老年系统性疾病患者拔牙时的心血管反应：单中心回顾性观察研究。

Cardiovascular Response of Aged Outpatients With Systemic Diseases During Tooth Extraction: A Single-Center Retrospective Observational Study.

机构信息

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.

State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.

出版信息

Front Public Health. 2022 Jul 19;10:938609. doi: 10.3389/fpubh.2022.938609. eCollection 2022.

DOI:10.3389/fpubh.2022.938609

PMID:35928496

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9344048/

Abstract

BACKGROUND

Aged people are maintaining many natural teeth due to improved oral health. However, compromised general health and poor oral hygiene habits at earlier ages resulted in poor status of preserved teeth. Therefore, tooth extraction is required in many aged people. More knowledge is needed because there are many risk factors during the surgery in frail aged adults. The aim of this study was to evaluate the cardiovascular response of such a population during tooth extraction and analyze risk factors to provide clinical guidance.

METHODS

A retrospective study was performed on aged patients with systemic diseases who underwent tooth extraction. Data regarding demographic profiles and cardiovascular parameters of heart rate and blood pressure were collected preoperative, when local anesthesia was administered, at the beginning of tooth extraction, 5 min after tooth extraction, and postoperative. The effects of risk factors, including age, sex, and systemic diseases on these parameters were analyzed with a multilevel model.

RESULTS

Heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) of aged patients increased significantly when performing local anesthesia and tooth extraction. During the operation, the older patients (β = 2.011, = 0.005) and the diabetics (β = 3.902, < 0.0001) were associated with higher SBP, while those with more tooth extractions exhibited higher HR (β = 0.893, = 0.007). Women patients showed both significantly elevated HR (β = 1.687, < 0.0001) and SBP (β = 2.268, < 0.0001). However, for coronary artery disease patients, HR (β = -2.747, < 0.0001) and blood pressure [SBP (β = -4.094, < 0.0001) and DBP (β = -0.87 = 0.016)] were markedly lower than those of patients without a diagnosis of coronary artery disease.

CONCLUSION

Cardiovascular response of aged outpatients with systemic diseases during tooth extraction is quite significant. Age, sex, systemic diseases, and the number of tooth extraction could be risk factors closely associated with cardiovascular response. The findings might provide safety guidance for dentists on tooth extraction in this population.

摘要

背景

由于口腔健康状况的改善，老年人保留了许多天然牙齿。然而，早年的整体健康状况不佳和口腔卫生习惯较差导致保留牙齿的状况不佳。因此，许多老年人需要拔牙。由于在体弱的老年人中手术期间存在许多危险因素，因此需要更多的知识。本研究的目的是评估此类人群在拔牙过程中的心血管反应，并分析危险因素，为临床提供指导。

方法

对患有系统性疾病并接受拔牙的老年患者进行回顾性研究。收集了与人口统计学特征和心率及血压等心血管参数相关的数据，这些数据分别在术前、局部麻醉时、拔牙开始时、拔牙后 5 分钟和术后采集。采用多水平模型分析了年龄、性别和系统性疾病等危险因素对这些参数的影响。

结果

在进行局部麻醉和拔牙时，老年患者的心率（HR）、收缩压（SBP）和舒张压（DBP）均显著升高。在手术过程中，年龄较大的患者（β=2.011，P=0.005）和糖尿病患者（β=3.902，P<0.0001）的 SBP 较高，而拔牙较多的患者 HR 较高（β=0.893，P=0.007）。女性患者的 HR（β=1.687，P<0.0001）和 SBP（β=2.268，P<0.0001）均显著升高。然而，对于患有冠心病的患者，HR（β=-2.747，P<0.0001）和血压[SBP（β=-4.094，P<0.0001）和 DBP（β=-0.87，P=0.016）]均明显低于未诊断为冠心病的患者。