不同剂量丙泊酚麻醉诱导用于老年抑郁症患者改良电休克治疗的效果  

Efficacy of anesthesia induction with different doses of propofol in elderly depression patients undergoing modified electroconvulsive therapy

作　　者：吴廷丽 陆军[1] 阮义峰[1] 王沛弟[2] WU Tingli;LU Jun;RUAN Yifeng;WANG Peidi(Department of Anesthesiology,Affiliated Brain Hospital,Nanjing Medical University,Nanjing 210029,CHINA)

机构地区：[1]南京医科大学附属脑科医院麻醉科,江苏210029 [2]南京医科大学附属脑科医院精神科,江苏210029

出　　处：《江苏医药》2024年第12期1254-1257,共4页Jiangsu Medical Journal

基　　金：南京市卫生健康委医药卫生科研课题(YKK17132);南京医科大学科技发展基金项目(NMUB2019129)。

摘　　要：目的 探讨不同剂量丙泊酚麻醉诱导用于老年抑郁症患者改良电休克治疗(MECT)的效果。方法 行MECT的老年抑郁症患者93例,随机分为三组,每组31例。麻醉诱导:A组静脉推注丙泊酚1.0mg/kg,B组静脉推注丙泊酚1.2mg/kg,C组静脉推注丙泊酚1.5mg/kg,给药时间均不少于30s。待Narcotrend(NT)指数<60后静脉注射琥珀胆碱1.0mg/kg,待肌肉松弛完全后行MECT。记录麻醉前(T0)、MECT前即刻(T1)、MECT后1min (T2)和10min (T3)时的MAP和HR。记录T1时患者NT指数、抽搐时间、呼吸恢复时间和苏醒时间。MECT前30min和MECT后24h检测心肌酶谱。记录患者麻醉恢复期不良反应的发生情况。结果 与T0时比较,三组MAP在T1时降低(P<0.05),在T2时升高(P<0.05),三组HR在T1和T2时升高(P<0.05)。T1时C组MAP低于A组和B组(P<0.05),T2时B组和C组MAP低于A组(P<0.05)。T1和T2时,B组和C组HR低于A组(P<0.05)。与A组比较,B组和C组NT指数降低,抽搐时间缩短(P<0.05);与C组比较,A组和B组苏醒时间更短(P<0.05)。与A组比较,B组和C组患者麻醉恢复期呛咳以及躁动谵妄的发生率更低(P<0.05)。结论 与丙泊酚1.0或1.5mg/kg麻醉诱导相比,丙泊酚1.2mg/kg麻醉诱导用于老年抑郁症患者MECT具有循环更稳定、恢复更快、不良反应发生率更低的优点。Objective To explore the efficacy of anesthesia induction with different doses of propofol in elderly depression patients undergoing modified electroconvulsive therapy(MECT).Methods A total of 93 elderly depression patients undergoing MECT were randomly divided into three groups with 31 cases each.During anesthesia induction,propofol 1.0mg/kg was injected in group A,1.2mg/kg was injected in group B and 1.5mg/kg was injected in group C.The administration time was not less than 30 seconds.When the Narcotrend(NT) index was less than 60,succinylcholine 1.0 mg/kg was injected intravenously.MECT was performed after complete muscle ralaxation.MAP and HR were recorded before anesthesia(T0),immediately before MECT(T1),1minute(T2) and 10 minutes(T3) after MECT.The NT index at T1,convulsion time,respiratory recovery time and awakening time were recorded.The myocardial enzyme profiles were detected 30minutes before MECT and 24hours after MECT.The occurrence of adverse reactions during the recovery period was recorded.Results Compared with T0,MAP was decreased at T1 and increased at T2,and HR was increased at T1 and T2 in three groups(P<0.05).MAP was lower in group C than that in groups of A and B at T1,which was lower in groups of B and C than that in group A at T2(P<0.05).HR was lower in groups of B and C than that in group A at T1 and T2(P<0.05).Compared with group A,the NT index was decreased and the convulsion time was shortened in groups of B and C(P<0.05).The awakening time was shorter in groups of A and B than that in group C(P<0.05).Compared with group A,the incidences of coughing,agitation and delirium were lower in groups of B and C during recovery period(P<0.05).Conclusion Compared to anesthesia induction with propofol 1.0 or 1.5mg/kg,anesthesia induction with propofol 1.2mg/kg has the advantages of more stable circulation,faster recovery and lower incidence of adverse reactions in elderly depression patients undergoing MECT.

关 键 词：丙泊酚 电休克治疗 抑郁症 老年 

分 类 号：R614[医药卫生—麻醉学]