右美托咪定预处理预防电抽搐治疗后血液动力学反应亢进：一项交叉、随机对照试验。
Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial.
机构信息
Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Psychiatry, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Rachathewi, Bangkok, 10400, Thailand.
出版信息
BMC Psychiatry. 2021 Aug 17;21(1):408. doi: 10.1186/s12888-021-03406-9.
BACKGROUND
Electroconvulsive therapy (ECT) is an effective therapy for psychiatric disorders, but is associated with acute hyperdynamic responses including transient hypertension and tachycardia. This study aimed to assess the effectiveness of premedication with dexmedetomidine for hemodynamic attenuation after ECT and to evaluate its effects on seizure duration, postictal asystole duration, post ECT agitation and recovery time.
METHODS
Twenty-four psychiatric patients who underwent a total of 72 ECT sessions (three sessions per patient) were randomly allocated to receive either dexmedetomidine 0.5 mcg/kg intravenous, dexmedetomidine 1 mcg/kg intravenous, or saline (control group) 15 min before the first ECT session. The patients subsequently received the other two premedication options for their next two ECT sessions. Blood pressure and heart rate were recorded at 5, 10, and 15 min after drug infusion and at 2.5, 5, 7.5, 10, 15, 20, 25, and 30 min after ECT. Asystole duration, seizure duration, post ECT agitation and recovery times were also recorded.
RESULTS
The baseline characteristics were similar between the groups. Systolic blood pressure in both dexmedetomidine groups was significantly lower than that in the control group after ECT (p = 0.002). Diastolic blood pressure and heart rate were significantly lower in the dexmedetomidine 1 mcg/kg group (p = 0.002 and p = 0.013, respectively) compared with the control group. Asystole duration, seizure durations, post ECT agitation and recovery times were similar between the groups.
CONCLUSIONS
Dexmedetomidine 1 mcg/kg administered 15 min before ECT attenuated the hemodynamic response, including suppressing the systolic, diastolic and heart rate increases, during ECT without affecting recovery time. It also did not prolong the post-stimulus asystole duration.
TRIAL REGISTRATION
TCTR20170715003 , registered at Thai Clinical Trials Registry (TCTR), principal investigator: Pattika Subsoontorn, date of registration: 15/07/2017.
背景
电痉挛疗法（ECT）是一种有效的精神科疾病治疗方法，但与急性动力反应有关，包括短暂的高血压和心动过速。本研究旨在评估在 ECT 前使用右美托咪定预给药对血液动力学衰减的效果，并评估其对癫痫持续时间、电刺激后停搏时间、ECT 后激越和恢复时间的影响。
方法
24 名接受总共 72 次 ECT 治疗（每名患者 3 次）的精神科患者被随机分配接受右美托咪定 0.5 mcg/kg 静脉注射、右美托咪定 1 mcg/kg 静脉注射或生理盐水（对照组）15 分钟，然后在第一次 ECT 治疗前。随后，患者在接下来的两次 ECT 治疗中接受其他两种预用药。在药物输注后 5、10 和 15 分钟以及 ECT 后 2.5、5、7.5、10、15、20、25 和 30 分钟记录血压和心率。还记录了停搏时间、癫痫发作持续时间、ECT 后激越和恢复时间。
结果
两组的基线特征相似。与对照组相比，右美托咪定组的收缩压在 ECT 后明显降低（p=0.002）。与对照组相比，右美托咪定 1 mcg/kg 组的舒张压和心率明显降低（p=0.002 和 p=0.013）。两组间停搏时间、癫痫发作持续时间、ECT 后激越和恢复时间相似。
结论
在 ECT 前 15 分钟给予右美托咪定 1 mcg/kg 可减轻 ECT 期间的血液动力学反应，包括抑制收缩压、舒张压和心率的增加，而不影响恢复时间。它也没有延长刺激后的停搏时间。
试验注册
TCTR20170715003，在泰国临床试验注册中心（TCTR）注册，主要研究者：Pattika Subsoontorn，注册日期：2017 年 7 月 15 日。
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