McCall W. Vaughn
Department of Psychiatry and Behavioral Medicine, Bowman Gray School of Medicine, Winston-Salem, North Carolina, USA.
Convuls Ther. 1993;9(4):317-325.
Prominent changes in hemodynamics occur during electroconvulsive therapy (ECT) despite general anesthesia and muscle relaxation and regardless of choice of stimulating electrode placement. The most common pattern is hypertension and tachycardia during the seizure, followed by relative bradycardia and a gradual return of blood pressure to normal within minutes of the end of the seizure. The mortal and morbid risk of these changes is generally small; nevertheless, it is common practice to administer antihypertensive medications to blunt this response. Several agents have proven able to reduce ECT-related hypertension and tachycardia; however, it is unknown whether these agents reduce mortality or cardiovascular morbidity or alter efficacy or cognitive effects of ECT. A few case reports suggest intravenous antihypertensives may be positively dangerous on occasion. Based upon these findings, antihypertensives need not be given routinely during ECT, and when given, conservative doses should be used. The short-acting beta blockers may be particularly suited to this task. To prevent needless use of these agents and the possibility of an adverse event, the patient's intravascular volume, blood pressure and pulse should be optimized prior to the first ECT.
尽管实施了全身麻醉和肌肉松弛，且无论刺激电极放置位置如何选择，在电休克治疗（ECT）期间仍会出现显著的血流动力学变化。最常见的模式是发作期间出现高血压和心动过速，随后是相对心动过缓，并且在发作结束后的几分钟内血压会逐渐恢复正常。这些变化导致死亡和发病的风险通常较小；然而，通常的做法是给予抗高血压药物来减弱这种反应。几种药物已被证明能够降低与ECT相关的高血压和心动过速；然而，尚不清楚这些药物是否能降低死亡率或心血管发病率，或者是否会改变ECT的疗效或认知效果。一些病例报告表明，静脉注射抗高血压药物有时可能具有积极的危险性。基于这些发现，在ECT期间不必常规给予抗高血压药物，如需使用，应采用保守剂量。短效β受体阻滞剂可能特别适合这项任务。为避免不必要地使用这些药物以及发生不良事件的可能性，应在首次ECT之前优化患者的血容量、血压和脉搏。
