| Objective:Modified Electroconvulsive Therapy(MECT)is a rapid and effective physical therapy for mental disorders,usually using propofol as the anesthetic agent.However,propofol may increase the seizure threshold of MECT,shorten seizure duration,reduce seizure intensity,and affect the therapeutic effect of MECT.Dexmedetomidine(DEX),a highly-selective ?2 adrenoceptor agonist,can reduce the dosage of propofol,stabilize the function of circulatory systems,exert sedative and analgesic effect,improve postoperative cognition,inhibit sympathetic activity and reduce the stress response of MECT.Nevertheless,it has not been clarified whether DEX can affect the therapeutic effect of MECT.In this study,we investigated whether DEX can influence the therapeutic effect of MECT and play a cardiac and cerebral protective role in schizophrenic patients,hoping to provide more reference for anesthetic selection during MECT.Methods:From June 2016 to June 2018,schizophrenic patients(ASA ?-?.n = 60)admitted to our hospital were recruited as the study subjects.Each patient received 6 times of MECT.The patients were assigned into two groups using a random number table including propofol combined with DEX group(PD group,30 patients intravenously injected with 0.5 ? g/kg DEX(diluted to 20ml))and propofol group(P group,30 patients intravenously injected with an equal dose of normal saline).All patients fasted for 6 h before treatment and were monitored in supine position for oxygen saturation,blood pressure,heart rate(HR)and electrocardiogram.Before anesthesia induction,DEX/normal saline was infused intravenously by using a micropump for 10 min,followed by intravenous injection of 0.5 mg atropine,1.5-2 mg/kg propofol,and 0.8 mg/kg succinylcholine chloride.When the patients become unconscious,face masks were used to assist respiration,oral protectors were placed in the mouth after muscle relaxation,and appropriate electric stimulation was selected to perform MECT.Assisted respiration was not removed immediately after MECT,and the patients could not leave the treating room until they recovered normal respiration and consciousness and could act according to orders and answer questions clearly.The blood pressure and HR were monitored and recorded when the patients entered the treating room,after administration of DEX,at the time of electric stimulation,and 3 min and 10 min after electric stimulation.Besides,the seizure duration(T),dosage of Propofol and recovery time were recorded.Moreover,the VAS score,RSS score and adverse effects were assessed after treatment,and the PANSS score as well as the WMA score were determined before and after the treatment.Results:(1)There was no statistical difference between P group and PD group in patients' age,gender ratio,and weight(all P>0.05);(2)Patients in PD group had a lower dosage of propofol(108 ± 16.3mg)than those in P group(123.2 ± 22.1 mg)(P<0.05);(3)the patients in P group and PD group showed no significant difference in systolic blood pressure(SBP),diastolic blood pressure(DBP),and HR when entering the treating room(P>0.05).However.both groups had increased blood pressure and HR at different time points after MECT,and inter-and intra-group comparisons were of statistical significance(all P<0.05).In addition,PD group increased less significantly in blood pressure and HR and had more stable hemodynamics than P group;(4)Patients in PD group had longer seizure duration(T)than those in P group(26± 4.9s vs.22.6 ± 6.9s,P<0.05);(5)Intra-group comparisons of PANSS score and WMA score have statistical significance before and after treatment(P<0.01),while inter-group comparisons of PANSS score and WMS score was of no statistical significance before treatment(P>0.05).After 6 times of treatment,both groups declined in PANSS score,but the inter-group difference was of no statistical significance in P group(63.73± 3.39)and PD group(62.79 ± 4.023)(P>0.05).Moreover,both groups had declined WMS score after MECT,with WMS score of 72.8±2.1 and 81.4±3.3 in P group and PD group respectively(P<0.05);(6)Patients in PD group had less adverse effects than those in P group regarding VAS score and RSS score(all P<0.05).Conclusions:(1)Injection of DEX before MECT can reduce the dosage of Propofol and make hemodynamics more stable,thus playing a cardioprotective role.(2)DEX can prolong convulsive seizures.But it has no therapeutic effect on schizophrenia.(3)Injection of DEX before MECT can alleviate such adverse effects as headache and muscle pain(myalgia),and ameliorate post-MECT cognitive function,thereby having a cerebral protective effect. |
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