机构地区:[1]皖西卫生职业学院附属医院麻醉科,安徽六安237000 [2]六安市精神卫生中心精神科
出 处:《山东医药》2024年第29期29-33,共5页Shandong Medical Journal
基 金:安徽省高校自然科学研究重点项目(KJ2021A1368)。
摘 要:目的观察右美托咪定预处理在改良电休克治疗(MECT)中的应用效果并探讨其最佳剂量。方法选择拟行MECT患者252例,采用随机数字表法分为D1组、D2组、D3组、D4组、D5组及对照组各42例。在麻醉诱导前10 min,D1、D2、D3、D4、D5组分别静脉泵入盐酸右美托咪定0.2、0.4、0.6、0.8、1.0μg/kg,对照组静脉泵入等容量生理盐水30 mL,使用MECT治疗仪对患者进行治疗。分别于右美托咪定预处理即刻(T_(1))、预处理后5 min(T_(2))、预处理后10 min(T_(3))、预处理后15 min(T_(4))、预处理后20 min(T5)、预处理后25 min(T6)、预处理后30 min(T7)记录各组心率(HR)及平均动脉压(MAP);比较各组癫痫发作持续时间、MECT过程中丙泊酚使用剂量、自主呼吸恢复时间、苏醒时间以及不良反应发生情况。结果与对照组同时点比较,D1组在T_(4)时点,D2、D3、D4、D5组在T_(2)~T7时点HR降低;D2组在T_(4)~T7时点,D3、D4、D5组在T_(2)~T7时点MAP降低(P均<0.05)。与同组T_(1)时点比较,D4、D5组在T7时点HR降低;D3、D4、D5组在T7时点MAP降低(P均<0.05)。各组癫痫发作持续时间比较差异均无统计学意义(P均>0.05);D2、D3、D4、D5组丙泊酚用量均少于对照组,D4、D5组自主呼吸恢复时间均多于对照组,D3、D4、D5组苏醒时间均多于对照组,D1、D2、D3、D4、D5组不良反应发生率均低于对照组(P均<0.05)。结论右美托咪定预处理能够有效减少MECT患者血流动力学波动,降低麻醉药物的使用剂量,提高麻醉恢复质量,且具有较好的安全性;在MECT中采用0.4μg/kg右美托咪定进行预处理效果最佳。Objective To investigate the application efficacy and optimal dosage of dexmedetomidine preconditioning in modified electroconvulsive therapy(MECT)and to explore its optimal dose.Methods Two hundred and fifty-two patients who were to undergo MECT were selected and were randomly divided into group D1,group D2,group D3,group D4,group D5 and control group,respectively,with 42 cases in each.Ten min before anaesthesia induction,0.2,0.4,0.6,0.8 and 1.0μg/kg dexmedetomidine hydrochloride was intravenously pumped into the D1,D2,D3,D4 and D5 groups,respectively,and the control group was intravenously pumped with an equal volume of normal saline 30 mL;the patients were treated by a MECT therapeutic instrument.Heart rate(HR)and mean arterial pressure(MAP)were recorded in each group at the immediate moment of dexmedetomidine pretreatment(T_(1)),5 min after pretreatment(T_(2)),10 min after pretreatment(T_(3)),15 min after pretreatment(T_(4)),20 min after pretreatment(T5),25 min after pretreatment(T6),and 30 min after pretreatment(T7),respectively;and the duration of seizure,the dose of propofol used during MECT,the recovery time of spontaneous respiration,the awakening time and the occurrence of adverse reactions were compared between the groups.Results Compared with the control group at the same time point,HR was reduced in the group D1 at T_(4),and in the groups D2,D3,D4,and D5 at T_(2)to T7;and MAP was reduced in the group D2 at T_(4)to T7,and in the groups D3,D4,and D5 at T_(2)to T7(all P<0.05).Compared with the same group at T_(1),HR was reduced in the groups D4 and D5 at T7;MAP was reduced in the groups D3,D4 and D5 at T7(all P<0.05).There was no statistically significant difference in seizure duration among groups(all P>0.05);the dosage of propofol was less in the groups D2,D3,D4,and D5 than in the control group;the recovery time of spontaneous respiration was longer in the groups D4 and D5 than in the control group;the time of awakening was longer in the groups D3,D4,and D5 than in the control group;and the incidence
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