牙科局部麻醉對病人心血管系統影響之評估研究

Cardiovascular Effect Following Dental Local Anesthesia

廖湄蓉(Fanny Liliani)

指導教授 ： 楊博正 ； 林俊彬 ； 郭英雄

國立臺灣大學/醫學院/臨床牙醫學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01040

摘要

中文摘要

臨床牙科當中經常使用局部麻醉劑，牙科局部麻醉劑使得牙科治療得較容易，並使得部分原本用於患者可能造成疼痛的臨床步驟可以較平順地操作。本研究欲發現包含不同濃度的腎上腺素的局部麻醉劑在注射期間即注射之後的生理變化，並檢視其於具有潛在疾病之患者的安全性。我們自92年八月份到93年二月份間，隨機選取在台大醫院在局部麻醉下欲接受拔牙的患者計203位。所有的患者接填寫手術及麻醉同意書，並回答Corah's Dental Anxiety Scale問卷藉以評估其焦慮程度。
在麻醉前、中、後，分別監控脈搏、血壓、心電圖、血氧濃度，然後依據病患過去的病史、注射方式、Corah's焦慮程度、局部麻醉劑種類，四項指標來歸類。
結果顯示，高血壓的患者以及高度焦慮的患者，對腎上腺素的反應較劇。Corah's焦慮程度平均值為9.3(±2.5)，女性較男性對牙科治療有較高的焦慮，而較年輕對牙科治療有較高的焦慮。浸潤式局部麻醉會造成脈搏上升，而後上齒和下顎阻斷麻醉會造成脈搏下降，但彼此差異並不顯著。本研究中，注射進入血管比率為3％，大部分是發生在下顎阻斷麻醉，而在整個過程中，這些患者並未顯現有不良反應。在整個過程當中，心電圖主要變化為心搏過速。
由上述發現我們可獲下列之結論：依本研究之注射方式，牙科局部麻醉不論是一般受試者、或是有潛在疾病者均相當安全。因此使用含有腎上腺素的牙科局部麻醉劑來達到適當的麻醉深度，在臨床上是可行且安全的。

關鍵字

心血管系統 ； 牙科局部麻醉

並列摘要

ABSTRACT

Local anesthetics are frequently used in dentistry. Its use makes the dental therapy easier and allows reassurance of patient to whom some painful techniques will be applied. This study attempted to examine the physiological changes during and after injection of local anesthetics containing different concentrations of epinephrine, and to evaluate the safety of local anesthetics with epinephrine for patients with underlying diseases. Two hundred and three patients who came to NTUH for dental extraction under local anesthesia were chosen randomly. Informed consent was given and questionnaire was obtained for patients’ psychologic response to dental treatment. Anxiety was measured by using Corah’s Dental Anxiety Scale, which has been translated into local language. Pulse rate, blood pressure, electrocardiograms, O2 saturation and symptoms are monitored before, during and after the local anesthesia. Then we distribute the data into several criteria to observe: according to the subjects’ past medical history, type of injection, Corah’s DAS, and type of local anesthesia solution that we employed. Hypertensive subjects and subjects with severe dental anxiety are hyperreactors to epinephrine. The mean DAS score were 9.3 (± 2.5), female appeared to have a higher dental anxiety level than male. Patients with a high score were younger than those with a low score. Infiltration anesthesia were produced an increased in heart rate, while PSA and mandibular block produced a reduction in heart rate, but these findings were insignificant. In this study, overall incidences of positive aspirations were 3%, and most of the incidences were occurred when giving the mandibular block anesthesia. .None adverse events had shown up on those subjects in this study during the entire procedure, even in the subjects with positive aspiration. It seems that the tachycardia were the main EKG changes during the entire procedure. We concluded that limited dental anesthetics with epinephrine were well tolerated by the subjects in our study, even those with underlying diseases. Therefore, a local anesthetic with epinephrine may be selected to obtain adequate levels of anesthesia.

並列關鍵字

Local anesthesia ； cardiovascular response

參考文獻

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