Kuşçu Özlem Özkan, Karacaer Feride, Biricik Ebru, Güleç Ersel, Tamam Lut, Güneş Yasemin
Akyurt State Hospital, Ankara, Turkey.
Department of Anaesthesiology and Reanimation, Çukurova University Faculty of Medicine, Adana, Turkey.
Turk J Anaesthesiol Reanim. 2015 Oct;43(5):313-7. doi: 10.5152/TJAR.2015.92668. Epub 2015 Aug 21.
We aimed to evaluate the effect of anaesthesia with thiopental (4 mg kg(-1)), ketamine (1 mg kg(-1)) and ketamine-thiopental (1 mg kg(-1) and 4 mg kg(-1), respectively) combination during electroconvulsive therapy (ECT) on the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patients with resistant major depression.
Patients with HDRS scores above 17 were included. The patients were randomly divided into three groups according to the anaesthesia used. Group 1 was given thiopental (4 mg kg(-1)), Group 2 was given ketamine (1 mg kg(-1)) and Group 3 was given ketamine (1 mg kg(-1)) and thiopental (4 mg kg(-1)). Succinylcholine (1 mg kg(-1)) was administered in all patients for muscle relaxation. HDRS and HAM-A scores were evaluated before ECT, after 3, 6. ECT and after the final ECT. Systolic and diastolic blood pressures, heart rates and oxygen saturations were recorded before and after anaesthesia induction and after the ECT procedure. Seizure duration was recorded.
Fifty-eight patients were included in the study. Thirty (52%) patients were male and 28 (48%) were female. The mean age was 42.7±15.8 years in Group 1, 44.8±11 years in Group 2 and 38.6±6.8 years in Group 3. In all groups, HDRS scores were reduced compared with the baseline values. There was no statistical significant difference between the groups regarding HDRS scores. HAM-A scores were higher in Group 2 and Group 3. Systolic and diastolic blood pressures and heart rate values were lower in Group 1 and the difference was statistically significant.
In this study, anaesthesia induced with thiopental, ketamine and thiopental-ketamine combination was observed to not result in a difference in ECT for patients with treatment-resistant depression. Ketamine at a dose of 1 mg kg(-1) given just before ECT did not enhance the antidepressant effect of ECT; however, anxiety scores were increased with ketamine application.
我们旨在评估硫喷妥钠（4毫克/千克）、氯胺酮（1毫克/千克）以及氯胺酮 - 硫喷妥钠联合用药（分别为1毫克/千克和4毫克/千克）麻醉在电休克治疗（ECT）期间对难治性重度抑郁症患者汉密尔顿抑郁量表（HDRS）、汉密尔顿焦虑量表（HAM - A）及血流动力学变量的影响。
纳入HDRS评分高于17分的患者。根据所使用的麻醉方法将患者随机分为三组。第1组给予硫喷妥钠（4毫克/千克），第2组给予氯胺酮（1毫克/千克），第3组给予氯胺酮（1毫克/千克）和硫喷妥钠（4毫克/千克）。所有患者均给予琥珀酰胆碱（1毫克/千克）用于肌肉松弛。在ECT前、3次ECT后、6次ECT后及最后一次ECT后评估HDRS和HAM - A评分。记录麻醉诱导前后及ECT操作后的收缩压、舒张压、心率和血氧饱和度。记录癫痫发作持续时间。
58例患者纳入研究。30例（52%）为男性，28例（48%）为女性。第1组平均年龄为42.7±15.8岁，第2组为44.8±11岁，第3组为38.6±6.8岁。所有组的HDRS评分均较基线值降低。各组间HDRS评分无统计学显著差异。第2组和第3组的HAM - A评分较高。第1组的收缩压、舒张压和心率值较低，差异有统计学意义。
在本研究中，观察到硫喷妥钠、氯胺酮及氯胺酮 - 硫喷妥钠联合诱导麻醉对难治性抑郁症患者的ECT效果无差异。ECT前给予1毫克/千克剂量的氯胺酮并未增强ECT的抗抑郁作用；然而，应用氯胺酮会使焦虑评分增加。
