电休克疗法对伴有自杀意念重性抑郁障碍青少年的疗效与安全性研究  

A study of the efficacy and safety of electroconvulsive therapy in adolescents with major depressive disorder with suicidal ideation

作　　者：李伟[1] 杜若南 蔡海鹏[3] 郜肖肖[1] 宋佳起 仝景慧 杨小雪 LI Wei;DU Ruonan;CAI Haipeng;GAO Xiaoxiao;SONG Jiaqi;TONG Jinghui;YANG Xiaoxue(Beijing Huilongguan Hospital,Beijing 100096,China)

机构地区：[1]北京回龙观医院五科,北京100096 [2]北京大学回龙观临床医学院 [3]北京回龙观医院老年科

出　　处：《中国神经精神疾病杂志》2025年第3期142-148,共7页Chinese Journal of Nervous and Mental Diseases

基　　金：首都卫生发展科研专项重点攻关项目(编号:首发2020-2-2134)。

摘　　要：目的探讨电休克疗法(electroconvulsive therapy,ECT)治疗伴有自杀意念的重性抑郁障碍青少年患者的有效性、安全性以及对认知功能的影响。方法纳入160例重性抑郁障碍青少年患者,ECT组(n=81)接受常规抗抑郁药物治疗联合8次ECT,对照组(n=79)仅接受常规抗抑郁药物治疗。在基线(ECT前)、ECT疗程结束后、治疗后2周和6周,分别使用17项汉密尔顿抑郁量表(17-item Hamilton rating scale for depression,HAMD-17)和自杀意念自评量表(self-rating idea of suicide scale,SIOSS)对患者抑郁症状、自杀意念进行评估,使用蒙特利尔认知评估量表(Montreal cognitive assessment,MoCA)对患者认知功能进行评估,并随访患者是否出现头晕、恶心等不良反应。结果广义估计方程分析HAMD-17、SIOSS评分结果表明,组别与时间均存在交互作用(P<0.01)。两组治疗后HAMD-17评分均降低(4个时间点评分:ECT组24.59±4.56 vs.13.25±4.32 vs.6.20±1.95 vs.3.62±2.04,对照组23.48±3.66 vs.15.42±3.11 vs.10.10±2.05 vs.4.68±2.01;P<0.01),ECT组治疗前后HAMD-17评分的平均差异为-9.62±3.13,对照组治疗前后HAMD-17评分的平均差异为-8.16±1.71。两组经过治疗后自杀意念有所改善(4个时间点SIOSS评分:ECT组18.57±2.85 vs.10.93±3.52 vs.8.02±2.79 vs.3.70±1.96,对照组18.97±3.03 vs.15.51±2.98 vs.11.11±2.18 vs.6.44±1.78;P<0.01)。认知功能评分方面,组别与时间无交互作用(P=0.21),不同随访时间点的MoCA评分改变的差异有统计学意义(P<0.01),两组的MoCA评分改变的差异无统计学意义(P=0.05),两组患者在治疗后6周时的认知功能可恢复至基线水平。研究期间两组患者均未报告严重不良反应。结论ECT对改善重性抑郁障碍青少年患者的抑郁症状和自杀意念有效,且较为安全。ECT对青少年重性抑郁障碍患者认知功能的损伤是可逆的。Objective To investigate the effectiveness and safety of electroconvulsive therapy(ECT)in reducing suicidal ideation and depressive symptoms of major depressive disorder patients,as well as its effect on cognitive function.Methods A total of 160 adolescent patients with major depressive disorder were recruited for this study.The ECT group(n=81)received conventional antidepressant medication combined with 8 sessions of electroconvulsive therapy,and the control group(n=79)received conventional antidepressant medication only.Depressive symptoms,suicidal ideation,and cognitive functioning were assessed using 17-item Hamilton rating scale for depression(HAMD-17)and self-rating idea of suicide scale(SIOSS),at baseline(before ECT),after ECT,and at 2 and 6 weeks after treatment.The Montreal cognitive assessment(MoCA)was used to evaluate the cognitive function of the patients,and the patients were followed up for side effects such as dizziness and nausea.Results Generalized estimating equation(GEE)analysis of HAMD-17 and SIOSS scores showed significant group×time interaction effects(P<0.01).Both groups exhibited a reduction in HAMD-17 scores before and after treatment(scores at four time points:ECT group 24.59±4.56 vs.13.25±4.32 vs.6.20±1.95 vs.3.62±2.04,control group 23.48±3.66 vs.15.42±3.11 vs.10.10±2.05 vs.4.68±2.01;P<0.01).The mean difference in HAMD-17 scores before and after treatment was-9.62±3.13 in the ECT group,and was-8.16±1.71 in the control group.Additionally,suicidal ideation reduced in both groups after treatment(SIOSS scores at four time points:ECT group 18.57±2.85 vs.10.93±3.52 vs.8.02±2.79 vs.3.70±1.96,control group 18.97±3.03 vs.15.51±2.98 vs.11.11±2.18 vs.6.44±1.78;P<0.01).For cognitive function scores,there was no interaction between group and time(P=0.21),the difference in the change in MoCA scores at different follow-up time points was significant(P<0.01),and the difference in the change in MoCA scores between the two groups was not significant(P=0.05),and the cognitive functions

关 键 词：青少年 电休克治疗 重性抑郁障碍 自杀意念 治疗效果 安全性分析 认知功能 

分 类 号：R749.4[医药卫生—神经病学与精神病学]