无症状人群拔牙术前心电图筛查的分析

Analysis of electrocardiogram screening of asymptomatic patients before tooth extraction

目的通过对无症状人群拔牙术前心电图的筛查,发现拔牙患者的潜在风险,探讨无症状人群在拔牙术前筛查心电图的必要性。方法收集2014年1月至2015年12月首都医科大学附属北京友谊医院的门诊拔牙无心脏病症状患者,采用随机数字表法分为术前进行心电图(electrocardiogram,ECG)检查组(以下简称ECG组)和不做心电图的对照组。ECG组共1 158例患者,对照组共1 230例。本研究记录并分析ECG组的异常心电图结果;同时对比两组患者在拔牙术中术后出现全身不适的发生率,并且对比其术后心电图异常的发生情况。结果在1 158例ECG组中共发现201例(17.36%)患者心电图有异常,其中40例为拔牙高风险心电图,建议患者去心内科进行进一步检查明确心脏病诊断后再酌情拔牙。ECG组患者发生拔牙术中术后全身不适的有6例(0.54%),而对照组为37例(3.01%),两组对比差异有统计学意义(P<0.001)。对比两组术中术后不适患者术后心电图,发现ECG组未见高风险心电图,而对照组有28例为高风险心电图,两组差异有统计学意义(P=0.002)。结论对于无症状人群的拔牙术前心电图筛查,能有效检出拔牙潜在的心脏病高风险患者,减少了拔牙术中术后全身不适情况的发生,提高了拔牙手术患者的安全性,建议作为常规术前检查。

Objective To evaluate the potential risk of cardiac disease and explore the necessity of electrocardiogram（ ECG）screening for asymptomatic patients before tooth extraction. Methods Adult patients before tooth extraction were recruited in the Department of Stomatology in Beijing Friendship Hospital,Capital Medical University from January 2014 to December 2015. All the patients were randomly divided into two groups,patients screened by electrocardiogram（ ECG group） or not（ control） before tooth extraction. The occurrence of systemic complication and the occurrence of abnormal ECG in patients of two groups after tooth extraction was observed and compared. Results Totally 2 388 patients were selected in the study. There were 1 158 cases in ECG group and 1 230 in control. In ECG group,there were 201 patients（ 17. 36%） with abnormal ECG. In the abnormal ECG cases,40 patients were regarded as having severe high risk of cardiac disease,and were not recommended for tooth extraction. There were 6 cases（ 0. 54%） and37 cases（ 3. 01%） of systemic complication respectively in ECG group and control group after tooth extraction. The difference between the two groups was statistically significant（ P〈 0. 001）. In 28 patients of the 37 cases in control group high risk ECG was found,while the ECG examination of all cases in ECG group was normal. Conclusion ECG screening is necessary for asymptomatic patients before tooth extraction,and is effective to detect potential heart disease of high risk in tooth extraction patients,which might reduce the systemic complication and improve the safety during dental operation.