摘要：
目的： 探讨无痛技术在心血管疾病（cardiovascular disease, CVD）患者心电监护下拔牙中的应用效果，并观察拔牙围手术期患者血压、心率的变化。方法： 选取600例CVD患者在心电监护下拔牙，将患者随机分为观察组和对照组，每组各300例。观察组采用表面麻醉+STA无痛麻醉仪黏膜下局部浸润麻醉，将患者对照组采用手动黏膜局部下浸润麻醉。应用疼痛视觉模拟评分表（visual analogue scale，VAS）和改良牙科焦虑量表 （modified dental anxiety scale，MDAS）分析患者麻醉前后疼痛和焦虑情况，并比较麻醉前，拔牙术中、术后患者的血压及心率变化。结果： 600例患者均顺利完成心电监护下拔牙手术。两组之间的麻醉效果无统计学差异（P>0.05）。麻醉注射时，观察组VAS评分较对照组低（P<0.05）；麻醉注射前，两组MDAS评分差异无明显统计学意义（P>0.05），而麻醉注射后，观察组MDAS评分明显低于对照组（P<0.05）。麻醉前，两组患者的收缩压、舒张压及心率差异无明显统计学意义（P>0.05）；对照组较观察组患者术中的收缩压、舒张压及心率明显升高，差异有统计学意义（P<0.05）；对照组患者术后收缩压、舒张压及心率较术中显著下降，与观察组患者的差异无统计学意义（P>0.05）。结论： CVD患者拔牙风险高，心电监护拔牙配合无痛技术可明显缓解患者的疼痛及焦虑情绪，有效控制患者的血压及心率波动，提高患者的配合度，值得推广。
关键词:
心血管疾病患者,
心电监护,
无痛麻醉,
拔牙
Abstract:
Objective: To explore the effect of painless technology during tooth extraction in patients with cardiovascular disease（CVD） under electrocardiogram(ECG) monitoring, and observe the changes in blood pressure and heart rate of patients during the perioperative period of tooth extraction. Methods: 600 patients with CVD to extract their teeth under ECG monitoring were randomly divided into observation group and control group，300 cases in each group. The observation group was treated with topical anesthesia + STA local submucosal infiltration painless anesthesia while the control group was treated with traditional local anesthesia for exodontia. The pain visual analogue scale (VAS) and modified dental anxiety scale (MDAS) were used to analyze the patient′s pain and anxiety before and after anesthesia, and the changes in blood pressure and heart rate before anesthesia, during and after tooth extraction were recorded and compared. Results: All 600 patients successfully completed the tooth extraction surgery under ECG monitoring. There was no significant difference in the anesthetic effect between the two groups(P>0.05). The VAS score showed that the observation group was significantly lower than the control group at the time of anesthesia injection (P<0.05). There was no significant difference in MDAS score between the two groups(P>0.05), before anesthesia injection, while the MDAS score of the observation group was significantly lower than that of the control group after anesthesia injection (P<0.05). Before anesthesia, there was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the observation group and the control group (P>0.05). The systolic blood pressure, diastolic blood pressure and heart rate of the control group during operation were significantly higher than those of the observation group. The difference was statistically significant(P<0.05). After operation, the systolic blood pressure, diastolic blood pressure and heart rate of the control group were significantly lower than those of the intraoperative patients. There was no significant difference in the systolic blood pressure, diastolic blood pressure and heart rate between the observation group and control group (P>0.05). Conclusion: Patients with CVD have high risk during tooth extraction. ECG monitoring combined with painless technology can significantly relieve pain and anxiety of patients, effectively control the fluctuations of blood pressure and heart rate, and improve the cooperation of patients. It is worth of promotion.
Key words:
cardiovascular disease patients,
electrocardiogram monitoring,
painless anesthesia,
tooth extraction
中图分类号:
管其帅, 陈子强, 黄国倩, 李大鲁, 杨世茂. 无痛技术在心血管疾病患者心电监护下拔牙中的应用效果评价[J]. 《口腔颌面外科杂志》, 2020, 30(5): 320-323.
GUAN Qishuai, CHEN Ziqiang, HUANG Guoqian, LI Dalu, YANG Shimao. Outcome of Painless Technology in Exodontia of Patients with Cardiovascular Disease under Electrocardiogram Monitoring[J]. 《Journal of Oral and Maxillofacial Surgery》, 2020, 30(5): 320-323.