A组、C组(P<0.05);A组抑制指数高于B、C组,脑电癫痫波运动发作时间低于B、C组(P<0.05);B组苏醒时间短于A、C组,琥珀胆碱用量少于A、C组(P<0.05);治疗后3组WAIS-RC评分高于治疗前,且A组高于B组、C组(P<0.05),而B组与C组比较差异无统计学意义(P>0.05);B组不良反应总发生率高于A组、C组(P<0.05),而A组与C组比较差异无统计学意义(P>0.05)。结论老年精神分裂患者行MECT中,运用丙泊酚复合依托咪酯进行全麻诱导安全有效,能延长脑癫痫运动发作时间,减少对认知功能的影响和不良反应的发生。Objective To investigate the safety of propofol combined with etomidate for induction of general anesthesia in elderly schizophrenic patients treated with modified electroconvulsive therapy(MECT).Methods 96 elderly schizophrenic patients who received MECT from January 2019 to June 2020 in the Inpatient Department of Mental Health Center Affiliated to Medical College of Shanghai Jiaotong University were selected as the research subjects.According to the random number table method,they were divided into three groups,32 cases in each group.Group A was given propofol for general anesthesia induction,group B was given etomidate for general anesthesia induction,and group C was given propofol combined with etomidate for general anesthesia induction.Before anesthesia,immediately after induction of anesthesia,immediately after MECT and 5 minutes after MECT,the changes of blood pressure,heart rate and blood glucose were examined and compared among the three groups.The number of respiratory depression,EEG seizure time,recovery time,succinylcholine dosage,cognitive function(WAIS-RC),adverse reactions,etc after MECT treatment were observed and compared among the three groups.Results There was no statistically significant difference in SBP,DBP,HR,and blood glucose between group A and group C at different time points(P>0.05).SBP,DBP and blood glucose of group B immediately after MECT and 5 min after MECT were higher than those before anesthesia and immediately after anesthesia induction,HR was faster than that before anesthesia and immediately after anesthesia induction.The SBP,DBP and blood glucose of group B immediately after MECT and 5 minutes after MECT were higher than those of group A and C,and HR was faster than that of group A and C(P<0.05).The inhibition index of group A was higher than that of group B and C,and the EEG seizure time of group A was shorter than that of group B and C(P<0.05).The recovery time of group B was shorter than that of group A and C,and the dosage of succinylcholine was less than that of group A

关 键 词：老年 精神分裂 无抽搐电休克治疗 丙泊酚 依托咪酯 全麻 安全性 

分 类 号：R614[医药卫生—麻醉学]