兩種無(wú)抽搐電休克治療模式對(duì)抑郁癥患者療效及記憶力影響的比較

王偉,徐清,周園園

·論著·

兩種無(wú)抽搐電休克治療模式對(duì)抑郁癥患者療效及記憶力影響的比較

王偉,徐清,周園園

目的比較兩種無(wú)抽搐電休克治療(MECT)模式對(duì)抑郁癥患者療效及記憶力的影響。方法將65例抑郁癥患者隨機(jī)分為醒脈通標(biāo)準(zhǔn)電刺激組(DGX組)和0.5 ms波寬模式組(LOW 0.5組),分別給予6～12次MECT治療。治療前后用漢密爾頓抑郁量表(HAMD-17)評(píng)定療效,用韋氏記憶量表(WMS)進(jìn)行記憶測(cè)定。結(jié)果DGX組和LOW 0.5組末次MECT治療后的HAMD評(píng)分均較治療前顯著下降(t=14.67、12.41,P均<0.05)；協(xié)方差分析顯示治療前后HAMD評(píng)分差值組間差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.698,P>0.05)；治療前兩組WMS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P均>0.05),協(xié)方差分析顯示治療后LOW 0.5組在圖片、再認(rèn)、背數(shù)等項(xiàng)目以及記憶商數(shù)上的得分顯著高于DGX組(F=9.127、7.312、13.261、5.135；P均<0.05)。結(jié)論LOW 0.5模式與DGX模式MECT的抗抑郁效果相當(dāng)；但在改善記憶力方面LOW 0.5模式優(yōu)于DGX模式。

無(wú)抽搐電休克治療； 抑郁癥； 記憶功能

Abstract：Objective： To explore the influence of the standard stimulus of Thymatron(DGX)and the Fixed 0.5ms pulse-width mode (LOW 0.5) MECT on efficacy and cognitive function in patients with depression.Method：65 patients with depression were randomly divided into the DGX group and the LOW 0.5 group and received 6 to 12 times therapies of MECT.Hamilton depression scale (HAMD-17) was used to assess the severity of depression and the Wechsler memory scale (WMS) was employed to assess the memory function before and after MECT,respectively.Results：The HAMD scores in both groups significantly decreased after MECT (t=14.67,12.41,bothP<0.05),despite ANCOVA showed no significant between-group difference in the D-value of HAMD (F=0.698,P>0.05).The WMS scores in two groups were comparable at the baseline.ANCOVA revealed that the pictures,recognition,digit span and total scores of the LOW 0.5 group were significantly higher than those of the DGX group (F=9.127,7.312,13.261,5.135,allP<0.05).Conclusion：The DGX mode and LOW 0.5 mode MECT has similar efficacy on treating depressive disorder; however,the LOW 0.5 mode may have better effect on improving memory function.

Keywords： modified electroconvulsive therapy; depression; memory function

目前國(guó)內(nèi)外對(duì)于存在自傷自棄或者多種藥物治療效果差的抑郁癥常采用無(wú)抽搐電休克治療(MECT),但MECT有時(shí)會(huì)導(dǎo)致患者遺忘[1]、譫妄[2],甚至持續(xù)6個(gè)月以上的記憶障礙[3]。國(guó)內(nèi)MECT治療常采用醒脈通標(biāo)準(zhǔn)電刺激(DGX)模式,其實(shí)MECT除了DGX模式,還有最低電量率(LOWEST)模式、超短0.25 ms波寬(LOW 0.25)模式、0.5 ms波寬(LOW 0.5)模式、雙倍電量刺激(2X DOSE)模式,在臨床上使用較少,其中醒脈通Ⅳ型治療儀使用手冊(cè)中推薦LOW 0.5模式可能對(duì)記憶力影響較小,但國(guó)內(nèi)外研究鮮有報(bào)道采用LOW 0.5模式MECT對(duì)抑郁癥的療效及記憶力影響,故本研究采用DGX模式和LOW 0.5模式MECT比較對(duì)抑郁癥患者療效及記憶力的影響,報(bào)告如下。

1 對(duì)象和方法

1.1 對(duì)象

為2013年2月至2016年5月在我院住院或門診治療的抑郁癥患者,入組標(biāo)準(zhǔn)：①符合《中國(guó)精神障礙分類與診斷標(biāo)準(zhǔn)》第3版(CCMD-3)抑郁癥診斷標(biāo)準(zhǔn),②年齡≥18歲；③……