电抽搐治疗的麻醉.ppt

Anesthesia for Electroconvulsive therapy 电抽搐疗法的麻醉 Indications Delusions or other psychotic symptoms with depression (伴随妄想症或其它精神症状的抑郁症) Pregnant and severely depressed (怀孕和严重抑郁症) Suicidal (自杀倾向的) Cannot take antidepressant drugs or Have not responce to antidepressant drugs (无法口服抗抑郁药物或药物无效) Mania, catatonia, and psychosis that do not improve enough with other treatments. (其它疗法无效的躁狂、紧张症) Procedures First, the patient has a mental and physical exam. Next, she has electrodes attached to her temples(颞部). Procedures Then, the patient gets an IV sedation that will put her to sleep and relax her muscles. Procedures When all is ready, a small electrical current painlessly runs through her brain and resets broken circuits. After the Procedure After a successful course of ECT, the patient will receive medications or less frequent ECT to reduce the risk of another depression episode. ECT is usually given once every 2- 5 days for a total of 6 - 12 sessions, but sometimes more sessions are needed. Complications Confusion 意识混乱 Headache 头痛 Hypotension or hypertension Memory loss Muscle soreness 肌肉酸痛 Nausea 恶心 Rapid heartbeat (tachycardia) or other heart problems 心律失常 Contraindications Intracranial hypertension (颅内压增高) (发作过程中，脑血流量增加约100%，脑脊液压力增高55cmH2O） Myocardial infarction (新近发作的心肌梗塞) Congestive heart-failure, Conduction abnormalities, coronary heart disease, pulmonary dysfunction (充血性心力衰竭、传导异常、冠心病和肺功能障碍) ECT without anesthesia Anesthesia Mask oxygen inhalation (面罩吸氧) Propofol 1-1.5mg/kg 镇静 Fentanyl or remifentanyl 增加舒适性 Scoline 1-1.5mg/kg 松弛肌肉 Atropine 0.25-0.5mg/kg 缓解窦缓，减少分泌物 Put teeth pad， Lift the chin ，Focus on ECG monitoring (置入牙垫，托好下颌，维持通气，关注心电状态) Conclusion 由于麻醉医生的存在和麻醉药物的发展，电抽搐疗法对于抑郁症或其它精神疾病来讲，是安全有效的。 * Depression 抑郁症 治疗师 药物 自杀倾向 电抽搐疗法 电抽搐疗法是治疗严重抑郁症的金标准，安全性越来越高，风险和并发症越来越少。 与过去和科幻不同，电抽搐疗法并不残忍，也不会以消除记忆为代价。 小剂量电流造成脑部的癫痫波，持续40s。肌松药可预防全身抽搐。 (电抽搐治疗后有必要继续药物和数次电抽搐疗法。治疗间隔不宜短于48小时。因为ECT后抽搐发作对脑功能的影响一般要48—72