摘要
目的观察氯胺酮联合异丙酚麻醉对无抽搐电休克治疗(MECT)难治性抑郁症(TRD)的疗效及认知功能的影响。方法选择2012年2月—2018年2月广州医科大学附属脑科医院收治的TRD患者120例为研究对象,按随机数字表法分为异丙酚MECT组、氯胺酮MECT组、联合MECT组各40例,分别进行相应治疗,比较各组治疗前、治疗8次后MCCB总分、血清BDNF水平、睡眠脑电图慢波发生率,并观察临床疗效及不良反应。结果治疗后,联合MECT组总有效率(95.0%)高于异丙酚MECT组(50.0%)(χ^(2)=62.297,P<0.01),而与氯胺酮MECT组(92.5%)比较差异无统计学意义(χ^(2)=0.213,P=0.644);治疗前,3组MCCB总分比较,差异无统计学意义(P>0.05);治疗后联合MECT组>氯胺酮MECT组>异丙酚MECT组(F=27.701,P<0.01)。治疗前,3组患者血清BDNF水平及血清BDNF/pro-BDNF比值比较,差异无统计学意义(P>0.05),治疗后,联合MECT组>氯胺酮MECT组>异丙酚MECT组(F=105.321、25.171,P均<0.01)。治疗后,脑电慢波发生率联合MECT组(5.00%)<氯胺酮MECT组(25.00%)<异丙酚MECT组(72.50%)(χ^(2)=38.393,P<0.01)。治疗后,3组不良反应(TESS)评分比较,差异均无统计学意义(P>0.05)。结论采用氯胺酮联合异丙酚麻醉MECT治疗TRD患者可明显提高临床疗效,提高认知功能、血清BDNF水平及血清BDNF/pro-BDNF比值,降低脑电慢波发生率,且安全性较高。
Objective To observe the effect of ketamine combined with propofol anesthesia on the efficacy and cognitive function of non-convulsive electroconvulsive therapy(MECT)refractory depression(TRD).Methods From February 2012 to February 2018,120 TRD patients admitted to the Brain Hospital of Guangzhou Medical University were selected as the research objects,and were divided into propofol MECT group,ketamine MECT group,and combined MECT group according to the random number table method,40 cases each,Carry out the corresponding treatments respectively,compare the total MCCB scores,serum BDNF levels,and the incidence of slow-wave sleep EEG before and after 8 treatments in each group,and observe the clinical efficacy and adverse reactions.Results After treatment,the total effective rate of the combined MECT group(95.0%)was higher than that of the propofol MECT group(50.0%)(χ^(2)=62.297,P<0.01),but there was no significant difference compared with the ketamine MECT group(92.5%)(χ^(2)=0.213,P=0.644);before treatment,the total score of MCCB in the three groups was not statistically different(P>0.05);after treatment,the combined MECT group>ketamine MECT group>propofol MECT group(F=27.701,P<0.01).Before treatment,the serum BDNF levels and serum BDNF/pro-BDNF ratio of the three groups were not statistically different(P>0.05).After treatment,the combined MECT group>ketamine MECT group>propofol MECT group(F=105.321,25.171,both P<0.01).After treatment,the incidence of slow EEG was combined with MECT group(5.00%)<ketamine MECT group(25.00%)<propofol MECT group(72.50%)(χ^(2)=38.393,P<0.01).After treatment,there was no significant difference in the scores of adverse reactions(TESS)between the three groups(P>0.05).Conclusion The use of ketamine combined with propofol to anesthetize TRD patients with MECT can significantly improve the clinical efficacy,improve cognitive function,serum BDNF level and serum BDNF/pro BDNF ratio,reduce the incidence of slow EEG,and has high safety.
作者
古智文
黄雄
张春平
王志杰
张敏玲
Gu Zhiwen;Huang Xiong;Zhang Chunping;Wang Zhiji;Zhang Minling(Department of Psychiatry,Guangzhou First People's Hospital,School of Medicine,South China University of Technology,Guangzhou 510180,China;不详)
出处
《疑难病杂志》
CAS
2021年第1期47-52,共6页
Chinese Journal of Difficult and Complicated Cases
基金
广东省科技计划项目(2013B21800043)。
关键词
氯胺酮麻醉
无抽搐电休克治疗
抑郁症
难治性
疗效
认知功能
Ketafol anesthesia
Non-convulsive electroconvulsive therapy
Refractory depression
Curative effect
Cognitive function
