目的：观察盐酸右美托咪定（ DEX）复合小剂量氯胺酮（ KTM）用于无抽搐电休克治疗（ MECT）精神病的临床疗效和安全性。方法选择2011年10月—2013年10月河北医科大学第一医院首次进行MECT治疗的精神科住院患者80例，采用随机双盲法，将其分为生理盐水（ NS）组、DEX组、KTM组、DEX复合KTM（ DKM）组，各20例。NS组术前10 min静脉注射0.9%氯化钠溶液0.5μg/kg，10 min后静脉注射丙泊酚；DEX组术前10 min静脉注射DEX 0.5μg/kg，10 min后静脉注射丙泊酚；KTM组术前10 min静脉注射KTM 0.5 mg/kg，10 min后静脉注射丙泊酚；DKM组术前10 min静脉注射DEX 0.5μg/kg，10 min后静脉注射KTM 0.5 mg/kg+丙泊酚。记录四组患者麻醉诱导前（T1）、电休克治疗前即刻（T2）、电休克治疗后即刻（T3）以及意识恢复时（T4）的生命体征，包括血氧饱和度（ SpO2）、平均动脉压（ MAP）、心率（ HR）；同时记录四组患者丙泊酚用量、抽搐能量指数、抽搐持续时间、意识恢复时间、定向力恢复时间以及不良反应发生情况。结果四组不同时点 SpO2比较，差异无统计学意义（ P >0.05）。四组不同时点MAP、HR 比较，差异均有统计学意义（ P <0.05）。组间比较显示，四组 T1、T2、T4时点MAP、HR比较，差异均无统计学意义（P>0.05）；DEX组、KTM组和DKM组（P<0.05）；KTM组T3时点HR高于DEX组和DKM组（P<0.05）。组内比较显示，与T1比较，NS组T3时点MAP和HR均升高（P<0.05）；与T1比较，KTM组T3时点HR升高（P<0.05）。四组抽搐持续时间、意识恢复时间、定向力恢复时间比较，差异均无统计学意义（ P>0.05）。四组丙泊酚用量和抽搐能量指数比较，差异均有统计学意义（ P<0.05），其中KTM组和DKM组丙泊酚用量均低于DEX组，抽搐能量指数均高于DEX组（ P<0.05）；DKM组丙泊酚用量低于KTM组（ P<0.05）。四组苏醒延迟发生率比较，差异无统计学意义（ P>0.05）。四组恶心呕吐、烦躁、惊恐发作、头痛发生率比较，差异均有统计学意义（P=0.037、0.024、0.045、0.003），其中KTM组烦躁和惊恐发作发生率均高于DEX组（P=0.043、0.014），DKM组烦躁、惊恐发作发生率均低于KTM组（P=0.037、0.048）。结论 DEX复合KTM用于MECT治疗精神病心血管反应小，丙泊酚用量少，抽搐能量指数高，不良反应少，值得临床推广应用。%Objective To evaluate the clinical efficacy and safety of Dexmedetomidine( DEX) combined with small dose of Ketamine(KTM)in modified electric convulsire therapy(MECT)for psychotic disorders. Methods 80 MECT pa-tients were randomized into groups normal saline( NS group),DEX,KTM,DEX+KTM( DKM group),20 in each. Before operation,NS group were given 0. 9% sodium chloride solution,iv,0. 5 μg/kg at the first 10 min and propofol,iv,after 10 min;DEX group given DEX,iv,0. 5 μg/kg at the first 10 min and propofol,iv,after 10 min;DKM group given DEX,iv, 0. 5 μg/kg at the first 10 min and KTM,0. 5 mg/kg plus propofol after 10 min. Patients' vital signs including blood oxygen satu-ration( SpO2 ),mean arterial pressure( MAP),heart rate( HR) and their propofol dosages,convulsion energy index,con-vulsion duration,consciousness recovery time,orientation recovery time and other adverse events before anesthesia induction (T1),immediately before MECT(T2),immediately after MECT(T3),at the time of consciousness recovery(T4)were re-corded. Results There was no significant difference in SpO2 in 4 groups(P>0. 05),there was difference in MAP,HR at difference time points(P<0. 05). In group comparison,there was no difference in MAP,HR in 4 groups at T1,T2,T4(P>0. 05),and groups DEX,KTM,DKM at T3(P<0. 05),HR higher in KTM group than in DEX group and DKM group at T3(P<0. 05). In intra-group comparison,MAP,HR were higher at T3 than at T1 in NS group(P<0. 05),HR higher at T3 than at T1 in KTM group(P<0. 05). There was no difference in convulsion duration,consciousness recovery time,orienta-tion recovery time in 4 groups(P>0. 05). There was difference in propofol dosage and convulsion energy index(P<0. 05), and propofol dosage was lower,convulsion energy index higher in groups KTM,DKM than in DEX group(P<0. 05),propofol dosage lower in DKM group than in KTM group(P<0. 05). There was no difference in incidence of delayed recovery in 4 group (P>0. 05),there was difference in incidences of nausea,vomiting,irritability,panic attacks,headaches(P =0. 037, 0. 024,0. 045,0. 003),and incidences of irritability and panic attacks higher in KTM group than in DEX group(P=0. 043, 0. 014),lower in DKM group than in KTM group(P=0. 037,0. 048). Conclusion DEX combined with KTM in MECT for mental disorders had few cardiovascular reaction,with small dosage of propofol,high convulsion energy indexes,fewer adverse reactions,which is worthy of clinical application.
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