摘要目的:探讨无抽搐电休克联合丙戊酸钠缓释片对双相情感障碍躁狂发作患者认知功能及预后的影响。方法:选择2016年1月至2019年1月绍兴市第七人民医院收治的躁狂发作的双相情感障碍患者100例为研究对象，按照随机数字表法将100例患者分为联合组(50例)和对照组(50例)。对照组患者口服丙戊酸钠缓释片，联合组患者则联合无抽搐电休克进行治疗。观察、比较两组患者的精神状况、认知功能以及预后情况等。结果:两组治疗前的简明精神病评定量表(BPRS)、Bech-Rafaelsen躁狂量表(BRMS)评分差异均无统计学意义(均 P>0.05)；联合组治疗4周后的BPRS、BRMS评分分别为(19.18±3.16)分、(6.16±2.71)分，均明显低于对照组的(22.23±3.73)分、(8.23±3.03)分，差异均有统计学意义( t＝4.411、3.600， P＝0.000、0.000)；治疗4周后，联合组的完成分类数为(3.23±0.58)，明显高于对照组的(3.23±0.58)，错误应答数、持续应答数和持续错误数分别为(31.49±8.18)、(21.66±7.48)、(10.47±2.88)，均明显低于对照组的(43.26±10.32)、(26.41±9.16)、(15.12±3.43)，差异均有统计学意义( t＝5.029、6.320、2.840、7.341， P＝0.000、0.000、0.005、0.000)；联合组韦氏成人智力量表评分中的言语智商、操作智商、智商评分分别为(108.81±13.66)分、(107.41±15.23)分、(109.71±16.23)分，均明显高于对照组的(101.55±10.08)分、(100.94±13.78)分、(102.48±14.64)分，差异均有统计学意义( t＝3.023、2.229、2.339， P＝0.、0.028、0.021)；联合组韦氏记忆量表评分中长时记忆、短时记忆、瞬时记忆、记忆商数分别为(41.55±6.12)分、(58.16±7.16)分、(13.55±2.71)分、(104.46±11.69)分，均明显高于对照组的(38.23±5.28)分、(49.11±5.31)分、(12.06±2.19)分、(98.71±9.51)分，差异均有统计学意义( t＝2.904、7.178、3.023、2.698， P＝0.004、0.000、0.003、0.008)；联合组患者的起效时间、约束时间、住院时间分别为(16.44±5.06)d、(30.71±9.27)h、(49.54±9.28)d，均明显短于对照组的(16.44±5.06)d、(30.71±9.27)h、(33.48±7.12)d，联合组约束、复发次数分别为(3.21±0.84)次、(3.03±0.76)次，均明显少于对照组的(1.36±0.49)次、(1.22±0.41)次，联合组住院费用为(6 155.79±678.11)元，明显低于对照组的(4 162.48±513.48)元)，差异均有统计学意义( t＝7.341、4.529、9.708、13.451、14.821、16.570，均 P＝0.000)。 结论:无抽搐电休克联合丙戊酸钠缓释片在治疗双相情感障碍躁狂发作上效果优于单一丙戊酸钠，可显著改善其精神状况及认知功能，能够有效促进患者快速恢复，缩短住院时间，减少住院费用。

abstractsObjective:To explore the effects of non-convulsive electroconvulsive therapy combined with sodium valproate sustained-release tablets on cognitive function and prognosis of bipolar disorder patients with manic episode.Methods:From January 2016 to January 2019, 100 patients with bipolar disorder manic episode admitted to the Seventh People's Hospital of Shaoxing were studied.According to the random number table method, 100 patients were divided into combined group (50 cases) and control group (50 cases). The patients in the control group were treated with valproate sustained-release tablets, and the patients in the combined group were treated with valproate sustained-release tablets combined with convulsive-free electroconvulsive therapy.The mental status, cognitive function and prognosis of the two groups were observed and compared.Results:There were no statistically significant differences in the scores of Brief Psychiatric Rating Scale(BPRS), Bech-Rafaelsen mania scale(BRMS) between the two groups before treatment (all P>0.05). The scores of BPRS and BRMS in the combined group after 4 weeks of treatment were (19.18±3.16)points, (6.16±2.71)points, respectively, which were significantly lower than those in the control group [(22.23±3.73)points, (8.23±3.03)points] ( t=4.411, 3.600, P=0.000, 0.000). After 4 weeks of treatment, the number of completed classification in the combined group was (3.23±0.58), which was significantly higher than that in the control group (3.23±0.58), and the number of errors, persistent responses and persistent errors in the combined group were (31.49±8.18), (21.66±7.48), (10.47±2.88), which were significantly lower than those in the control group[(43.26±10.32), (26.41±9.16), (15.12±3.43)], the differences were statistically significant ( t=5.029, 6.320, 2.840, 7.341, P=0.000, 0.000, 0.005, 0.000). The verbal intelligence quotient, operational intelligence quotient and IQ score of WAIS-RC scale in the combined group were (108.81±13.66)points, (107.41±15.23)points, (109.71±16.23)points, respectively, which were significantly higher than those in the control group [(101.55±10.08)points, (100.94±13.78)points, (102.48±14.64)points], the differences were statistically significant( t=3.023, 2.229, 2.339, P=0.003, 0.028, 0.021). The long-term memory, short-term memory, instantaneous memory and memory quotient in WMS scale scores of the combined group were (41.55±6.12)points, (58.16±7.16)points, (13.55±2.71)points, (104.46±11.69)points, respectively, which were significantly higher than those in the control group [(38.23±5.28)points, (49.11±5.31)points, (12.06±2.19)points, (98.71±9.51)points], the differences were statistically significant ( t=2.904, 7.178, 3.023, 2.698, P=0.004, 0.000, 0.003, 0.008). The onset time, restraint time and hospitalization time of the combined group were (16.44±5.06)d, (30.71±9.27)h, (49.54±9.28)d, respectively, which were significantly shorter than those of the control group [(16.44±5.06)d, (30.71±9.27)h, (33.48±7.12)d], the restraint times and recurrence times of the combined group were (3.21±0.84)times, (3.03±0.76)times, respectively, which were significantly less than those of the control group [(1.36±0.49)times, (1.22±0.41)times], and the hospitalization expense of the combined group was (6 155.79±678.11)CNY, which was significantly lower than that of the control group [(4 162.48±513.48)CNY], the differences were statistically significant ( t=7.341, 4.529, 9.708, 13.451, 14.821, 16.570, P=0.000). Conclusion:Non-convulsive electroconvulsive therapy combined with sodium valproate sustained-release tablets is superior to sodium valproate alone in the treatment of bipolar disorder manic episode.And it can significantly improve the mental status and cognitive function, promote the rapid recovery, shorten hospitalization time and reduce hospitalization cost.It is worthy of promotion in clinical practice.