McCall W V, Reid S, Ford M
Department of Psychiatry, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157.
Convuls Ther. 1994 Mar;10(1):25-33.
The American Psychiatric Association Task Force on ECT has recommended that electroconvulsive therapy (ECT) stimuli be dosed at "moderately suprathreshold" intensities. Empiric estimation of the convulsive threshold by stimulus dose titration may expose the patient to subconvulsive stimuli, and subconvulsive stimuli have been reported by some to carry serious cardiovascular risk. This study examines the electrocardiographic (ECG) and cardiovascular effects of subconvulsive stimuli. Forty consecutive inpatients (29 women, 11 men; mean age 68 years) with major depression received subconvulsive stimuli during titrated, right unilateral (RUL) ECT. Successively larger stimuli were administered until a convulsion began. The effects of subconvulsive stimuli on the ECG, heart rate (HR), and blood pressure (BP) were assessed with multivariate repeated measures analysis. Subconvulsive stimuli prolonged the R-R interval and decreased HR compared with baseline values immediately before the subconvulsive stimulus, but the changes were of questionable clinical significance. BP was not changed. In conclusion, subconvulsive stimuli are well tolerated in the context of titrated RUL ECT. If stimulus dose titration proves to be useful in optimizing efficacy with fewer cognitive side effects, then cardiovascular considerations should not be an obstacle in the application of stimulus dose titration in most patients.
美国精神病学会电休克治疗特别工作组建议，电惊厥治疗（ECT）刺激应采用“适度阈上”强度给药。通过刺激剂量滴定法对惊厥阈值进行经验性估计可能会使患者受到阈下刺激，并且一些研究报告称阈下刺激会带来严重的心血管风险。本研究考察阈下刺激对心电图（ECG）及心血管的影响。40例连续住院的重度抑郁症患者（29名女性，11名男性；平均年龄68岁）在进行滴定式右侧单侧（RUL）ECT期间接受阈下刺激。依次给予强度递增的刺激，直至出现惊厥。采用多变量重复测量分析评估阈下刺激对心电图、心率（HR）和血压（BP）的影响。与阈下刺激前即刻的基线值相比，阈下刺激使R-R间期延长，心率降低，但这些变化的临床意义存疑。血压未发生改变。总之，在滴定式RUL ECT过程中，阈下刺激耐受性良好。如果刺激剂量滴定法被证明有助于在减少认知副作用的情况下优化疗效，那么对于大多数患者而言，心血管方面的顾虑不应成为应用刺激剂量滴定法的障碍。
