摘要： 目的：探讨围术期监测麻醉（montiored anesthetic care, MAC）对颌面外科手术患者围术期焦虑及疼痛程度的影响，以评价该技术在此类手术治疗中的价值。方法：颌面外科手术患者160例，随机分成局部麻醉组（LA组）和监测麻醉组（MAC组）各80例。预约手术后即刻让2组患者填写贝克焦虑量表，测定为预约后焦虑值；然后对2组患者均进行常规术前宣教和术前访谈，分别于术前30 min、术后30 min、术后第1天及术后第2天均进行一次焦虑值测评，并记录2组患者术后24 h后疼痛分级情况。结果：2组患者一般情况的比较差异无统计学意义（P＞0.05）。组内不同时间点比较，LA组术前30 min和术后第2天，相比预约手术时的焦虑值明显降低；MAC组术前30 min、术后30 min、术后第1天及术后第2天，均比预约手术时的焦虑值明显降低（P＜0.05）。LA组与MAC组行组间比较，在术后30 min、术后第1天时LA组焦虑值明显升高（P＜ 0.05）；MAC组较LA组患者术后疼痛明显减轻，差异有统计学意义（P＜0.05）。结论：MAC能明显减轻颌面外科手术患者围术期焦虑及术后疼痛程度，利于手术的顺利进行和术后的恢复。

关键词: 监测麻醉, 焦虑, 镇痛, 颌面部手术

Abstract:  Objective: This study aimed to determine effectiveness and efficiency of monitored anesthetic care (MAC) in the reduction of peri-operative anxiety and pain levels in oral and maxillofacial surgery. Methods: 160 facial surgery patients were recruited and randomly divided into two groups: MAC group (n=80), comparison group (n=80) in which local anesthesia were selected for oral surgery.   A subjective clinical assessment was carried out following discussion with, and observation of, each patient. A valid questionnaire of Beck Anxiety Scale was used to assess general anxiety and dental anxiety in each patient which completed at days prior to, and on the day 30 min before treatment, as well as 30 min, 1 day, and 2 days after treatment. Further more, these two groups of patients were scored at 24 hours after surgery according to pain grade. The data were entered into SPSS for Windows 13.0. Means of different groups were compared by one-way ANOVA .P<0.05 was considered significant. Results: There was no statistically significant (P>0.05) on the general conditions between these two groups of patients. In MAC group, anxiety values in 30 min before surgery, 30 min, 1d, and 2d after surgery were significantly lower than that of making the operation appointment. As in comparison group，significance were only manifested at two time points: 30 min before surgery and 2d after surgery.  At the time point of 30 min, and 1d after surgery, anxiety values in comparison group were significantly higher than MAC group. Postoperative pain was significantly reduced in MAC group compared with comparison group, the difference was significant (P<0.05). Conclusion: MAC may  act beneficial role in phobic dental patients for oral and maxillofacial surgery.

Key words: monitored anesthesia care, anxiety, analgesic, facial surgery

中图分类号: 

• R782.054