张莉等

【摘要】 目的：探讨两种剂量组罗库溴铵与琥珀胆碱运用于麻醉状态下无抽搐电休克治疗精神疾病患者肌松效果的影响。方法：选择确诊为精神疾病、有明确电休克治疗适应证、ASA分级I级、年龄18～50岁、1周接受3次电休克治疗且平均至少接受6次治疗的患者60例，按随机数字表法分为三组，分别以0.3 mg/kg（R1组）、0.45 mg/kg（R2组）罗库溴铵和1 mg/kg琥珀胆碱（S组）配伍丙泊酚（1 mg/kg）用作麻醉诱导，电抽搐治疗后R1、R2组给予新斯的明（0.1 mg/kg）加阿托品（0.05 mg/kg）拮抗罗库溴铵，比较三组患者治疗后自主呼吸恢复时间、睁眼时间、肢体运动时间以及电击前与电击时心率、血压及血氧饱和度的变化。结果：R2组自主呼吸恢复时间较其他两组长，差异均有统计学意义（P<0.05）；三组睁眼时间、体动时间比较差异均无统计学意义（P>0.05）；三组诱导后与电击时心率、血压及血氧饱和度差值比较差异均无统计学意义（P>0.05）。结论：0.45 mg/kg罗库溴铵可导致患者自主呼吸恢复时间延长，不推荐运用于无抽搐电休克治疗；0.3 mg/kg罗库溴铵复合使用肌松拮抗药可作为琥珀胆碱的替代药物运用于无抽搐电休克治疗。

【关键词】 电休克治疗； 骨骼肌松弛药； 罗库溴铵； 琥珀胆碱

The Comparison between Therapeutic Effect of Neuromuscular Blocking Using Modified Electroshock Therapy with Different Doses of Rocuronium and Suxamethonium under Anesthesia/ZHANG Li，YANG Bao-zhong，WANG Zu-jin，et al.//Medical Innovation of China，2014，11（16）：031-034

【Abstract】 Objective：To discuss the influence of different doses of rocuronium and suxamethonium applied to modified electroshock therapy （ECT） under anesthesia to treat mental patient with neuromuscular blocking. Method：Patients diagnosed as mental illness should be chosen and must be characterized by explicit electroshock therapy indications. The classification of ASA was at I level and their ages should be between 18 and 50.All patients received ECT for three times a week and must received ECT for at average about six times at least. 60 patients were divided into three groups according to random number table method，the control group was 1 mg/kg suxamethonium group （the group S），the treatment groups were 0.3 mg/kg （the group R1） rocuronium group and 0.45 mg/kg （the group R2） rocuronium group， all these groups should be respectively combined with propofol（1 mg/kg） as anesthesia induction. After ECT， neostigmine （0.1 mg/kg）and atropine（0.05 mg/kg） antagonism rocuronium were added to the two group doses of rocuronium. Consequently， the comparison shall be made among three patients on the recovery time of automatic respiration， the time to open eyes， the time of body movement as well as the heart rate and the change of blood pressure and oxygen saturation before electroshock and during electroshock.Result： The patients automatic respiration recovery time of the R2 group were significantly longer than the other groups， the differences were statistical significance （P<0.05）.There were no statistical significance in the time of opening eyes and body movement among the three groups（P>0.05）；no matter before electroshock or during electroshock， there were no statistical significance in patients HR， the change of BP and SpO2 among three groups（P>0.05）. Conclusion：0.45 mg/kg rocuronium can result in extending the recovery time of patients automatic respiration.，so its not supported to be applied to modified electroshock therapy； 0.3 mg/kg rocuronium used with neuromuscular blocking antagonist can be the replacement for suxamethonium being applied to modified electroshock therapy.

【Key words】 Electroshock therapy； Neuromuscular blocking agent； Rocuronium； Suxamethonium

First-authors address：Shanxi Medical University，Taiyuan 030001，China

doi：10.3969/j.issn.1674-4985.2014.16.010

电休克疗法指运用短暂、适当的电流刺激大脑，引起患者神智丧失和全身抽搐，而达到控制精神症状的治疗方法，对于躁狂症、精神分裂症等疾病治疗效果较为良好。无抽搐电休克治疗（MECT）是利用现代麻醉技术，使患者在安睡和肌肉完全松弛的状态下，接受电休克治疗的一种方法，越来越广泛地用于精神病患者的治疗。目前为止，氯化琥珀胆碱以其起效快、作用时间短、价格低廉等优点为电休克治疗中运用最为广泛的神经肌肉接头阻滞剂，但随着肌松药种类的不断发展，非去极化肌松药也逐渐运用于电休克治疗中[1]。