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| 艾司氯胺酮对重度抑郁症患者电休克治疗后认知功能的影响 |
| Effect of esketamine on cognitive function in patients with major depressive disorder after electroconvulsive therapy |
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| DOI：10.12089/jca.2024.07.010 |
| 中文关键词: 重度抑郁症 电休克治疗 艾司氯胺酮 认知 |
| 英文关键词: Major depressive disorder Electroconvulsive therapy Esketamine Cognition |
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| 中文摘要: |
目的： 探讨艾司氯胺酮对电休克治疗（ECT）重度抑郁症患者改善抑郁和术后认知功能的影响。
方法： 选择接受ECT的重度抑郁症患者115例，男37例，女78例，年龄≥12岁，BMI 18～30 kg/m2，ASA Ⅰ或Ⅱ级，采用随机数字表将患者随机分为两组：艾司氯胺酮组（E组，n=56）和对照组（C组，n=59）。E组在麻醉诱导时使用艾司氯胺酮0.3~0.5 mg/kg、丙泊酚0.3~1.0 mg/kg和琥珀胆碱0.5~1.25 mg/kg，C组在麻醉诱导时使用丙泊酚1~2 mg/kg和琥珀胆碱0.5~1.25 mg/kg。每次ECT过程中记录ECT指标（包括EEG抽搐时间、总抽搐时间、刺激强度和抽搐能量指数）。在ECT前和ECT疗程结束后采用蒙特利尔认知评估量表（MoCA）和简易认知状态评价量表（MMSE）评价认知功能，使用汉密尔顿抑郁量表（HAMD）进行抑郁评分。记录头疼、恶心、呕吐、头晕、谵妄等不良反应的发生情况。
结果： 与C组比较，E组EEG抽搐时间明显延长（P<0.05），ECT疗程结束后MoCA评分下降≥1分和MMSE评分下降≥1分比例明显降低（P<0.05），恶心、呕吐和头晕发生率明显降低（P<0.05）。
结论： 艾司氯胺酮用于ECT重度抑郁症患者可改善治疗后的认知功能。 |
| 英文摘要: |
Objective: To investigate the effect of esketamine on depression and improvement of postoperative cognitive function in patients with major depressive disorder treated by electroconvulsive therapy (ECT).
Methods: A total of 115 patients with major depressive disorder, 37 males and 78 females, aged ≥ 12 years, BMI 18-30 kg/m2, ASA physical status Ⅰ or Ⅱ were selected to receive ECT. The patients were randomly divided into two groups using a random number table: the esketamine group (group E, n = 56) and the control group (group C, n = 59). Group E received esketamine, propofol, and succincholine during anesthesia induction, and group C received propofol and succincholine during anesthesia induction. ECT indicators (including EEG twitch time, total twitch time, stimulus intensity, and twitch energy index) were recorded during each ECT session. Montreal cognitive assessment (MoCA) and Mini-mental state examination (MMSE) were used to evaluate cognitive function at baseline and after ECT treatment. Hamilton depression (HAMD) scale was used to score depression. The occurrence of headache, nausea, vomiting, dizziness, delirium, and other adverse reactions were recorded.
Results: Compared with group C, the EEG convulsion time in group E was significantly prolonged (P < 0.05), the incidence of MoCA score decreased by ≥ 1 point and MMSE score decreased by ≥ 1 point in group E after the end of ECT treatment was significantly reduced (P < 0.05), the incidence of nausea, vomiting, and dizziness were significantly decreased (P < 0.05).
Conclusion: Using esketamine in ECT for the treatment of major depressive disorder can improve cognitive function after ECT. |
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