Li Xiang, Tan Fang, Cheng Nan, Guo Na, Zhong Zhi-Yong, Hei Zi-Qing, Zhu Qian-Qian, Zhou Shao-Li
From the Departments of *Anesthesiology, and †Psychiatry, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.
J ECT. 2017 Sep;33(3):152-159. doi: 10.1097/YCT.0000000000000398.
The aim of this study was to investigate how the combined use of dexmedetomidine with intravenous anesthetics influences seizure duration and circulatory dynamics in electroconvulsive therapy (ECT).
A literature search was performed to identify studies that evaluated the effect of dexmedetomidine on motor- or electroencephalogram (EEG)-based seizure durations and maximum mean arterial pressure (MAP) and heart rate (HR) after ECT. Moreover, recovery time and post-ECT agitation were evaluated.
Six studies enrolling 166 patients in 706 ECT sessions were included. There was no significant difference in motor or EEG seizure duration between dexmedetomidine and nondexmedetomidine groups [motor: 6 studies; mean difference (MD), 1.62; 95% confidence interval (CI), -2.24 to 5.49; P = 0.41; EEG: 3 studies; MD, 2.34; 95% CI, -6.03 to 10.71; P = 0.58]. Both maximum MAP and HR after ECT were significantly reduced in the dexmedetomidine group (MAP: 6 studies; MD, -4.83; 95% CI, -8.43 to -1.22; P = 0.009; HR: 6 studies; MD, -6.68; 95% CI, -10.74 to -2.62; P = 0.001). Moreover, the addition of dexmedetomidine did not significantly prolong recovery time when the reduced-dose propofol was used (4 studies; MD, 63.27; 95% CI, -15.41 to 141.96; P = 0.12).
The use of dexmedetomidine in ECT did not interfere with motor and EEG seizure durations but could reduce maximum MAP and HR after ECT. Besides, the addition of dexmedetomidine in ECT did not prolong recovery time when reduced-dose propofol was used. It might be worthwhile for patients to receive dexmedetomidine before the induction of anesthesia in ECT.
本研究旨在探讨右美托咪定与静脉麻醉药联合使用对电休克治疗（ECT）中癫痫发作持续时间和循环动力学的影响。
进行文献检索，以确定评估右美托咪定对ECT后基于运动或脑电图（EEG）的癫痫发作持续时间以及最大平均动脉压（MAP）和心率（HR）影响的研究。此外，还评估了恢复时间和ECT后的躁动情况。
纳入了6项研究，共166例患者，进行了706次ECT治疗。右美托咪定组与非右美托咪定组在运动或EEG癫痫发作持续时间上无显著差异[运动：6项研究；平均差值（MD），1.62；95%置信区间（CI），-2.24至5.49；P = 0.41；EEG：3项研究；MD，2.34；95% CI，-6.03至10.71；P = 0.58]。右美托咪定组ECT后的最大MAP和HR均显著降低（MAP：6项研究；MD，-4.83；95% CI，-8.43至-1.22；P = 0.009；HR：6项研究；MD，-6.68；95% CI，-10.74至-2.62；P = 0.001）。此外，当使用减量丙泊酚时，添加右美托咪定并未显著延长恢复时间（4项研究；MD，63.27；95% CI，-15.41至141.96；P = 0.12）。
在ECT中使用右美托咪定不会干扰运动和EEG癫痫发作持续时间，但可降低ECT后的最大MAP和HR。此外，在ECT中使用减量丙泊酚时添加右美托咪定不会延长恢复时间。对于ECT患者，在麻醉诱导前使用右美托咪定可能是值得的。
