ICU精神障碍合并多发性躯体疾病患者的临床特点及改良电抽搐治疗可行性研究  

Clinical characteristics of ICU patients with mental disorders and multiple physical diseases and feasibility of modified elec-troconvulsive therapy

作　　者：李万文 孙小丽 申永辉 黄华丽 丁超 LI Wanwen;SUN Xiaoli;SHEN Yonghui;HUANG Huali;DING Chao(Department of Psychiatry,Hangzhou Seventh People's Hospital(Affiliated Mental Health Center,Zhejiang University School of Medicine),Hangzhou 310063,China)

机构地区：[1]杭州市第七人民医院(浙江大学医学院附属精神卫生中心)精神科,310063

出　　处：《浙江医学》2024年第21期2297-2300,2313,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2024KY1369)。

摘　　要：目的探讨ICU精神障碍合并多发性躯体疾病患者的临床特点及改良电抽搐治疗的可行性。方法回顾性选取2021年12月至2023年12月在杭州市第七人民医院ICU住院并行改良电抽搐治疗的精神障碍合并多发性躯体疾病患者32例,收集其社会人口学特点和临床资料,分析改良电抽搐治疗ICU精神障碍合并多发性躯体疾病患者的临床特点及可行性。结果接受改良电抽搐治疗患者的精神障碍类型包括精神分裂症13例,抑郁症6例,双相情感障碍3例,分裂情感性障碍2例,其他精神障碍8例;合并的躯体疾病主要有肺炎(56.25%)、高血压(31.25%)、糖尿病及酮症酸中毒(21.88%)、低氧血症(15.63%)、高乳酸血症(15.63%)等。所有患者躯体疾病经对症治疗后均在控制稳定或明显改善、生命体征平稳的情况下再行改良电抽搐治疗,选择改良电抽搐治疗的原因包括无法耐受药物不良反应(27.38%),药物抑制症状差或伴精神分裂(16.67%),幻觉、妄想等精神症状明显(16.67%),木僵趋势、不配合治疗(13.10%),紧张综合征(11.90%),濒临自伤、自杀或威胁自杀行为(9.52%),恶性综合征(4.76%)。1例患者因气管套管局部有漏气在第1次治疗结束后被迫终止治疗,31例患者精神症状及躯体症状均好转,总有效率为96.88%。所有患者治疗后WHO功能缺陷评定量表较治疗前明显降低[(39.81±9.25)分比(72.63±8.06)分,P<0.001],大体评定量表评分较治疗前明显升高[(60.05±11.98)分比(18.84±5.10)分,P<0.001],治疗过程中发生头痛、头晕、发热等不良反应发生率为64.52%。结论对于伴有木僵违拗、兴奋躁动、药物耐受性差、恶性综合征及精神症状影响躯体疾病治疗的ICU患者,可采取改良电抽搐治疗且临床疗效较好。Objective To explore the clinical characteristics of ICU patients with mental disorders and multiple physical diseases and feasibility of modified electroconvulsive therapy(MECT).Methods A retrospective study was conducted on 32 patients with mental disorders and multiple physical diseases who were admitted to the ICU of the Hangzhou Seventh People's Hospital from December 2021 to December 2023 and they received MECT.Their sociodemographic characteristics and clinical data were collected to analyze the clinical characteristics and feasibility of MECT for ICU patients with mental disorders and multiple physical diseases.Results The mental disorders of the patients received MECT included schizophrenia(n=13),depression(n=6),bipolar disorder(n=3),schizoaffective disorder(n=2),and others(n=8).The main comorbid physical diseases were pneumonia(56.25%),hypertension(31.25%),diabetes and ketoacidosis(21.88%),hypoxemia(15.63%),hyperlactatemia(15.63%),etc.All patients received MECT under the condition of stable controlled or significantly improved physical diseases after symptomatic treatment,and stable vital signs.The reasons for choosing MECT included intolerance to adverse drug reactions(27.38%),poor effects of drugs in inhibiting symptoms or accompanied by schizophrenia(16.67%),obvious mental symptoms such as hallucinations and delusions(16.67%),stupor tendency and non-cooperation with treatment(13.10%),catatonic syndrome(11.90%),imminent self-harm,suicidal or threatened suicidal behaviors(9.52%),and malignant syndrome(4.76%).One patient was forced to terminate the treatment after the first session due to air leakage in the tracheal cannula.The mental and physical symptoms of 31 patients were improved,with a total effective rate of 96.88%.After treatment,the WHO Disability Assessment Schedule scores of all patients were significantly lower than those before treatment[(39.81±9.25)points vs.(72.63±8.06)points,P<0.001],and the Global Assessment Scale scores were significantly higher than those before treatment[(60.05±11

关 键 词：改良电抽搐治疗 精神障碍 躯体疾病 重症监护病房 精神症状 

分 类 号：R749[医药卫生—神经病学与精神病学]