氧化亚氮吸入镇静对老年高血压病患者拔牙术中心率和血压及焦虑的影响

The effect of nitrous oxide inhalation sedation on elderly patients with hypertension during tooth extraction

目的 评价氧化亚氮吸入联合局部麻醉对老年高血压病患者拔牙术中心率和血压及焦虑的影响.方法 选取2011年5月至2013年5月来北京老年医院口腔科就诊的老年高血压病患者共340例.完全随机分为观察组与对照组,各170例.观察组在氧化亚氮加局部麻醉下拔牙;对照组仅在局部麻醉下拔牙.监测并记录患者在术前就诊安静时（T1）、给予麻醉时（T2）、拔除患牙即刻（T3）及术后10 min（T4）时的心率、血压值;记录治疗前后改良牙科焦虑量表（MDAS）测得的牙科焦虑评分.结果 观察组169例顺利完成拔牙,手术全过程血压、心率维持平稳.1例因为吸入氧化亚氮2 min后出现烦躁、身体运动加剧,不能配合而停止治疗.对照组166例顺利完成拔牙,4例因为血压短时间内急剧升高,收缩压≥185 mmHg（1 mmHg=0.133 kPa）或者舒张压≥125 mmHg,放弃拔牙.观察组T1、T2、T3、T4时心率分别为（78±9）、（78±10）、（74±6）、（75±4）次/min;T1、T2、T3、T4时收缩压分别为（136±10）、（134±8）、（135±8）、（130±7）mmHg;T1、T2、T3、T4时舒张压分别为（86 ±4）、（85 ±6）、（87 ±8）、（86±6） mmHg.观察组在拔牙过程中T3、T4时间点心率低于T1时（P＜0.05）,T4时收缩压低于T1时（P＜0.05）,其余未见明显改变.对照组T1、T2、T3、T4时心率分别为（76 ±4）、（85±6）、（88±5）、（79±5）次/min;T1、T2、T3、T4时收缩压分别为（138±8）、（142±6）、（155 ±6）、（144±8）mmHg;T1、T2、T3、T4时舒张压分别为（84±2）、（86±4）、（87±5）、（84±2）mmHg.对照组在拔牙过程中T2、T3、T4时间点心率高于T1时间点,差异有统计学意义（均P＜0.01）,在T3、T4时间点收缩压高于T1时间点,差异有统计学意义（P＜0.01或P＜0.05）,在T3时间点舒张压高于T1时间点,差异有统计学意义（P＜0.05）.在T2、T3、T4时间点对照组收缩压高于对照组,差异有统计学意义（P＜0.01或P＜0.05）;T3时间点心率大于对照组（P＜0.05）.其余各项差异无统计学意义.结论 氧化亚氮吸入清醒镇静法具有良好的抗焦虑、镇静作用,对于老年高血压病患者是一种比较安全有效的拔牙辅助方法.

Objective To evaluate the effect of nitrous oxide inhalation sedation on elderly patients with hypertension during tooth extraction.Methods Totally 340 elderly hypertensive patients were divided into two groups：experimental group and control group from May 2011 to May 2013.The experimental group was treated with oxide inhalation sedation and local anesthesia.The control group was treated with local anesthesia.The modified dental anxiety scale（MDAS） scores were measured before and after treatment.Heart rate and blood pressure were recorded at different time：T1 （after five minutes quiet in the operative room） ; T2 （anesthesia） ; T3 （tooth extraction completed） ; T4 （10 minutes after operation）.Results All 169 cases were successfully completed in the experimental group.One patient was excluded from study because of dysphoria after inhaling nitrous oxide.166 cases were completed in control group.Four patients failed because of a sharp increase in blood pressure in a short time （SBP≥185 mmHg or DBP≥125 mmHg）.The heart rate in the experimental group was （78 ±9）,（78 ± 10）,（74±6）,（75 ±4）bpm at T1,T2,T3,T4.The SBP and DBP at T1,T2,T3,T4 was （136± 10）,（134 ± 8）,（135 ± 8）,（130 ± 7） mmHg and （86 ± 4）,（85 ± 6）,（87 ± 8）,（86 ± 6） mmHg,respectively.Compared with T1,the heart rate and SBP decreased at the time point of T3,T4 and T4 respectively in the experimental group （P〈0.05）.The heart rate,SBPand DBP in the control group were （76±4）,（85±6）,（88±5）,（79± 5）bpm; （138±8）,（142±6）,（155±6）,（144±8） mmHg; （84±2）,（86±4）,（87±5）,（84± 2） mmHg at T1,T2,T3,T4.Compared with T1,the heart rate increased at the time point of T2,T3,T4 （P 〈0.05）.The SBP and DBP were significantly higher at the time point of T3,T4 and T3 respectively in the control group （P 〈 0.05）.The SBP at T2,T3,T4 and the heart rate at T3 in the experimental group was higher than in the control group.Conclusions The nitrous oxide inhalation sedation is effective to alleviate anxiety.It can be a safe and effective auxiliary approach in elderly patients with hypertension undergoing tooth extraction.