改良（无抽搐）电痉挛疗法对老年期抑郁状态的疗效及对血压和心率的影响

Efficacy of modified electroconvulsive therapy in treatment of elderly depression and its influence on blood pressure and heart rate

摘要:

目的 评价改良（无抽搐）电痉挛疗法（MECT）治疗老年期抑郁状态的疗效及对血压、心率的影响。方法 选择2013年1月1日至2013年12月31日在首都医科大学附属北京安定医院MECT中心接受治疗的老年期抑郁患者70例，在药物治疗的基础上，联合给予MECT治疗6次。在治疗前、治疗3次后、治疗6次后进行汉密尔顿抑郁量表（HAMD）评估临床疗效；于首次MECT治疗前、麻醉后、发作后、发作后30min、发作后60min测量收缩压（SBP）、舒张压（DBP）和心率（HR）。结果 MECT治疗3次和6次结束时，HAMD评分与治疗前相比差异有统计学意义（均P＜0.01），有效率分别为80.0%和95.7%。麻醉后SBP、DBP明显下降，HR明显加快，与治疗前相比差异有统计学意义（均P＜0.01）；发作后SBP、DBP明显升高，HR明显加快，与治疗前相比差异有统计学意义（均P＜0.01）；发作后30min SBP、DBP明显升高，HR明显加快，与治疗前相比差异有统计学意义（均P＜0.01）；发作后60min SBP、DBP、HR恢复至治疗前水平（均P＞0.05）。结论 MECT联合药物治疗老年期抑郁患者，起效快，疗效好，值得在临床中广泛推广应用；在MECT治疗过程中，麻醉后血压下降，发作后血压明显增高，心率加快，约60min后恢复至治疗前水平，应持续观察。

Abstract:

Objective To evaluate the efficacy of modified electroconvulsive therapy (MECT) in the treatment of elderly depression and investigate its effect on heart rate and blood pressure. Methods A total of 70 elderly patients with depression undergoing MECT in the MECT center of our hospital in the year of 2013 were recruited in this study. Beside drug treatment, they all finished 6 times of MECT. Hamilton Depression Scale (HAMD) was used to assess the clinical symptoms before, and in 3 and 6 times after treatment. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded before treatment, after anesthesia, and in 0, 30 and 60 min after convulsion. Results Significant differences were found in HAMD scores in all patients between pre-treatment and 3 or 6 times after MECT (all P＜0.01), with an efficacy of 80.0% and 95.7% respectively. Compared with pre-treatment, SBP and DBP were significantly decreased while HR increased after anesthesia (all P＜0.01); SBP, DBP and HR were significantly increased after convulsion (all P＜0.01) and in 30 min after convulsion (all P＜0.01). However, SBP, DBP and HR returned to the levels of pre-treatment in 60 min after convulsion (all P＞0.05). Conclusion MECT combined with drug treatment is effective in the treatment of elderly depression, with rapid onset and good efficacy, and is worthy of being widely applied in clinical practice. In the process of MECT, blood pressure is reduced after anesthesia, and then obviously rises with HR after convulsion, but all these indices return to the levels before treatment in 60 min after convulsion. Continuous monitoring should be carried out during the whole process.