咪达唑仑联合丙泊酚靶控输注静脉镇静对拔除下颌第三磨牙患者焦虑水平的影响  

Intravenous sedation with midazolam and propofol target controlled infusion on patients' perioperative anxiety under the mandibular third molar extraction

作　　者：王天骄 刘宇[1] 关明[1] 

机构地区：[1]北京大学口腔医学院.口腔医院口腔颌面外科口腔数字化医疗技术和材料国家工程实验室口腔数字医学北京市重点实验室,北京100081

出　　处：《北京大学学报（医学版）》2017年第6期1044-1049,共6页Journal of Peking University:Health Sciences

摘　　要：目的:研究咪达唑仑联合丙泊酚靶控输注(target controlled infusion,TCI)静脉镇静对拔除下颌第三磨牙患者在围手术期焦虑水平的影响。方法:选择北京大学口腔医院拔除下颌阻生第三磨牙,在初次就诊时状态焦虑量表(state anxiety inventory,SAI)得分≥38分的患者,根据是否于静脉镇静下拔牙分为静脉镇静+局部麻醉组(intravenous sedation,IVS)和局部麻醉组(local anesthesia,LA)。每组患者再根据初次就诊时的SAI评分分为两个亚组:IVS-Ⅰ、LA-Ⅰ(SAI得分38~50)和IVS-Ⅱ、LA-Ⅱ(SAI得分51~80)。根据患者在初诊(T1)、手术前(T2)和手术后7 d(T3)时SAI评分,评价患者在手术前后的焦虑情况。通过观察患者术中的心率、血压和疼痛视觉模拟评分(visual analogue scale,VAS)评价患者手术中的焦虑情况。结果:IVS组和LA组在T1、T2、T3时的SAI评分差异无统计学意义(P>0.05),IVS组在术中的心率、血压和VAS疼痛评分显著低于LA组(P<0.001)。结论:咪达唑仑联合丙泊酚靶控输注静脉镇静可以显著降低拔除下颌第三磨牙患者术中的焦虑,提高手术的舒适性,使心率、血压、血氧饱和度维持在正常水平。但对比两组患者的SAI评分发现,静脉镇静对初诊(T1)、手术前(T2)、手术后7d(T3)的焦虑水平无明显影响。Objective： To evaluate whether midazolam with propofol target controlled infusion（ TCI）intravenous sedation during the mandibular third molar extraction influences patients＇ perioperative anxiety. Methods： The subjects were patients who planned to undergo the mandibular third molar extraction in Peking University School and Hospital of Stomatology,whose state anxiety inventory（ SAI） scores were≥38 at the initial visit. They were divided into intravenous sedation group（ IVS） and local anesthesia group（ LA） on the basis of the planned intravenous sedation. Each group was divided into two subgroups according to the overall SAI scores at the initial visit： IVS-Ⅰ,LA-Ⅰ（ SAI： 38-50） and IVS-Ⅱ,LA-Ⅱ（ SAI： 51-80）. The anxiety before and after the surgery was evaluated by the SAI scores at the initial visit（ T1）,before surgery（ T2） and 7 days after surgery（ T3）. The anxiety during the surgery was evaluated by the heart rate,blood pressure and visual analogue scale（ VAS） scores. Results： There were no significant differences on SAI at T1,T2,and T3 in the two groups（ P 〈 0. 05）. The heart rate,blood pressure and VAS pain scores of IVS group were significantly lower than those of LA group during the surgery（ P 〈 0. 001）. Conclusion： Intravenous sedation with midazolam and propofol TCI was effective on the patients＇ anxiety during the third molar extraction,which successfully made the patients more comfortable and their heart rate,blood pressure and oxygen saturation more stable during the surgery. But there were no significant differences on the patients ＇anxiety at the initial visit（ T1）,before surgery（ T2） and 7 days after surgery（ T3） according to the SAI scores in the two groups.

关 键 词：清醒镇静 麻醉 静脉 焦虑 磨牙 第三 拔牙 

分 类 号：R614.24[医药卫生—麻醉学]