无抽搐电休克治疗难治性精神分裂症临床观察

目的 评价无抽搐电休克( MECT)治疗难治性精神分裂症的临床疗效.方法 选择2010年6月至2011年6月期间我院收治的100例难治性精神分裂症患者,应用抗精神病药合并MECT治疗.应用阳性和阴性症状量表( PANSS)评估临床疗效,采用副反应量表(TESS)评定不良反应.结果 本组患者经合并MECT治疗1、4及8周后有效率分别为9％、29％、56％.与合并MECT治疗前比较,治疗4周、8周后PANSS总分、阳性症状、阴性症状及一般精神病理分均显著降低(P＜ 0.05或P＜0.01).不同治疗时段TESS总分均较治疗前降低,但差异比较均无统计学意义(P＞0.05).治疗过程中不良反应均较轻微,不影响治疗.结论 抗精神病药合并MECT治疗难治性精神分裂症的临床疗效确切,未增加副反应,是治疗难治性精神分裂症的有效方法.     

Prolonged QTc intervals in medicated patients with schizophrenia

Psychotropic drugs have been associated with sudden deaths and the lengthening of corrected-QT interval (QTc) on the electrocardiogram which may be a precursor of life-threatening arrhythmias as reported with some of these drugs. The objectives of this study were to measure the frequency of QTc lengthening in patients with schizophrenia receiving psychotropic drugs, and to assess whether QTc lengthening was associated with certain psychotropic drugs and other risk factors. One hundred and sixty three patients with schizophrenia (104 males and 59 females) were included in the study. Clinical and demographic data were collected from the case records. One hundred healthy volunteers were recruited to establish values for upper limits of normal for measurement of QTc interval and dispersion. Eleven (6.7%) of the patients had a prolonged QTc interval. The significant predictors obtained from a logistic regression modelling were chlorpromazine, flupenthixol decanoate and fluphenazine decanoate. Caution should be exercised and monitoring with ECG should be considered in patients prescribed chlorpromazine and depot antipsychotic medications even at recommended doses.     

无抽搐电休克治疗精神分裂症的临床护理

目的总结无抽搐电休克治疗精神分裂症的临床护理技能,探讨无抽搐电休克（MECT）,或称改良电痉挛治疗精神分裂症的疗效和护理。方法采用回顾性调查的方法对2009年7月～2011年7月到本院就诊的73例精神分裂症患者的临床资料进行整理、归纳和分析,通过实时护理总结了护理体会。结果73例共进行327次MECT治疗过程都很顺利,无严重并发症发生。结论MECT安全有效,不良反应少,做好充分的术前准备、密切观察病情变化及良好的心理沟通是MECT治疗顺利进行和成功的重要保证。     

利多卡因对精神病患者无抽搐电休克治疗后肌痛的影响

目的 观察利多卡因对精神分裂症患者行无抽搐电休克治疗(MECT)后肌痛的影响.方法 在麻醉下行电休克治疗患者60例,随机均分为两组:L组麻醉前静脉注射利多卡因40mg;N组用等容量生理盐水作为对照.麻醉采用丙泊酚1.0-1.5 mg/kg和琥珀胆碱1mg/kg.MECT治疗后30 min、1h和6h评估患者肌痛VAS评分.结果 两组患者电击后脑电发作均超过26s.L组术后30 min、1h和6h的肌痛发生率分别为50％、51％和50％,均明显低于N组的68％、68％和65％(P＜0.05).两组MECT后苏醒时间相仿[(6.5±1.7) min vs.(6.0±1.6) min] (P＞0.05).L组患者苏醒后30 min、1h和6h的VAS肌痛评分均明显低于N组(P＜0.05).治疗后即刻和治疗后1 min,L组HR和MAP均低于N组(P＜0.05).结论 静脉预注利多卡因能够降低精神分裂症患者MECT后肌痛.     

常压氧疗法对降低精神分裂症患者无抽搐电痉挛治疗引起的记忆功能损伤研究

目的研究常压氧疗法对精神分裂症患者无抽搐电痉挛治疗(MECT)对记忆功能的影响。方法选择本院2012年7月至2013年12月84例精神分裂症患者,随机分为2组,每组42例,对照组在每次行MECT后予常规处理,试验组在每次MECT治疗后行常压氧吸氧处理。进行治疗前、治疗后及结束治疗后4周各阶段阳性和阴性症状量表(PANSS)评估,并用韦氏记忆量表(WMS)进行记忆测试。结果对照组与试验组治疗后、结束治疗后4周与治疗前各项指标比较差异均有统计学意义(P<0.05);试验组治疗结束后4周PANSS分别为17.0±3.1和11.0±2.9,低于对照组(分别为19.3±2.9和13.8±2.2),差异具有统计学意义(P<0.05);试验组结束治疗后4周一般病理症状评分为24.9±2.8,低于对照组29.3±2.2(P<0.05);试验组治疗后4周再认和图片评分分别为11.8±1.9和14.2±3.0,高于对照组(分别为10.4±1.2和11.8±1.5)(P<0.05);试验组治疗后4周联想和背数评分分别为15.6±1.2和15.7±2.5,高于对照组(分别为13.3±1.8和13.5±1.9),差异具有统计学意义(P<0.05)。结论常压氧疗法能降低精神分裂症患者MECT引起的记忆功能损伤。     

QT离散度在急性冠脉综合征中的临床意义及PCI术后QT离散度的变化研究

目的 探讨急性冠脉综合征（ACS）中体表心电图QT离散度（QTd及QTcd）的变化、冠状动脉严重狭窄行PCI术后及PCI术时应用替罗非班其QTd及QTcd的变化.方法 回顾性分析2010年2月份至2013年6月份行冠状动脉造影检查的312例急性冠脉综合症患者的临床资料,测量分析其心电图QT离散度的变化.把已行PCI术患者的QT离散度与其PCI术前的QT离散度进行对比,观察其变化.对行PCI术的36例未用替罗非班患者的QT离散度与30例行PCI术时应用替罗非班的患者的QT离散度对比分析.结果 急性冠脉综合征组体表心电图QT离散度数值比冠状动脉正常组明显增大.其中,不稳定型心绞痛组中二支病变组比一支病变组增大,三支病变组大于双支病变组,心肌梗死组较冠状动脉正常组显著增大.PCI术后其QTd及QTcd较PCI术前明显降低,近似接近正常组.PCI术组应用替罗非班后其QTd及QTcd值较未用替罗非班组小,能够显著降低缺血性心肌的QT离散度,改善预后.结论 体表心电图QT离散度的改变对判断冠状动脉病变血管支数及心肌急性缺血状态具有一定的价值.     

Concurrent electroconvulsive therapy in patients receiving reboxetine

There are few studies of the potential interaction between antidepressants and electroconvulsive therapy (ECT), although there is a theoretical risk of serotonin syndrome when ECT is used in patients receiving selective serotonin reuptake inhibitors. There may also be an increased cardiovascular risk during ECT therapy in patients receiving tricyclic antidepressants. Reboxetine is a novel selective noradrenaline reuptake inhibitor, with actions specific to the noradrenergic system and negligible affinity for other neurotransmitter receptors. Here we report two cases in which ECT was used in patients receiving reboxetine. In both cases the episodes of ECT appeared uncomplicated by the concomitant administration of reboxetine. We suggest that the combined use of ECT with reboxetine is well tolerated. Copyright © 1999 John Wiley & Sons, Ltd.     

QT离散度在高血压伴脑出血中的应用研究

目的探讨QT离散度(QTd)在高血压伴脑出血者中的变化及其对预后的价值。方法测量30例高血压伴脑出血者(组I)、34例单纯高血压者(组Ⅱ)及35例健康对照组(组Ⅲ)的QTd及校正后的QT离散度(QTcd),并对各组进行比较分析。结果组ⅠQTd和QTcd较组Ⅱ、组Ⅲ延长(P<0.01),组Ⅱ与组Ⅲ间比较无统计学差异(P>0.05);组Ⅰ中QTd和QTcd在死亡者中较存活者延长(P<0.05),出血部位靠近中轴者QT离散度较长(P<0.05)。结论高血压伴脑出血者QT离散度延长,并可能与预后有关,且可能受出血部位的影响。     

Olanzapine therapy in elderly patients with schizophrenia.

Compared to young adults, elderly individuals with schizophrenia may have a six-fold increase in the prevalence of tardive dyskinesia. The atypical antipsychotic, olanzapine, may offer particular benefit for this population. This is a prospective, open-label trial of olanzapine therapy in elderly schizophrenic patients. Individuals aged 65 years or older with DSM-IV schizophrenia and a history of neuroleptic responsiveness were given olanzapine as an add-on therapy to their existing medication regimen. Other antipsychotic medication was gradually discontinued. Psychopathology was assessed using the Brief Psychiatric Rating Scale (BPRS). Abnormal movements were assessed with the Simpson-Angus Neurological Rating Scale (SA), the Barnes Akathisia Scale (BA), and the Abnormal Involuntary Movement Scale (AIMS). Cognitive status was assessed with the Mini-Mental State Evaluation (MMSE). Twenty-seven individuals received a mean dosage of 8.4 (+/- 4.2) mg/day. Mean age of the group was 70.6 (+/- 4.1) with a range of 65 to 80 years. Patients had a mean of 1.6 (+/- 1.4) significant comorbid medical illnesses. Change in BPRS scores were not significant for the group as a whole, whereas SA score change was substantial, with a pre-treatment mean of 13.7 (+/- 10.3), compared with a mean of 4.8 (+/- 4.1) for those treated with olanzapine (p < .0002). Changes in AIMS and BA score were also significant on olanzapine therapy. MMSE score change was not statistically significant. Comorbid medical illnesses were not adversely affected. Olanzapine is an effective antipsychotic medication in older adults with schizophrenia, and is associated with significant improvement in extrapyramidal side effects. Implications for effect on cognitive status should be explored in larger, long-term trials.     

慢性肺源性心脏病病人QT间期离散度变化

目的 探讨慢性肺源性心脏病病人QT间期离散度的变化。方法 选择本院1999年1月至2002年9月住院病人及同期体检的正常人，分组进行心电图描记，测量QTd、QTc并对比。结果 患病组QTd、QTc延长，与正常对照组比较差异有显著意义。结论 慢性肺心病病人QTd、QTc对预测快速室性心律失常有重要意义，可作为判断预后的客观指标。     

银杏达莫注射液对急性心肌梗死患者冠状动脉再通治疗后QT离散度的影响

目的 观察银杏达莫注射液对急性心肌梗死(AMI)患者冠状动脉再通治疗后QT离散度(QTd)的影响,进一步探讨其临床应用价值.方法 将68例AMI成功接受溶栓或急诊PCI术患者完全随机分为银杏达莫干预组(34例)和常规治疗组(34例),分别在冠状动脉再通治疗前和再通治疗后1、5、10 d做12导联心电图描记,计算QTd.以同期体检健康者68人为正常对照组.结果 AMI患者QTd较正常对照者明显延长[ (76±8) ms比(36±5)ms,P＜0.05].2组患者冠状动脉再通治疗后各时间点QTd较再通治疗前均明显降低[常规治疗组再通治疗后1、5、10 d分别为(56±6)、(58±5)、(46±6)ms比(76±8)ms;银杏达莫干预组分别为(56±7)、(47±5)、(36±4) ms比(77±9 )ms,均P＜0.05].常规治疗组再通治疗后10 d QTd明显低于再通治疗后1、5 d(均P ＜0.05).银杏达莫干预组再通治疗后5dQTd低于再通治疗后1d,再通治疗后10 d低于再通治疗后5d(均P＜0.05).冠状动脉再通治疗后5、10 d,银杏达莫干预组QTd明显低于常规治疗组.结论 银杏达莫注射液可有效降低AMI患者冠状动脉再通治疗后的QTd,有很好的临床应用价值.     

Transdiagnostic modulation of brain networks by electroconvulsive therapy in schizophrenia and major depression

Major depressive disorder (MDD) and schizophrenia (SCZ) share neurobiological and clinical commonalities. Altered functional connectivity of large-scale brain networks has been associated with both disorders. Electroconvulsive therapy (ECT) has proven to be an effective treatment in severe forms of MDD and SCZ. However, the role of ECT on the modulation of the dynamics of brain networks is still unknown. In this study, we used resting state functional magnetic resonance imaging (rs-fMRI) to investigate functional connectivity in 16 pharmacoresistant patients with SCZ or MDD and a matched group of normal controls. Patients were scanned before and after right-sided unilateral ECT. Group spatial independent component analysis was carried out with a multiple analysis of covariance (MANCOVA) approach to estimate the effects of ECT treatment on intrinsic components (INs). Functional network connectivity (FNC) was calculated between pairs of INs. Patients had reduced connectivity within a striato-thalamic network in the thalamus as well as increased low frequency oscillations in a striatal network. ECT reduced low frequency oscillations (LFOs) on a striatal network along with increasing functional connectivity in the medial prefrontal cortex within the DMN. Following ECT treatment, the FNC of the executive network was reduced with the DMN and increased with the salience network, respectively.Our findings suggest transnosological effects of ECT on the connectivity of large-scale networks as well as at the level of their interplay. Furthermore, they support a transnosological approach for the investigation not only of the neural correlates of the disease but also of the brain mechanism of treatment of mental disorders.     

经皮冠状动脉介入治疗对QTd、QTcd的影响

目的研究经皮腔内冠状动脉介入治疗(PCI)对QTd、QTcd的影响。方法38例有一支或多支冠状动脉狭窄达75%以上并行PCI的冠心病患者。术前、术后1天、3天、1周、1个月描记同步十二导联体表心电图。测量QT间期并计算QTd、QTcd。结果QTd、QTcd分别从术前的51.59±20.49和54.83±22.01下降到术后1天、3天、1周、1个月的41.98±18.33、36.94±15.54、40.56±16.54、37.01±13.45和45.54±19.68、39.12±14.75、42.82±16.64、39.14±13.42,术前与术后各时间点比较,差异有显著性(P<0.001),术后各时间点之间差异无显著性(P>0.05)。结论PCI后24小时内至术后1个月QT离散度明显持续降低,反映心肌复极的非均质性得到改善,并可能反映了冠状动脉的持续有效开通。     

急性心肌梗死患者QT间期离散度的临床价值

目的：通过观察急性心肌梗死（AMI）患者QT间期离散度（QTd）变化,探讨其与临床关系。方法：应用体表同步十二导联心电图对60例AMI患者进行入院后第一次心电图QTd和校正QT间期离散度（QTcd)测定,并与50例正常人做对照。结果：（1）AMI患者入院后第一次心电图的QTd、QTcd均明显长于对照组（P＜0．01）。（2）死亡组QTd、QTcd均明显长于生存组（P＜0．01）。（3）室性心律失常组QTd、QTcd明显长非心律失常组（P＜0．01）。（4）心衰组QTd、QTcd亦明显长于非心衰组（P＜0．01）。结论：AMI患者QTd、QTcd明显延长,提示AMI患者心肌存在明显电不稳定和复极的不同步性。其不失为AMI发生心脏事件和猝死简单而实用的重要预测指标。     

急性心肌梗塞溶栓治疗相关动脉再灌注对QT离散度的影响

目的　探讨急性心肌梗塞 (AMI)患者溶栓治疗相关动脉再灌注对 QT离散度 (QTd)的影响。方法　 6 2例 AMI患者分为溶栓再通组、未通组及非溶栓组 ,测量溶栓前后 QTd,并进行比较。结果　 AMI溶栓前溶栓组 (6 5 .6± 13.9) ms与非溶栓组 (6 3.2± 18.2 ) m s QTd 差异无显著性 (P>0 .0 5 ) ,溶栓治疗再通后 ,QTd明显减小。溶栓未通组及非溶栓组 (4 6 .7± 11.6 ) ms、(4 7.5± 13.2 ) ms,显著高于溶栓再通组 (31.4± 9.4) ms,(P<0 .0 1)。伴心室颤动者 QTd(70 .6± 16 .2 ) ms明显高于不伴心室颤动者 (4 7.9± 13.5 ) ms,(P<0 .0 1)。结论　急性心肌梗塞溶栓治疗相关动脉再灌注后 QTd 明显减小 ,心室颤动的发生率降低。     

QT离散度与高血压左室肥厚关系分析

目的:探讨高血压患者左心室肥厚(LVH)与QT离敞度(QT dispersion,QTd)改变的关系.方法:观察组为原发性高血压左室肥厚患者38例,采用12导联心电图同步描记及心脏超声检查等方法做QTd及左心室肥厚,左心室质量检测分析.结果:高血压左心室肥厚组较正常对照组QTd明显增大(P<0.001).结论:原发性高血压左心室肥厚,左心室质量增大可使QTd明显增大,增加了室性心动过速、心室颤动及猝死的危险性.