Wang F, Zhao Y Y, Guan M, Wang J, Xu X L, Liu Y, Zhai X L
Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China.
Department of Stomatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Feb 18;52(1):181-186. doi: 10.19723/j.issn.1671-167X.2020.01.029.
To analyze the clinical data of patients undergoing intravenous sedation in oral and maxillofacial surgery, to understand the epidemiological characteristics, to evaluate the efficacy and safety of intravenous sedation for oral surgery, and to summarize our experience.
We retrospectively reviewed the clinical data of patients undergoing intravenous sedation between January 2010 and December 2018 in the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. The gender, age, source, disease types, the values of perioperative vital signs, the use of sedatives and analgesics, duration of surgery and sedation, effect of sedation during the operation and the postoperative anterograde amnesia were analyzed.
A total of 2 582 patients experienced oral surgery by intravenous sedation. The peak age was 3.5 to 10 years and between 21 to 40 years. Supernumerary teeth (38%, 981/2 582) and impacted third molars (30%, 775/2 582) were the major disease types, and other types of disease accounted for 32 percent (826/2 582). The values of heart rate(HR), mean arterial pressure(MAP), respiration rate(RR) and bispectral index(BIS) showed statistically significant differences at the time of before sedation, local anesthesia injection, surgical incision, 10 min after operation and the end of operation. In the study, 69%(1 781/2 582) cases received midazolam alone, 7%(181/2 582) cases received propofol alone, and 24% (620/2 582) cases received midazolam and propofol combined for intravenous sedation. Fentanyl (33%, 852/2 582)was the most common intravenous analgesic we used, followed by flurbiprofen axetil (23%, 594/2 582) and ketorolac tromethamine (6%, 157/2 582). Besides, 35% (907/2 582) patients didn't use any intravenous analgesic during the surgery. The average operation time was (31.2±20.8) min, and the average sedation time was (38.4±19.2) min. During the surgery procedure, most of the patients scored on a scale of 2 to 4 according to the Ramsay sedation score (RSS). The postoperative anterograde amnesia rates of local anesthesia injection, surgical incision and dental drill during surgery were 94% (2 431/2 582), 92% (2 375/2 582) and 75% (1 452/1 936).
Intravenous sedation on the oral and maxillofacial surgery is effective and safe, can make the patients more comfortable, and should be further promoted and applied.
分析口腔颌面外科静脉镇静患者的临床资料，了解其流行病学特征，评估口腔手术静脉镇静的有效性和安全性，并总结经验。
回顾性分析2010年1月至2018年12月在北京大学口腔医学院口腔颌面外科接受静脉镇静患者的临床资料。分析患者的性别、年龄、来源、疾病类型、围手术期生命体征值、镇静剂和镇痛药的使用情况、手术及镇静时间、术中镇静效果及术后顺行性遗忘情况。
共有2582例患者接受口腔手术静脉镇静。年龄高峰为3.5至10岁以及21至40岁。多生牙（38%，981/2582）和阻生第三磨牙（30%，775/2582）是主要疾病类型，其他疾病类型占32%（826/2582）。心率（HR）、平均动脉压（MAP）、呼吸频率（RR）和脑电双频指数（BIS）在镇静前、局部麻醉注射时、手术切口时、术后10分钟及手术结束时差异有统计学意义。本研究中，69%（1781/2582）的病例单独使用咪达唑仑，7%（181/2582）的病例单独使用丙泊酚，24%（620/2582）的病例联合使用咪达唑仑和丙泊酚进行静脉镇静。芬太尼（33%，852/2582）是最常用的静脉镇痛药，其次是氟比洛芬酯（23%，594/2582）和酮咯酸氨丁三醇（6%，157/2582）。此外，35%（907/2582）的患者在手术期间未使用任何静脉镇痛药。平均手术时间为（31.2±20.8）分钟，平均镇静时间为（38.4±19.2）分钟。手术过程中，大多数患者根据Ramsay镇静评分（RSS）评分为2至4分。术中局部麻醉注射、手术切口和牙钻操作后的术后顺行性遗忘率分别为94%（2431/2582）、92%（2375/2582）和75%（1452/1936）。
口腔颌面外科静脉镇静有效且安全，可使患者更舒适，应进一步推广应用。
