右美托咪定预防电抽搐治疗后癫痫后谵妄的效果：一项随机对照研究。
Preventive effect of dexmedetomidine on postictal delirium after electroconvulsive therapy: A randomised controlled study.
机构信息
From the Department of Anesthesiology (ZQ, SZ, NG, PH, ZH, XL), Department of Psychiatry (MZ), The Third Affiliated Hospital, Sun Yat-sen University and Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, China, Guangzhou, China (PX).
出版信息
Eur J Anaesthesiol. 2020 Jan;37(1):5-13. doi: 10.1097/EJA.0000000000001113.
BACKGROUND
Postictal delirium (PID) is a relatively common complication following electroconvulsive therapy (ECT).
OBJECTIVE
We investigated whether prophylactic dexmedetomidine administration would safely decrease the incidence of PID in psychiatric patients after ECT.
DESIGN
A randomised, double-blind, placebo-controlled trial.
PATIENTS
A total of 223 patients undergoing ECT were randomly allocated to two groups.
INTERVENTIONS
Patients received 0.5 μg kg dexmedetomidine (Dex group, n=111) or 0.9% sodium chloride (Con group, n=112) before ECT. Propofol was used for anaesthesia and succinylcholine for muscle relaxation. The incidence of PID was measured using the Confusion Assessment Method for the Intensive Care Unit.
MAIN OUTCOME MEASURES
The percentage of patients who were diagnosed with PID at any ECT session during the whole treatment.
RESULTS
PID occurred in 76 (67.9%) of 112 patients given saline (0.9% sodium chloride), and in 49 (44.1%) of 111 patients given dexmedetomidine during the whole treatment. There was a significant difference in the incidence of PID between two groups (P < 0.001). Post hoc analyses showed that the incidence of PID was significantly lower in the Dex group than in the Con group from the first to the seventh ECT session (P < 0.005). There were no significant differences in seizure duration or recovery time between the two groups. Heart rate and mean arterial pressure in the Dex group were significantly lower than in the Con group at 0, 5 and 15 min after electrical stimulation. No patients developed bradycardia, hypotension or respiratory depression during recovery.
CONCLUSION
Pretreatment with dexmedetomidine leads to a significant reduction in the incidence of PID with no respiratory depressant effect. Dexmedetomidine might be considered an effective method for the prevention of PID post-ECT.
TRIAL REGISTRATION
Chinese Clinical Trial Registry ChiCTR-IOR-17012306.
背景
电抽搐治疗（ECT）后发生癫痫后谵妄（PID）是一种相对常见的并发症。
目的
我们研究了在 ECT 后预防性给予右美托咪定是否能安全降低精神科患者 PID 的发生率。
设计
随机、双盲、安慰剂对照试验。
患者
共 223 例接受 ECT 的患者被随机分配到两组。
干预措施
患者在 ECT 前分别接受 0.5μg/kg 右美托咪定（Dex 组，n=111）或 0.9%氯化钠（Con 组，n=112）。丙泊酚用于麻醉，琥珀胆碱用于肌肉松弛。使用 ICU 意识模糊评估法测量 PID 的发生率。
主要观察指标
整个治疗过程中任何一次 ECT 时被诊断为 PID 的患者百分比。
结果
在接受生理盐水（0.9%氯化钠）的 112 例患者中，PID 发生在 76 例（67.9%）；在接受右美托咪定的 111 例患者中，PID 发生在 49 例（44.1%）。两组 PID 发生率有显著差异（P<0.001）。事后分析显示，从第一次到第七次 ECT 时，Dex 组的 PID 发生率明显低于 Con 组（P<0.005）。两组的癫痫发作持续时间和恢复时间无显著差异。电刺激后 0、5 和 15 分钟，Dex 组的心率和平均动脉压明显低于 Con 组。在恢复过程中，没有患者出现心动过缓、低血压或呼吸抑制。
结论
预先给予右美托咪定可显著降低 PID 的发生率，且无呼吸抑制作用。右美托咪定可能是预防 ECT 后 PID 的有效方法。
试验注册
中国临床试验注册中心 ChiCTR-IOR-17012306。
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