盐酸右美托咪定复合丙泊酚在无抽搐电休克中的应用研究

Study of dexmedetomidine combined with propofol for electroconvulsive therapy without altering seizure duration

摘要:

目的：观察盐酸右美托咪定（Dexmedetomidine，DEX）复合丙泊酚对无抽搐电休克（Modified eleotroconvulsive therapy，MECT）术后的心血管反应、能量抑制指数及患者苏醒时间的影响，观察安全性和有效性。方法：选择MECT患者60例，随机分为2组：DEX组，术前10 min给予DEX1 μg/kg；NS组，术前10 min给予等容量生理盐水。麻醉诱导给予丙泊酚直至动态脑电图（Dynamic electroencephalogram，EEG）显示慢波睡眠出现或睫毛反射消失后给予琥珀酰胆碱1/（mg·kg），记录麻醉前、DEX给药后10 min及电刺激后1、3 min及意识恢复后平均动脉血压（Mean arterial blood pressure，MAP）、心率（Heart rate，HR）、能量抑制指数及清醒时间。结果：DEX与NS组相比，HR、MAP在给药后10 min，和电刺激后1、3 min均有下降，差异有统计学意义（P<0．05），且HR、MAP峰值均低于NS组。而能量抑制指数与NS组相比差异无统计学意义（P>0．05）。DEX组患者苏醒时间较NS组延长（P<0．05）。结论：丙泊酚麻醉诱导前静脉缓慢注射1 μg/kg DEX可安全有效的应用于MECT。

Abstract:

Objective：To evaluate the effect of dexmedetomidine（DEX） combined with propofol on the postoperative cardiovascular responseses，inhibition index of energy and recovery time in patients undergoing eleotroconvulsive therapy and to investigate the effi－cacy and the security of dexmedetomidine combined with propofol for ECT． Methods：Sixty MECT patients were randomized into two groups：DEX group（n=30），with DEX 1.0 μg/kg，administered 10 min preoperatively； and NS group（n=30），with normal saline of the same volume administered．Anesthesia was induced with propofol till appearance of slow wave sleep by dynamic electroencephalogra－phy（EEG） or disappearance of lash reflex． Then succinylcholine 1/（mg·kg） was administered． Mean arterial blood pressure（MAP） and Heart rate（HR） were recorded prior to anesthesia，10 min after DEX administration and at each time point after MECT were recorded as well as seizure duration，the inhibition index of energy and the time points of resuscitation． Results：Compared with NS group，HR and mean arterial pressure（MAP） in the DEX group declined 10 min after administration and 1 min and 3 min after seizure and the time points of resuscitation. While the differences at 1 min and 3 min had statistical significance（P<0.05），and the peaks HR and MAP were lower in the dexmedetomidine groups compared with the NS group（P<0．05）． However，the inhibition index of energy in the DEX groups were similar to those in the NS group（P>0．05）． But the resuscitation time was markedly retarded in DEX group in comparison with NS group（P>0．05）． Conclusion：DEX 1.0 μg/kg Ⅳ slowly administered over 10 min before the induction of anesthesia with propofol is safe and effective for MECT．