伴牙科焦虑症的心血管病患者阿替卡因麻醉拔牙的临床观察

Clinical observation of cardiovascular patients associated with dental anxiety during tooth extraction by anesthesia with articaine

目的研究阿替卡因麻醉对伴有牙科焦虑症的心血管病患者拔牙时心率及血压增幅的变化,为其安全拔牙提供参考。方法采用改良的牙科焦虑量表(DAS),筛选出需要拔牙的152例伴有牙科焦虑症的心血管病患者,随机分为含微量肾上腺素的阿替卡因麻醉实验组和盐酸利多卡因麻醉对照组,通过心电监护仪全程监测,观察拔牙过程中的血压、心率数值变化,并对数据进行统计学分析。结果 2组患者均顺利完成手术;在麻醉时和拔牙时,实验组收缩压、舒张压和心率明显高于对照组,且差异有统计学意义(P<0.01);在麻醉前、拔牙后,实验组与对照组收缩压、舒张压和心率的差异无统计学意义(P>0.05)。结论对伴有牙科焦虑症的心血管病患者使用复方阿替卡因麻醉下拔牙具有较高的风险性,必须严密监测麻醉时和拔牙时血压、心率的变化,以防心脑血管意外发生。

Objective To evaluate the safety of articaine in cardiovascular patients with dental anxiety （DA） during tooth extraction according to the change of heart rate and blood pressure. Methods 152 cardiovascular patients with dental anxiety requiring tooth ex- traction were selected by Modified Dental Anxiety Scale （DAS）, and they were randomly divided into artieaine infiltrate-anesthesia group and lidocaine block-anesthesia group. The blood pressure （BP） and heart rate （HR） were monitored by electrocardiogram moni- tor in the whole process of extraction,and then the differences of BP and HR between two groups were analyzed statistically. Results Tooth extraction in all patients was successfully completed. In the articaine group, systolic blood pressure, diastolic blood pressure and heart rate were significantly higher during anesthesia and tooth extraction than those of lidocaine group（ P 〈 0.01 ） ; The BP and HA in the articaine group showed no statistically significant difference from the data of lidocaine group before anesthesia and after tooth extrac- tion （P 〉 0.05 ）. Conclusions In order to prevent cardiovascular and cerebrovascular accidents,articaine should be highly cautiously used in cardiovascular patients associated with dental anxiety during tooth extraction.