Pallasch T J
University of Southern California School of Dentistry, USA.
J Calif Dent Assoc. 1998 Sep;26(9):668-73, 676.
The use of vasoconstrictors in local anesthetics, as topical hemostatic agents, and in gingival retraction cord, remains controversial although data exists from which to formulate reasonable guidelines. The value of such vasoconstrictors to increase local anesthetic efficacy and reduce systemic uptake is unquestioned. Elevated blood levels of epinephrine can occur with their use but do not generally appear to be associated with any significant cardiovascular effects in healthy patients or those with mild to moderate heart disease. Reduced dosages or local anesthetics without vasoconstrictors are indicated for patients with more significant disease, and epinephrine-impregnated retraction cord should be used cautiously or avoided in certain situations. Endogenous epinephrine released in dental treatment-associated stress may also reach significant blood levels and make it difficult to determine causation of cardiovascular adverse events. The safety record of dental local anesthetics and their vasoconstrictors has been impressive and will remain so with continued judicious use of these agents.
血管收缩剂在局部麻醉剂中用作局部止血剂以及用于牙龈收缩线，尽管有数据可用于制定合理的指导方针，但仍存在争议。此类血管收缩剂提高局部麻醉效果并减少全身吸收的价值是毋庸置疑的。使用血管收缩剂会导致肾上腺素血药浓度升高，但在健康患者或轻度至中度心脏病患者中，一般似乎不会产生任何明显的心血管效应。对于病情较重的患者，应使用剂量减少的或不含血管收缩剂的局部麻醉剂，在某些情况下，应谨慎使用或避免使用含肾上腺素的收缩线。牙科治疗相关应激中释放的内源性肾上腺素也可能达到显著的血药浓度，从而难以确定心血管不良事件的病因。牙科局部麻醉剂及其血管收缩剂的安全记录令人印象深刻，继续明智地使用这些药物仍将如此。
