Matsumura K, Miura K, Takata Y, Kurokawa H, Kajiyama M, Abe I, Fujishima M
Department of Internal Medicine, Kyushu Dental College, Kitakyushu, Japan.
Am J Hypertens. 1998 Nov;11(11 Pt 1):1376-80. doi: 10.1016/s0895-7061(98)00157-5.
The objective of the present study was to determine the changes in blood pressure, pulse rate, and heart rate variability during dental surgery. The study included 40 patients, 19 to 74 years of age (mean age: 42.7+/-3.0 years), who underwent tooth extraction at our hospital. Holter electrocardiographic monitoring was used to determine the power spectrum of R-R variability before and during dental surgery. The low frequency (LF: 0.041 to 0.140 Hz), high frequency (HF: 0.140 to 0.500 Hz), and total spectral powers (TF; 0.000 to 4.000 Hz) were calculated, and the ratio of LF to HF and percentage of HF relative to TF (%HF: HF/TF x 100) were used as indices of sympathetic and parasympathetic activities, respectively. The baseline blood pressure and pulse rate were 121+/-3/70+/-2 mm Hg and 70+/-1 beats/min, respectively. After the administration of local anesthetic (2% lidocaine) containing 1:80,000 epinephrine, both the blood pressure and pulse rate increased. During dental surgery, blood pressure increased further to 132+/-3/73+/-2 mm Hg. The increase in blood pressure was greater in middle-aged and older patients (> or =40 years old). In young patients (<40 years old), the %HF decreased and the LF/HF increased during local anesthesia. In contrast, in middle-aged and older patients, the LF/HF decreased during local anesthesia. These results suggest 1) that middle-aged and older patients have a greater increase in blood pressure during dental surgery than younger patients, and 2) that the regulation of the autonomic nervous system during dental surgery differs between younger and older patients.
本研究的目的是确定牙科手术期间血压、脉搏率和心率变异性的变化。该研究纳入了40例年龄在19至74岁（平均年龄：42.7±3.0岁）的患者，他们在我院接受了拔牙手术。采用动态心电图监测来确定牙科手术前和手术期间R-R间期变异性的功率谱。计算低频（LF：0.041至0.140Hz）、高频（HF：0.140至0.500Hz）和总频谱功率（TF；0.000至4.000Hz），并分别将LF与HF的比值以及HF相对于TF的百分比（%HF：HF/TF×100）用作交感神经和副交感神经活动的指标。基线血压和脉搏率分别为121±3/70±2mmHg和70±1次/分钟。在给予含1:80,000肾上腺素的局部麻醉剂（2%利多卡因）后，血压和脉搏率均升高。在牙科手术期间，血压进一步升高至132±3/73±2mmHg。中年及老年患者（≥40岁）的血压升高幅度更大。在年轻患者（<40岁）中，局部麻醉期间%HF降低，LF/HF升高。相比之下，在中年及老年患者中，局部麻醉期间LF/HF降低。这些结果表明：1）中年及老年患者在牙科手术期间的血压升高幅度比年轻患者更大；2）年轻患者和老年患者在牙科手术期间自主神经系统的调节存在差异。
