Alemany-Martínez Aurelia, Valmaseda-Castellón Eduard, Berini-Aytés Leonardo, Gay-Escoda Cosme
School of Dentistry, University of Barcelona, Barcelona, Spain.
J Oral Maxillofac Surg. 2008 Mar;66(3):453-61. doi: 10.1016/j.joms.2007.06.634.
This study was conducted to determine the hemodynamic changes in healthy patients during the surgical removal of lower third molars, and to evaluate whether these variations are attributable to patient anxiety and pain experienced during the surgical procedure.
A prospective study was made of 80 normotensive individuals (40 females and 40 males, mean age, 27 years [range, 18 to 67 years]) seen in the Service of Oral Surgery in the context of the Master's Degree Program in Oral Surgery and Implantology, School of Dentistry, University of Barcelona, for surgical extraction of the lower third molars. Local anesthesia comprised 4% articaine with vasoconstrictor (adrenalin 1:100.000). The following parameters were monitored in each of the surgical interventions: systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SaO(2)). Finally, tests of patient anxiety (Corah's Dental Anxiety Scale and Kleinknecht's Dental Fear Scale) were carried out, and the degree of pain experienced during the surgical procedure was assessed by means of a visual analog scale.
The females showed higher levels of anxiety. The most anxious patients had the lowest BP values and the highest HR, although the differences did not reach statistical significance. The variations in BP and HR during surgical extraction of the molars were within normal limits. In the case of BP, no significant changes were recorded; the highest mean SBP and DBP values were observed at the time of ostectomy and/or tooth sectioning. The lowest HR values were recorded at baseline, before the start of the surgical procedure, whereas the highest values were obtained during incision and flap raising. The SaO(2) values showed no significant changes and were lower at the start of the surgical procedure.
Most of the cardiovascular changes induced by the surgical extraction of molars were within normal ranges, considering the anxiety and stress induced by surgery. We consider it essential to avoid pain and minimize patient anxiety to ensure safe clinical practice.
本研究旨在确定健康患者在拔除下颌第三磨牙手术过程中的血流动力学变化，并评估这些变化是否归因于手术过程中患者的焦虑和疼痛。
对巴塞罗那大学牙科学院口腔外科与种植硕士学位项目中的80名血压正常个体（40名女性和40名男性，平均年龄27岁[范围18至67岁]）进行前瞻性研究，这些患者因下颌第三磨牙手术拔除而就诊于口腔外科。局部麻醉采用含血管收缩剂（肾上腺素1:100,000）的4%阿替卡因。在每次手术干预中监测以下参数：收缩压（SBP）、舒张压（DBP）、心率（HR）和血氧饱和度（SaO₂）。最后，进行患者焦虑测试（科拉牙科焦虑量表和克莱因克内希特牙科恐惧量表），并通过视觉模拟量表评估手术过程中经历的疼痛程度。
女性表现出更高水平的焦虑。最焦虑的患者血压值最低，心率最高，尽管差异未达到统计学意义。磨牙手术拔除过程中血压和心率的变化在正常范围内。就血压而言，未记录到显著变化；在骨切开术和/或牙齿分割时观察到最高的平均收缩压和舒张压值。最低心率值记录在手术开始前的基线，而最高值在切开和掀起皮瓣时获得。血氧饱和度值无显著变化，且在手术开始时较低。
考虑到手术引起的焦虑和压力，磨牙手术拔除引起的大多数心血管变化在正常范围内。我们认为避免疼痛并尽量减少患者焦虑对于确保安全的临床实践至关重要。
