Balasubramaniyan Nathiya, Rayapati Dilip Kumar, Puttiah Raghuveer Hosahalli, Tavane Prashanth, Singh Shobha Eswara, Rangan Vinod, Kalakunta Prithvi Raj
Post Graduate Student, Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences , Bangalore, Karnataka, India .
Professor, Department of Oral and Maxillofacial Surgery, Dayananda Sagar College of Dental Sciences , Bangalore, Karnataka, India .
J Clin Diagn Res. 2016 Aug;10(8):ZC123-7. doi: 10.7860/JCDR/2016/19685.8391. Epub 2016 Aug 1.
Anxiety towards exodontic procedures is a common occurrence in dental practice. In hypertensive patients this anxiety induced stress may have an effect on cardiovascular system which may be clinically significant.
To evaluate the cardiovascular changes in hypertensive patients that may manifest following anxiety induced stress in patients undergoing exodontic procedures under local anaesthesia.
Eighty known hypertensive patients under medication reporting to Department of Oral and Maxillofacial surgery, Dayananda Sagar College of Dental Sciences Bangalore, Karnataka, India for extraction of teeth were taken up for the study. Anxiety was measured before local anaesthetic delivery using Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Cardiovascular response data including blood pressure, heart rate, pulse rate, oxygen saturation and electrocardiographic changes were measured pre-operatively, immediately after local anaesthesia administration and Post-operatively at five, ten and fifteen minutes interval. Kruskal-Wallis test was used to compare continuous variables before and after the injection of local anaesthesia including heart rate, pulse rate, oxygen saturation, and blood pressure. Repeated-measures analysis of variance (ANOVA) was used to analyse the significance of changes in heart rate, pulse rate, blood pressure, and oxygen saturation over time between groups.Chi-square test was used to analyse the significance of electrocardiographic changes.
The results revealed that the mean anxiety score before administration of local anaesthetic was 9.91(S.D ±2.9) with a range 4-20. Severe preoperative anxiety (<12) was associated with significantly increased heart rate, pulse rate, systolic blood pressure. At the pre-injection phase the mean values were systolic blood pressure (130.72±9.2), diastolic blood pressure (81.6±7.7), heart rate (72.7±11.9) and oxygen saturation (95.2±1.9). These values were increased immediately after local anaesthetic delivery and this relation was statistically significant for all parameters except oxygen saturation. Electrocardiographic abnormalities were found before and after injection of local anaesthetic (p>0.001). One patient showed right bundle branch block pattern.
Dental anxiety impacts the effects of delivery of local anaesthesia on blood pressure, heart rate, pulse rate and electrocardiograph and is significantly associated with the increase in systolic blood pressure, heart rate, pulse rate and changes in electrocardiograph. Thus, present study supported that increased anxiety in hypertensive patients who underwent extraction is associated with cardiovascular changes.
牙科治疗中对拔牙手术的焦虑是常见现象。在高血压患者中，这种焦虑引发的应激可能会对心血管系统产生影响，且可能具有临床意义。
评估在局部麻醉下接受拔牙手术的高血压患者，焦虑引发的应激后可能出现的心血管变化。
选取80名正在接受药物治疗的已知高血压患者，他们前往印度卡纳塔克邦班加罗尔达亚南达萨加尔牙科学院口腔颌面外科就诊，进行拔牙手术，纳入本研究。在注射局部麻醉剂前，使用阿姆斯特丹术前焦虑与信息量表（APAIS）测量焦虑程度。术前、局部麻醉剂注射后即刻以及术后每隔5分钟、10分钟和15分钟测量心血管反应数据，包括血压、心率、脉搏率、血氧饱和度和心电图变化。采用Kruskal-Wallis检验比较局部麻醉剂注射前后的连续变量，包括心率、脉搏率、血氧饱和度和血压。采用重复测量方差分析（ANOVA）分析两组间心率、脉搏率、血压和血氧饱和度随时间变化的显著性。采用卡方检验分析心电图变化的显著性。
结果显示，局部麻醉剂注射前的平均焦虑评分为9.91（标准差±2.9），范围为4 - 20。术前严重焦虑（<12）与心率、脉搏率、收缩压显著升高相关。注射前阶段的平均值为收缩压（130.72±9.2）、舒张压（81.6±7.7）、心率（72.7±11.9）和血氧饱和度（95.2±1.9）。局部麻醉剂注射后这些值立即升高，除血氧饱和度外，所有参数的这种关系均具有统计学意义。注射局部麻醉剂前后均发现心电图异常（p>0.001）。一名患者出现右束支传导阻滞图形。
牙科焦虑会影响局部麻醉剂对血压、心率、脉搏率和心电图的作用，且与收缩压、心率、脉搏率升高及心电图变化显著相关。因此，本研究支持接受拔牙手术的高血压患者焦虑增加与心血管变化有关。
