右美托咪定和丙泊酚用于电休克治疗联合奥氮平治疗精神分裂症疗效的影响  

Effect of Dexmedetomidine and Propofol on Electroconvulsive Therapy Combined with Olanzapine in the Treatment of Schizophrenia

作　　者：张梅 高信国 张红[2] 陈静[3] 张索远 姚新宇[5] ZHANG Mei;GAO Xin-guo;ZHANG Hong;CHEN Jing;ZHANG Suo-yuan;YAO Xin-yu(Department of Surgical Anesthesia,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China;Department of Mental and Somatic 1,Beijing Changping Hospital of Integrated Chinese and Western Medicine,Beijing,102208,China;Department of Surgical Anesthesia,Beijing Cancer Hospital,Beijing,100142,China;Department of Psychosomatic Medicine,Peking University Huilongguan Clinical Medical School,Beijing Huilongguan Hospital,Beijing,100085,China;Department of Anesthesiology,Xingtai People's Hospital,Xingtai,Hebei,054031,China)

机构地区：[1]北京市昌平区中西医结合医院麻醉科,北京102208 [2]北京市昌平区中西医结合医院精神合并躯体1科,北京102208 [3]北京大学肿瘤医院麻醉科,北京100142 [4]北京大学回龙观临床医学院,北京回龙观医院心身医学科,北京100085 [5]邢台市人民医院麻醉科,河北邢台054031

出　　处：《现代生物医学进展》2022年第7期1366-1370,共5页Progress in Modern Biomedicine

基　　金：河北省重点研发计划项目(182777151)。

摘　　要：目的:探究精神分裂症患者联用奥氮平与电休克治疗的可行性,并分析电休克治疗前应用右美托咪定和丙泊酚对患者应激反应的影响。方法:选择2019年4月至2021年4月在我院接受治疗的120例精神分裂症患者为研究对象,将其按照随机数字表法区分为A组、B组和C组(每组各40例患者),A组患者单纯接受奥氮平治疗,B组患者在A组基础上加用电休克治疗(术前使用丙泊酚麻醉),C组在B组电休克治疗基础上加用右美托咪定麻醉,就A组和B组患者治疗前后的PANSS评分及治疗效果进行比较,就B组和C组患者血流动力学指标、电休克治疗指标以及不良反应发生率进行比较。结果:(1)治疗前两组患者PANSS量表中阳性症状、阴性症状、一般精神病理及总分组间无差异(P>0.05),治疗6周后B组患者阳性症状、阴性症状、一般精神病理及总分均明显低于A组(P<0.05);(2)麻醉前(T0)时两组患者的HR、MAP组间比较无差异(P>0.05),而在麻醉给药10 min(T1)和电击后5 min(T2)时,C组患者的HR与MAP均低于B组(P<0.05);(3)B组与C组患者电休克治疗的相关指标诸如苏醒时间、自主呼吸恢复时间以及能量抑制指数上组间无差异(P>0.05);(4)B组患者呃逆、躁动、头痛等不良反应总发生率为32.50%(13/40)高于C组患者上述不良反应总发生率5.00%(2/40)(P<0.05)。结论:电休克治疗联合奥氮平对精神分裂症具有较好的治疗效果,术前若能够联用右美托咪定和丙泊酚进行麻醉,将显著改善患者应激症状,降低术后各类并发症发生率。Objective: To explore the feasibility of combined olanzapine and electroconvulsive therapy in patients with schizophrenia, and to analyze the effects of dexmedetomidine and propofol on the stress response of patients before electroconvulsive therapy. Methods: 120 patients with schizophrenia who were treated in our hospital from April 2019 to April 2021 were selected as the research objects, and they were divided into groups A, B and C according to the random number table method(40 for each group).Patients in group A were treated with olanzapine alone, patients in group B were treated with electroconvulsive therapy on the basis of group A(preoperative propofol anesthesia), and patients in group C were treated with electroconvulsive therapy on the basis of electroconvulsive therapy in group B. Medetomidine anesthesia, compare the PANSS scores and treatment effects of patients in group A and B before and after treatment, and compare the hemodynamic indexes, electroconvulsive treatment indexes and the incidence of adverse reactions in group B and C patients Compare. Results:(1) There was no difference between the positive symptoms, negative symptoms, general psychopathology, and the general group in the PANSS scale of the two groups of patients before treatment(P>0.05).After 6 weeks of treatment, the positive symptoms and negative symptoms of group B were Symptoms, general psychopathology and total score were lower than group A(P<0.05);(2) Before anesthesia(T0), the differences in HR and MAP between the two groups were not different(P>0.05), while the HR and MAP of patients in group C were lower than those in group B(P<0.05) at 10 minutes(T1) and5 minutes after electric shock(T2) after the administration of anesthesia;Treatment-related indicators such as wake-up time, spontaneous breathing recovery time, and energy suppression index were not different(P>0.05);(4) The total incidence of hiccup, agitation, headache and other adverse reactions in group B was 32.50 %(13/40), higher than 5.00 %(2/40) in group C(P<0.05). C

关 键 词：右美托咪定 丙泊酚 电休克治疗 奥氮平 精神分裂症 

分 类 号：R749.3[医药卫生—神经病学与精神病学]