笑气吸入镇静技术联合微创拔牙术在牙科焦虑症患者中的应用

发布时间：2018-06-04 21:19

  本文选题：笑气 + 高速气涡轮手机　； 参考：《安徽医科大学》2017年硕士论文

【摘要】：目的目前,下颌阻生智齿的拔除是口腔颌面外科门诊中最常见的手术之一,是临床常见病和多发病。然而在口腔门诊患者中存在很多牙科焦虑症患者,对口腔治疗尤其是拔牙感到紧张、害怕,甚至逃避治疗。患者的紧张、焦虑、不配合给医生的治疗带来困难,同时也使患者在心理上备受煎熬。笑气/氧气吸入镇静技术是一种安全有效、可提高患者痛阈、减轻疼痛,并减轻或消除焦虑,使患者达到放松、舒适、合作的镇静技术。而高速气涡轮手机作为目前口腔颌面外科门诊拔牙最常用的微创拔牙器械,已经得到了基本的普及。本文主要探讨浓度分别为40%、60%的笑气吸入清醒镇静法结合高速气涡轮手机在牙科焦虑症患者下颌阻生第三磨牙拔除术中的临床效果。方法选择2015年7月—2016年8月于安徽省口腔医院口腔颌面外科门诊拔除下颌阻生第三磨牙牙科焦虑症患者120例,纳入标准符合:(1)患者全身健康情况为美国麻醉医师协会评分指标Ⅰ级~Ⅱ级;(2)有牙科焦虑症状,表现为对诊疗过程恐惧、紧张、逃避等;(3)下颌阻生第三磨牙需符合牙根发育完成、中位或低位阻生、近中倾斜等条件;(4)下颌第二磨牙无松动、无倾斜,对拔牙过程不产生影响;(5)无药物过敏史;(6)无智力障碍,无沟通障碍,能正确判断疼痛强度;(7)无拔牙禁忌证,患者经知情同意志愿参加本实验并签署知情同意书。120例患者随机分为三组,每组40例:A组(40%笑气浓度+局麻),B组(60%笑气浓度+局麻),C组对照组只在局麻下拔牙。拔牙过程中三组患者均在心电监护仪下监测心率和血氧饱和度,观察记录手术前、中、后各项生命体征变化,术后对各组患者进行VAS疼痛评分以及Ramsay镇静评分,并对结果进行统计分析。结果1.生物学指标观察结果采用重复测量数据的方差分析法得出A组患者与B组患者三个时间点的HR、Sp O2差异无显著性(P0.05),C组患者与A、B组患者三个时间点的HR、Sp O2均有显著性差异(P0.05)。2.镇静程度观察结果A组患者与B组患者在局麻时的Ramsay评分无显著性差异(P0.05),但是B组患者的镇静程度与A组相比较高。C组患者与A、B组患者在局麻时的Ramsay评分均有显著性差异(P0.05)。三组患者的Ramsay评分在拔牙时均有显著性差异(P0.05)。3.疼痛程度观察结果三组患者的VSA评分在局麻时均有显著性差异(P0.05),A组患者与B组患者在拔牙时的VAS评分无显著性差异(P0.05),但是B组患者的镇痛程度与A组患者相比较好。C组患者与A、B组患者在拔牙时的VAS评分均有显著性差异(P0.05)因此,试验组和对照组在手术过程中,生命体征变化评估以及镇静镇痛的效果比较差异均有统计学意义(P0.05)。结论笑气吸入清醒镇静技术具有减轻焦虑、镇痛镇静作用,能使患者更好地配合治疗,有利于手术的进行,且60%笑气浓度较40%效果更佳,值得临床推广应用。
[Abstract]:Objective at present, extraction of mandibular impacted wisdom teeth is one of the most common operations in oral and maxillofacial surgery. However, there are many dental anxiety patients in oral outpatients, who feel nervous, afraid and even avoid treatment for oral treatment, especially tooth extraction. Nervousness, anxiety, and lack of coordination make it difficult for doctors to treat, and they suffer psychologically. Nitrous oxide / oxygen inhalation sedation technique is a safe and effective sedative technique, which can increase pain threshold, relieve pain, relieve or eliminate anxiety, and make patients relax, comfortable and cooperate. As the most commonly used minimally invasive tooth extraction device in oral and maxillofacial surgery clinic, high speed gas turbine phone has been widely used. The purpose of this study was to investigate the clinical effect of 40% nitrous oxide inhaled conscious sedation combined with high speed gas turbine cell phone in the extraction of mandibular impacted third molar in patients with dental anxiety. Methods from July 2015 to August 2016, 120 patients with mandibular impacted third molar dental anxiety were selected from oral and maxillofacial surgery clinic of Anhui Oral Hospital. The general health status of the patients was evaluated by the American Association of Anesthesiologists, grade 鈪，

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