Kucia Krzysztof, Merk Wojciech
Katedra i Klinika Psychiatrii i Psychoterapii ŚUM w Katowicach.
Psychiatr Pol. 2015;49(6):1255-63. doi: 10.12740/PP/31748.
In recent years, data on the possibility of rapid clinical improvement after administration of ketamine in patients diagnosed with depression have been published more frequently. Ketamine, used as an anaesthetic during ECT procedures, despite earlier concerns, has both: a good safety profile and minimal effect on seizure threshold, which is used in cases of non-response to ECT. Postulated action of ketamine causes a rapid resolution of depressive symptoms raised hopes to accelerate therapeutic effect of ECT in patients with severe depression, but studies provide contradictory data pointing to brevity of the observed effect. Studies examining the use of ketamine combined with other anaesthetic drugs emphasized not only its antidepressant effect, but also improvement in hemodynamic parameters during ECT treatment. The aim of this work on one hand is to make psychiatrists aware that the role of anaesthesiologist at ECT is not limited to anaesthetise a patient and provide muscle relaxation, and, on the other hand, to make anaesthesiologists aware that drugs they use have a significant effect on seizure parameters and indirectly on the effectiveness of ECT. Due to small size of studied populations the issue of antidepressant efficacy of ketamine requires further exploration.
近年来，关于诊断为抑郁症的患者使用氯胺酮后临床快速改善可能性的数据发表得越来越频繁。氯胺酮在ECT手术中用作麻醉剂，尽管早期存在担忧，但它具有良好的安全性，并且对癫痫阈值影响极小，这在ECT无反应的情况下使用。氯胺酮的假定作用能迅速缓解抑郁症状，这引发了人们加速ECT对重度抑郁症患者治疗效果的希望，但研究提供了相互矛盾的数据，表明观察到的效果持续时间较短。研究氯胺酮与其他麻醉药物联合使用的情况，不仅强调了其抗抑郁作用，还指出了ECT治疗期间血流动力学参数的改善。这项工作的目的一方面是让精神科医生意识到麻醉医生在ECT中的作用不仅限于麻醉患者和提供肌肉松弛，另一方面是让麻醉医生意识到他们使用的药物对癫痫参数有显著影响，进而间接影响ECT的有效性。由于研究人群规模较小，氯胺酮的抗抑郁疗效问题需要进一步探索。
