CAJ | 학술논문

目的观察无抽搐电痉挛治疗(MECT)后抽搐发作延长的发生率和心肌损伤标志物的变化.方法 26例MECT后抽搐发作延长者为发作延长组,41例MECT后无抽搐发作延长者为正常发作组,同时设31例未行MECT者为对照组.分别在发作延长、正常发作后即刻、发作后3h和次日留取血标本,对照组即刻留取血标本测量心肌损伤标志物.包括磷酸肌酸激酶(CK)、磷酸肌酸激酶同功酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氧酶(α-HBDH)和心脏肌钙蛋白(cTnT),并对3组间的心肌损伤标志物进行比较.结果发作延长组与正常发作组和对照组比较,CK-MB(即刻)、α-HBDH(即刻、3h和次日)、LDH(即刻、3h)差异有显著性(P＜0.05);发作延长组的即刻CK值高于对照组(P＜0.05).正常发作组与发作延长组cTnT阳性率分别为17.1%和30.8%,二者比较差异无显著性.结论 MECT过程中及其后可能存在的相对低氧状态,是否可能导致心肌微小损伤需引起警惕.
목적 관찰무추휵전경련치료(MECT)후추휵발작연장적발생솔화심기손상표지물적변화.방법 26례MECT후추휵발작연장자위발작연장조,41례MECT후무추휵발작연장자위정상발작조,동시설31례미행MECT자위대조조.분별재발작연장、정상발작후즉각、발작후3h화차일류취혈표본,대조조즉각류취혈표본측량심기손상표지물.포괄린산기산격매(CK)、린산기산격매동공매(CK-MB)、유산탈경매(LDH)、α-간정산탈양매(α-HBDH)화심장기개단백(cTnT),병대3조간적심기손상표지물진행비교.결과 발작연장조여정상발작조화대조조비교,CK-MB(즉각)、α-HBDH(즉각、3h화차일)、LDH(즉각、3h)차이유현저성(P＜0.05);발작연장조적즉각CK치고우대조조(P＜0.05).정상발작조여발작연장조cTnT양성솔분별위17.1%화30.8%,이자비교차이무현저성.결론 MECT과정중급기후가능존재적상대저양상태,시부가능도치심기미소손상수인기경척.
Objectiye To observe the prevalence of prolonged seizures and the changes of biochemical markers of myocardial injury in patients with prolonged seizures after modified electroconvulsive therapy(MECT).Methods Patients treated with MECT or simulated ECT were divided into three groups.Group Ⅰ , 26 patients,experienced at least one prolonged seizure after MECT;group Ⅱ,41 selected patients, had not prolonged seizures at all during a course of MECT treatments and group Ⅲ, 31 patients, received simulated ECT.Biochemical markers of myocardial injury, including phosphocreatine kinase (CK), MR isoenzyme of phosphocreatine kinase (CK-MB), lactate dehydrogenase ( LDH ), α-hydroxybutyrate dehydrogenase ( α-HBDH ) and cardiac troponin (cTnT) ,were measured immediately, 3 hours later and on the following day after the first prolonged seizure for group Ⅰ ,the same time points as group Ⅰ after the first treatment of MECT for group Ⅱ , immediately after simulated ECT for group Ⅲ.These indexes were compared between the patients of three groups.Results The positive rate ofcTnT was 30.8%(8/26) and 17.1% (7/41)in group Ⅰ and Ⅱ respectively, but no difference was found(P＞0.05 ).CK measured immediately after MECT in patients of group Ⅰ was significantly higher than that of group Ⅲ(P ＜ 0.05 ).CK-MB (immediately), LDH ( immediately and 3 hours later) and α-HBDH ( immediately, 3 hours later and on the following day) in patients of group Ⅰ were significantly higher than those of group Ⅱ and Ⅲ measured after MECT or simulated ECT(P＜0.05 ).Conclusion More attention should be paid that absolute or relative hypoxemia may lead to minor myocardial injury.