Shirakawa T, Noe Y, Oikawa T, Shinoguchi K, Oguchi H
Department of Pediatric Dentistry, Hokkaido University, School of Dentistry.
Shoni Shikagaku Zasshi. 1990;28(4):1056-65.
Children with congenital heart disease (CHD) are prone to present abrupt changes in cardiovascular functions which cause hypoxic spells or acute heart failure, so that oxygen monitoring during dental treatment is of great importance in cyanotic CHD patients. Monitoring of arterial oxygen saturation (SpO2) by pulse oximetry has several advantages, including rapid response time, freedom from skin injury, self-calibration and continuous readout of the SpO2 value. In these studies, SpO2 was measured in 68 pediatric patients (55 were CHD children and 13 were normal children) during dental treatment at the Pediatric Dentistry, Hokkaido University Dental Hospital. In all of the normal patients, SpO2 did not desaturate less than 95%. On the other hand, SpO2 ranged from 56% to 98% in CHD patients, and in 22% (n = 12) of these, SpO2 desaturated below 80%. All of the SpO2 less than 80% patients had been diagnosed as cyanotic CHD. Classification of CHD cases (n = 144, the total number of measurements) on the pattern of the SpO2 variation revealed that in 11% (n = 16) of the CHD cases, SpO2 decreased during dental treatment. Twelve of these 16 cases could not readily accept dental treatment. We suggest that behavior management is the most important factor in CHD patients for keeping SpO2 stable. Motion artifact of the SpO2 value, which was easily evoked when a patient bent his elbow or shook his finger, often made the pulse oximetry useless. In our studies, the SpO2 value sometimes became inaccurate in fearful infants or handicapped patients. Pulse waveform displayed on the front panel of pulse oximetry was useful to identify the motion artifact. We conclude that pulse oximetry is an appropriate apparatus for continuous arterial oxygen monitoring in pediatric patients during dental treatment as far as motion artifact is effectively eliminated.
患有先天性心脏病（CHD）的儿童容易出现心血管功能的突然变化，从而导致缺氧发作或急性心力衰竭，因此在牙科治疗期间进行氧气监测对青紫型CHD患者至关重要。通过脉搏血氧饱和度仪监测动脉血氧饱和度（SpO2）有几个优点，包括响应时间快、无皮肤损伤、自动校准以及SpO2值的连续读数。在这些研究中，对北海道大学牙科医院儿童牙科治疗期间的68名儿科患者（55名是CHD儿童，13名是正常儿童）进行了SpO2测量。在所有正常患者中，SpO2饱和度不低于95%。另一方面，CHD患者的SpO2范围为56%至98%，其中22%（n = 12）的患者SpO2饱和度低于80%。所有SpO2低于80%的患者均被诊断为青紫型CHD。根据SpO2变化模式对CHD病例（n = 144，测量总数）进行分类显示，在11%（n = 16）的CHD病例中，牙科治疗期间SpO2下降。这16例中的12例无法顺利接受牙科治疗。我们认为行为管理是CHD患者保持SpO2稳定的最重要因素。当患者弯曲肘部或晃动手指时很容易诱发SpO2值的运动伪影，这常常使脉搏血氧饱和度测量无用。在我们的研究中，SpO2值在惊恐的婴儿或残疾患者中有时会变得不准确。脉搏血氧饱和度仪前面板上显示的脉搏波形有助于识别运动伪影。我们得出结论，只要有效消除运动伪影，脉搏血氧饱和度仪是牙科治疗期间对儿科患者进行连续动脉血氧监测的合适设备。
