Zielinski R J, Roose S P, Devanand D P, Woodring S, Sackeim H A
Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032.
Am J Psychiatry. 1993 Jun;150(6):904-9. doi: 10.1176/ajp.150.6.904.
This study was conducted to determine the safety of electroconvulsive therapy (ECT) for depressed patients with serious cardiac disease.
The rate of complications in 40 patients with major depressive disorder and left ventricular impairment, ventricular arrhythmias, and/or conduction delay who received ECT was compared to the rate of complications in a matched comparison group of 40 depressed patients without cardiac disease who also received ECT. In addition, 21 of the patients with cardiac illness had received one or more inpatient trials of tricyclic antidepressants before receiving ECT, thereby permitting a comparison of cardiovascular complications of medication and ECT in the same patients.
The patients with cardiac disease had a significantly higher rate of cardiac complications during ECT than did the comparison group without cardiac disease. The type of preexisting cardiac abnormality strongly predicted the type of cardiac complication that occurred during ECT. However, most of the complications were transitory and did not prevent the completion of ECT. Of the 21 patients with cardiac disease who had received tricyclic trials before ECT, 11 had been forced to discontinue drug treatment because of substantial cardiovascular side effects. In comparison, 38 of the 40 cardiac patients completed the course of ECT.
With close monitoring for the development of arrhythmia and ischemic episodes, ECT can be given with relative safety to patients with severe cardiovascular disease.
本研究旨在确定电休克治疗（ECT）对患有严重心脏病的抑郁症患者的安全性。
将40例患有重度抑郁症且伴有左心室功能损害、室性心律失常和/或传导延迟并接受ECT治疗的患者的并发症发生率，与40例同样接受ECT治疗但无心脏病的抑郁症匹配对照组患者的并发症发生率进行比较。此外，21例患有心脏病的患者在接受ECT治疗前曾接受过一次或多次三环类抗抑郁药的住院试验，从而可以对同一患者药物治疗和ECT的心血管并发症进行比较。
患有心脏病的患者在ECT治疗期间的心脏并发症发生率明显高于无心脏病的对照组。先前存在的心脏异常类型强烈预测了ECT治疗期间发生的心脏并发症类型。然而，大多数并发症是暂时的，并不妨碍ECT治疗的完成。在21例在ECT治疗前接受过三环类药物试验的心脏病患者中，有11例因严重的心血管副作用而被迫停药。相比之下，40例心脏病患者中有38例完成了ECT疗程。
通过密切监测心律失常和缺血发作的发生情况，ECT可以相对安全地用于重度心血管疾病患者。
