174例冠状动脉旁路移植术后患者心电监护下拔牙的临床观察  

Clinical evaluation of cardiovascular influence of tooth extraction in patients after coronary artery bypass graft operation under electrocardiographic monitoring

作　　者：项天庆[1] 段向青[1] 宣玮[1] 余兰[1] 吕亚林[1] 

机构地区：[1]首都医科大学附属北京安贞医院口腔科,主治医师北京100029

出　　处：《中华老年口腔医学杂志》2015年第2期92-96,共5页Chinese Journal of Geriatric Dentistry

基　　金：首都特色临床应用研究项目(项目编号:Z121107001012026)

摘　　要：目的:评估拔牙手术对冠状动脉旁路移植(CABG)术后患者心血管系统的影响。方法:174例冠状动脉旁路移植术后患者复方阿替卡因注射液(必兰)局部麻醉,心电监护下拔除患牙,记录静息状态下(T0)、麻药注射过程中(T1)、麻药注射后5min(T2)、拔牙术中(T3)及拔牙术后5min(T4)收缩压、舒张压、心率等血流动力学参数、心电图变化和患者症状体征,计算心率一收缩压乘积(RPP)和平均动脉压心率商(PRQ)。结果:160例患者完成拔牙手术,14例患者因收缩压持续升高、频发室性早搏、心绞痛等原因终止拔牙手术。结论:大多数基础病变控制良好的CABG术后患者可以在心电监护下完成拔牙手术。Objective：To evaluate the safety of tooth extraction in patients after coronary artery bypass graft （CABG） operation under local anesthesia with 4% articaine hydrochloride with 1∶100000 epinephrine.Methods：A total of 174 patients requiring tooth extraction under local infiltration anesthesia or nerve block anesthesia with 1-3 capsules of articaine were enrolled in this study. The following hemodynamic parameters were observed during the operation at 5 different moments： systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, the electrocardiogram changes, rate pressure product（RPP）, pressure rate quotient（RPQ） and the symptoms were also involved in estimation.Results：160 patients completed the operation and 14 patients were dropped due to elevated blood pressure, arrhythmia, chest pain, et al. SBP was increased significantly during injection of anesthetic solution （P=0.038） and tooth extraction （P=0.012）; RPP was also ascended significantly during tooth extraction（P=0.025）. No statistical changes were observed with DBP, HR and RPQ at any different moments.Conclusion：Most patients after CABG could finish tooth extraction under electrocardiographic monitoring; the procedure was safe by means of careful preparation and gentle performance.

关 键 词：冠状动脉旁路移植 心电监护 拔牙 阿替卡因 

分 类 号：R654.2[医药卫生—外科学] R782.11[医药卫生—临床医学]