Tsuchihashi T, Takata Y, Kurokawa H, Miura K, Maruoka Y, Kajiyama M, Fujishima M
Department of Internal Medicine, Kyushu Dental College, Kitakyushu, Japan.
Hypertens Res. 1996 Sep;19(3):189-94. doi: 10.1291/hypres.19.189.
To investigate blood pressure and pulse rate responses to dental surgery, 21 patients 18 to 73 years of age (mean age, 42 +/- 4 years) who visited our hospital for tooth extraction were studied. Before dental treatment, the patients underwent a mental arithmetic stress test, electrocardiography, and an anxiety evaluation with the State-Trait Anxiety Inventory. Baseline blood pressure and pulse rate were 118 +/- 4/70 +/- 3 mmHg and 69 +/- 2 beats/min, respectively. Blood pressure rose by 24 +/- 3/17 +/- 2 mmHg during the mental stress test, and the magnitude of the rise in systolic blood pressure was significantly correlated with age (r = 0.81, p < 0.001) and baseline blood pressure (r = 0.56, p < 0.01). After the topical injection of local anesthetic containing 1: 80,000 epinephrine, a transient increase in systolic blood pressure was observed. The maximum blood pressure and pulse rate increases during dental surgery were 24 +/- 4/13 +/- 2 mmHg and 17 +/- 3 beats/min, respectively. Similarly, the rate pressure product increased from 8,196 +/- 486 to 11,802 +/- 682. The magnitude of the blood pressure increase during dental surgery was not correlated with age, sex, family history of hypertension, baseline blood pressure, anxiety score, or response to mental stress. On the other hand, when the subjects were divided into two subgroups according to the blood pressure response during dental surgery, the larger response group (increase in mean blood pressure greater than 15 mmHg, n = 9) required a significantly larger dose of local anesthetic than did the smaller response group. The number of cases of pericoronitis of the third molar tended to be greater in the larger response group. These results indicate that an increase in blood pressure during dental surgery cannot be predicted on the basis of baseline blood pressure or the response to mental stress, but is related to the cause of tooth extraction and the volume of local anesthetics required to control the pain.
为研究牙科手术时的血压和脉搏率反应，我们对21名年龄在18至73岁（平均年龄42±4岁）来我院拔牙的患者进行了研究。在牙科治疗前，患者接受了心算应激测试、心电图检查以及使用状态-特质焦虑量表进行的焦虑评估。基线血压和脉搏率分别为118±4/70±3 mmHg和69±2次/分钟。在精神应激测试期间，血压升高了24±3/17±2 mmHg，收缩压升高幅度与年龄（r = 0.81，p < 0.001）和基线血压（r = 0.56，p < 0.01）显著相关。在局部注射含1:80,000肾上腺素的局部麻醉剂后，观察到收缩压短暂升高。牙科手术期间血压和脉搏率的最大升高分别为24±4/13±2 mmHg和17±3次/分钟。同样，心率血压乘积从8196±486增加到11802±682。牙科手术期间血压升高幅度与年龄、性别、高血压家族史、基线血压、焦虑评分或精神应激反应无关。另一方面，根据牙科手术期间的血压反应将受试者分为两个亚组时，反应较大组（平均血压升高大于15 mmHg，n = 9）所需的局部麻醉剂剂量明显大于反应较小组。第三磨牙冠周炎的病例数在反应较大组中往往更多。这些结果表明，牙科手术期间的血压升高不能根据基线血压或精神应激反应来预测，而是与拔牙原因和控制疼痛所需的局部麻醉剂用量有关。
