盐酸右美托咪定对重度抑郁患者改良电休克治疗的认知保护作用及最佳剂量研究  

Study on the cognitive protective effect and optimal dose of dexmedetomidinehydrochloride on modified electroconvulsive therapy inpatients with severe depression

作　　者：陈礼 苏华龙[2] 李巧 谭佩 CHEN Li;SU Hualong;LI Qiao;TAN Pei(Department of Anesthesiology,Chongqing Mental Health Center,Chongqing,Chongqing 400036,China;Department of Psychiatry,Chongqing Mental Health Center,Chongqing,Chongqing 400036,China)

机构地区：[1]重庆市精神卫生中心麻醉科,重庆400036 [2]重庆市精神卫生中心精神科,重庆400036

出　　处：《重庆医学》2024年第9期1323-1327,1332,共6页Chongqing medicine

基　　金：重庆市科卫联合医学科研项目(2020MSXM053)。

摘　　要：目的研究盐酸右美托咪定(DEX)对重度抑郁患者改良电休克治疗(MECT)治疗的认知保护作用及最佳剂量。方法选取2021年6月至2022年12月该院重度抑郁患者120例作为研究对象,随机分为DEX组(D1、D2、D3组)与对照组,每组各30例。D1、D2、D3组麻醉前10 min分别静脉泵入DEX 0.2、0.4、0.6μg/kg,对照组泵入等容量生理盐水。比较4组麻醉前(T_(0))、泵注DEX 10 min(T_(1))、麻醉诱导意识消失后(T_(2))、MECT结束时(T_(3))、MECT结束后5 min(T_(4))的心率(HR)、平均动脉压(MAP),自主呼吸恢复时间、苏醒时间,T_(0)时及术后1 d、术后3 d简易精神状态检查量表(MMSE)评分,不良反应发生情况。结果T_(1)、T_(2)时,D1组HR及D2、D3组HR、MAP低于T_(0),差异有统计学意义(P<0.05);T_(3)时,4组HR、MAP均达峰值,但在T_(4)时HR、MAP逐渐下降;T_(4)时,对照组HR、MAP高于T_(0),D2、D3组HR、MAP低于T_(0),差异有统计学意义(P<0.05);D1、D2、D3组自主呼吸恢复时间短于对照组,丙泊酚用量低于对照组,差异有统计学意义(P<0.05);苏醒时间由长到短依次为D3、D2、D1组,差异有统计学意义(P<0.05);术后1 d、术后3 d,D1、D2、D3组MMSE评分高于对照组,且D3组MMSE评分最高,差异有统计学意义(P<0.05)。结论DEX可剂量依赖性减轻重度抑郁患者MECT应激反应、术后不良反应,保护认知功能。Objective To study the cognitive protective effect and optimal dose of dexmedetomidine hydrochloride(DEX)in patients with severe depression treated with modified electroconvulsive therapy(MECT).Methods A total of 120 patients with severe depression in our hospital from June 2021 to December 2022 were randomly divided into DEX group(D1,D2,D3 group)and control group,with 30 cases in each group.DEX 0.2,0.4,and 0.6μg/kg were intravenously pumped 10 min before anesthesia in groups D1,D2,and D3,respectively,and the same volume of normal saline was pumped in the control group.The heart rate(HR),mean arterial pressure(MAP),spontaneous breathing recovery time,recovery time,mini-mental state examination(MMSE)score at T_(0),one d and three d after operation,and adverse reactions were compared among the four groups before anesthesia(T_(0)),10 min after infusion of DEX(T_(1)),after anesthesia induction and loss of consciousness(T_(2)),at the end of MECT(T_(3)),and five min after MECT(T_(4)).Results At T_(1)and T_(2),HR in group D1 and HR and MAP in groups D2 and D3 were lower than those at T_(0),and the differences were statistically significant(P<0.05).At T_(3),the HR and MAP of the four groups reached the peak,but at T_(4),the HR and MAP gradually decreased.At T_(4),the HR and MAP of the control group were higher than those at T_(0),and the HR and MAP of the D2 and D3 groups were lower than those at T_(0),the differences were statistically significant(P<0.05).The recovery time of spontaneous breathing in D1,D2 and D3 groups was shorter than that in the control group,and the dosage of propofol was lower than that in the control group,the differences were statistically significant(P<0.05).The recovery time from long to short was D3,D2 and D1 group,and the difference was statistically significant(P<0.05).At one d and three d after operation,the MMSE scores of D1,D2 and D3 groups were higher than those of the control group,and the MMSE score of D3 group was the highest,the difference was statistically significant(P<0.05).Concl

关 键 词：盐酸右美托咪定 重度抑郁 改良电休克治疗 认知保护 最佳剂量 

分 类 号：R749[医药卫生—神经病学与精神病学]