应用异丙酚及异丙酚、氯胺酮联合应用超浅麻醉的临床对比研究

目的：为比较异丙酚单独应用和异丙酚、氯胺酮联合应用超浅麻醉在口腔门诊的效果。方法：选择ＡＳＡＩ级下颌智齿拔除患者３９例，随机分为两组，一组为异丙酚组２０例，年龄为２１～３８岁；一组为异丙酚＋氯胺酮组１９例，年龄为２３～３９岁，在超浅麻醉辅以局麻下拔牙，结果：两组术前、术中、术后血压、脉搏、呼吸、血氧饱和度维持平稳，患者均获得满意的镇静，在整个过程中放松、合作，毫无紧张焦虑感，并且自始自终与医生保持言语上的联系，有遗忘作用，副作用小，达到离院标准时间短。结论：异丙酚与亚麻麻醉量的氯胺酮联合应用，可以有效减小氯胺酮的不良反应。     

异丙酚静脉浅麻醉在拔牙术中的应用

应用异丙酚静脉麻醉后拔牙 ,可极大缓解患者的疼痛和恐惧情绪 ,具有起效快、清醒迅速、不良作用少等优点。一、临床资料选取对拔牙有恐惧感 ,精神紧张 ,而心肺功能基本正常的患者 2 0例 ,年龄 2 3～ 5 8岁 ,体重 47～ 85公斤 ,男 15例 ,女 5例。随机分为两组 ,每组 10例。一组愿意接受异丙酚静脉麻醉加局部麻醉 ;二组单纯采用局部麻醉。二、操作方法1.麻醉及手术 :手术在门诊小手术室进行 ,通过静脉缓慢推注异丙酚 1～ 1.5ｍｇ/ｋｇ ,同时应用 2 %利多卡因进行局部麻醉 ,当患者意识减弱后即可开始手术 ,术中注意随时吸尽口腔内的异物 ,一般…     

氧化亚氮、氧气、七氟醚吸入浅全麻用于腭裂患儿术后拆线

本文报告了氧化亚氮、氧气、七氟醚吸入浅全麻用于腭裂患儿术后拆线的体会。本组１２例患儿，ＡＳＡＩ级，年龄为２．６～１０岁，体重为１４～３０ｋｇ，拆线时间为２～６ｍｉｎ。麻醉采用氧化亚氮３升／分、氧气２升／分、七氟醚０．５％～４％，诱导时间为２．０５±０．８４分，苏醒时间为３．３９±１．３５分。表明：氧化亚氮、氧气、七氟醚吸入浅全麻用于腭裂患儿术后拆线，诱导及苏醒快，易于控制。     

异丙酚在小儿口腔外科门诊治疗的应用

笔者使用短效麻醉剂异丙酚在门诊治疗患者 5 2例 ,报告如下。一、病例资料1996年 5月至 2 0 0 0年 6月 ,使用异丙酚麻醉下治疗小儿口腔颌面外科疾病 5 2例 ,男 31例 ,女 2 1例 ,年龄 2月～11岁 ,平均 5 .5岁。同期门诊使用氯胺酮麻醉的 32例小儿治疗作对照。二、治疗方法患儿常规做好全麻前及手术前准备 ,排除手术及麻醉禁忌症。麻醉方法 :采用美国产异丙酚 (Ｐｒｏｐｏｆｏｌ) ,由我院麻醉师实施微泵电脑控制静脉给药麻醉。唇裂拆线、口内注射治疗血管瘤 :采用超浅麻醉 (清醒镇静 ) ,不加止痛药 ,只需维持几分钟或十几分钟 ,剂量为 2～ 3ｍ…     

氧化亚氮/氧吸入镇静在老年高血压患者拔牙术中的应用

目的：探讨氧化亚氮/氧吸入镇静辅助局麻在老年高血压患者拔牙术中的应用价值。方法：选取40例老年高血压患者,年龄70~90岁,随机分为对照组和实验组,每组20例。对照组单纯采用局麻进行手术,实验组采用氧化亚氮/氧吸入镇静配合局麻进行手术。观察2组患者术前、术中和术后收缩压(SBP)、舒张压(DBP)和心率(HR)变化以及术后有无不良反应。应用SPSS 11.0软件包进行t检验。结果：2组患者术前和术后SBP、DBP和HR无显著差异。对照组术中SBP、DBP和HR均显著高于实验组(P<0.05)。实验组在整个操作过程中,SBP、DBP和HR比较平稳(P>0.05)。结论：氧化亚氮/氧吸入镇静辅助局麻拔牙能够维持老年高血压患者的血流动力学平稳,安全、有效。     

评述

氧化亚氮(NO2)俗称笑气，1772年由Priesffley研制成功，1844年由Wells首先应用于牙科拔牙手术镇痛，并取得成功。多年来，因其化学性质稳定、镇痛作用强、术后患者清醒迅速等优点被广泛用于临床麻醉。随着氧化亚氮循环吸入系统和氧监测系统的广泛应用，氧化亚氮已成为临床最常用的吸入麻醉药之一，它可单独应用，但大多数情况下与其他吸入麻醉药或静脉麻醉药合用。近年来有研究表明，吸入低浓度氧化亚氮有良好的镇静作用，且吸入低浓度氧化亚氮患者较吸入高浓度的患者更易接受和合作。在欧美等国家，氧化亚氮吸入是一种成熟技术，广泛应用于牙科镇静、镇痛。     

老年高血压患者拔牙时血压波动的原因及处理

在拔牙过程中,常出现高血压老人因恐惧和疼痛导致血压进一步升高,进而影响操作。本研究的目的是观察在拔牙过程中,恐惧和疼痛对高血压老人的影响,从而找出操作前后引起血压变化的规律,探讨预防血压升高的有效方法。临床资料1本组132例高血压老年患者,男性60例,女性72例。年龄63～78岁。2拔牙术在2%利多卡因局麻下进行。操作过程中有28例患者出现疼痛。按照高血压普检标准和方法,作者用同一血压计测量患者血压,患者平躺于牙科治疗椅上,上身与地面呈45°角,安静休息5ｍｉｎ后分别测量麻醉前、麻醉中、拔牙过程中、术后15ｍｉｎ的血压值,各项指…     

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目的观察老年人拔牙中麻醉剂复方阿替卡因(碧兰麻)及利多卡因局部浸润麻醉或阻滞麻醉后行拔牙术镇痛的疗效。方法将2009年1月至2010年10月大理州人民医院口腔颌面外科门诊收治的134例老年拔牙患者随机分为复方阿替卡因麻醉组(67例)、利多卡因麻醉组(67例)。分别使用麻醉剂5min后,行牙拔出术,根据患者表情和医生评价确定麻醉效果,统计麻醉完全、良好、有效和无效的比例,以及不良反应的发生率,并对麻醉起效时间进行比较。结果复方阿替卡因麻醉组麻醉效果及起效时间明显优于利多卡因麻醉组(均P<0.05)。两组患者均无局部疼痛、水肿、头晕、恶心、呕吐和过敏反应等不良反应的发生。结论复方阿替卡因在老年人拔牙术中,是一种安全可靠值得推广使用的口腔局部麻醉药。     

患者自控镇静术在拔除阻生牙中的临床应用研究

有效的镇静、镇痛技术是提高拔牙麻醉质量的首要因素。患者自控镇静术 (ｐａｔｉｅｎｔｃｏｎｔｒｏｌｌｅｄｓｅｄａｔｉｏｎ ,ＰＣＳ)是近年来应用于临床麻醉的一种新的镇静方法。我们对患者自控镇静术在拔牙中的临床应用进行了研究 ,以探讨ＰＣＳ技术的应用价值。一、材料与方法1 病例 :2 2例骨埋伏阻生的双侧下颌第三磨牙需拔除的患者 ,平均年龄 33岁 (18～ 40岁 ) ,双侧阻生情况基本相同。2 方法 :(1)实验组 (ＰＣＳ组 )在患者自控镇静术联合下牙槽神经阻滞麻醉下拔除一侧阻生牙 ;对照组 (Ｃ组 ) 2周后同一患者在单纯下牙槽神经阻滞麻…     

高血压病患者全麻下拔除牙隐裂致冠根联合折病牙的临床观察

目的：探讨高血压患者在全身麻醉下拔除牙隐裂致冠根联合折病牙的临床效果。方法：12例高血压患者因牙隐裂致冠根联合折需拔牙手术治疗，在全身麻醉下，通过术中控制性降压，使血压维持在120～140／80～90mmHg。结果：高血压患者在全麻下拔除冠根联合折病牙，没有发生不良反应和并发症。结论：高血压患者牙隐裂致冠根联合折病牙可在全身麻醉下进行拔牙手术，能在短时间内解决患者痛苦，保证了手术的安全，是一种较好的手术方案。     

口腔门诊治疗中1429例患者应用笑气镇静技术的回顾性分析

目的 回顾性分析笑气镇静技术在口腔门诊中的使用情况及效果.方法 对2016年1月1日至2018年12月30日期间在广州医科大学附属口腔医院门诊使用笑气吸入镇静治疗的1429个病例进行如下分析:病例的人群分布、牙科治疗项目、使用笑气吸入的原因、不同年龄段患者的镇静效果和不良反应.结果1429例患者中,男性587例,女性8...     

氧化亚氮吸入清醒镇静在拔牙术中的止痛作用

实验组选取无笑气吸入禁忌证拔牙患者112例,随机分为60%笑气组61例,40%笑气组51例,在笑气吸入清醒镇静辅以局麻下拔牙;对照组53例,只在局麻下拨牙.结果表明:60%笑气组与40%笑气组的VAS疼痛评分大多较低,与对照组相比,在统计学上有非常显著性差异(P<0.001).提示笑气具有一定的镇静、止痛作用,联合局麻应用可以较好地控制患者焦虑与疼痛的复合状态.     

牙列中度与重度拥挤人群牙量和骨量的相关性研究

目的 分析牙齿和基骨的各项指标对牙列拥挤度的影响。方法 选取中度、重度拥挤患者101例,运用牙(牙合)模型系统测量两组的牙齿和基骨的各项指标,将测量结果进行比较。结果 两组患者牙量差异有显著性;基骨宽度和基骨长度的差异无显著性;牙量和骨量的比值,即Howes值的差异有显著性。结论 牙列拥挤度与牙量、Howes值有关,骨量对拥挤度的影响不明显。提示临床对于拥挤度较大的患者应采用拔牙矫治。     

Randomized controlled trial of the intraligamental use of a local anaesthetic (lignocaine 2%) versus controls in paediatric tooth extraction

BACKGROUND: Children still experience pain upon waking following dental extraction under general anaesthesia. Local anaesthetic has been shown to reduce this pain, but needs to be administered via a method that causes minimum injury or distress to the child. AIM: This study aims to evaluate the use of intraligamental injection of local anaesthetic, under general anaesthesia prior to the extraction of the tooth, for postoperative pain control in children aged 2-5 years. DESIGN: A randomized, single-blind, controlled trial of intraligamental lignocaine (2% lignocaine solution with adrenaline (epinephrine) 1 : 80 000) for primary teeth extraction under general anaesthesia was performed. Pain was scored by the investigators at 5-, 15-, 30-, and 60-min time points in the first hour using the Toddler-Preschooler Postoperative Pain Scale. RESULTS: Eighty-six children were recruited in the study: 42 randomized in the lignocaine treatment group and 44 in the control group. There was no significant difference (P = 0.42, Mann-Whitney U-test) in the cumulative four time point median pain score over the first hour. In the lignocaine treatment group, this was 3 (interquantile range (IQR) 0-7.5) and in the control group this was 3 (IQR: 0-10). At the 5-min time point after the child returned from recovery, the pain score in the lignocaine group (0 IQR 0-1) was statistically lower than that in the control group (0 IQR 0-5) (P = 0.023). There was no difference in the 15-, 30-, or 60-min time points. CONCLUSIONS: Intraligamental lignocaine used for dental extraction under general anaesthesia in young children initially causes less pain after recovery, but this difference is not sustained over the first hour after dental extraction.     

Assessment of early postoperative pain and haemorrhage in young children undergoing dental extractions under general anaesthesia

BACKGROUND: There have been a lot of guidelines issued about dental extractions under general anaesthesia. There is a considerable body of research about the use of local anaesthetic as an adjunct. Some of this research appears to be contradictory about the use of local anaesthetic in addition to general anaesthesia in very young children. This study attempts to clarify the issue. AIM: To determine whether postoperative pain/distress in the early recovery period was different for those children who did or did not have local infiltration anaesthesia for extractions under general anaesthetic, and whether the incidence of clinically significant postoperative bleeding was different for the two groups. DESIGN: Children aged 2-6 years, admitted for extraction of deciduous posterior teeth under general anaesthetic, were randomized to groups that were or were not given local infiltration anaesthesia during the procedure. The children were premedicated with paracetamol and ibuprofen, and had absorbable haemostatic packs inserted during the operation. Staff blinded to treatment allocation made observations in the recovery period of pain and any interventions for bleeding. RESULTS: There was no difference in postoperative pain, as measured using CHEOPS scale between the two groups, but an increase in post operative bleeding in the group who did not have local anaesthetic administered 5/38 compared to 0/38, P = 0.02. CONCLUSIONS: As use of local anaesthetic reduces bleeding without altering pain or distress in young children undergoing posterior deciduous tooth extraction, we should consider using as an adjunct to general anaesthesia.     

笑气镇静配合椅位视频在牙科畏惧症患者拔牙手术中的应用

目的:观察笑气和椅位视频系统对牙科畏惧症患者拔牙手术治疗依从性的作用.方法:100 例牙科畏惧症拔牙患者随机分为2 组,一组使用笑气和椅位视频观看影视节目为实验组,另一组单独使用笑气为对照组.拔牙中测量患者心率和脉搏氧值,拔牙结束后调查2 组患者对整个拔牙过程的感受,填写患者Frankl治疗依从性量表和Houpt行为量表.结果: 2 组患者心率和脉搏氧值统计学无差异(P>0.05).2 组Frankl治疗依从性评分值和Houpt行为评分值均有统计学差异(P<0.05).结论:牙科畏惧症患者在拔牙时使用笑气吸入配合椅位视频系统可以分散患者对拔牙时的注意力,使患者意识集中于视频节目中的娱乐节目,有利于缓解拔牙时的紧张情绪,可以舒适地渡过拔牙手术期.     

Effects of early tooth extractions on hippocampal GFAP-positive cells in aged senescence-accelerated mice

The effects of early tooth extractions on age-associated changes in cognitive function were evaluated. Specifically, teeth were extracted at an early age in senescence-accelerated mice (SAM)P8, and the number of glial fibrillary acid protein (GFAP)-positive astrocytes and spatial perception were evaluated at young, mature, and old ages. The following results were obtained:1. Concerning spatial perception evaluated by the Morris water maze test, the shortening of the time until the animals reached the platform was significantly slower in mature or old mice of the tooth extraction group compared with age-matched controls. However, no significant difference was noted in the rate of shortening in young mice between the tooth extraction and control groups.2. The number of GFAP-positive cells was significantly higher in the CA3 region of the hippocampus in the mature or old mice of the tooth extraction group compared with age-matched controls. However, no significant difference was observed in the CA1 and dentate gyrus (DG) region of the hippocampus in the mature or old mice and in the CA1, CA3, and DG region in the young mice between the two groups.These results suggest that the loss of teeth at an early age accelerated aging and that GFAP-positive astrocytes increased to compensate for a decrease in pyramidal cells.     

Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial

It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p < 0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).     

丙泊酚和异氟醚麻醉对舌癌围术期患者细胞因子反应的影响

目的比较丙泊酚和异氟醚麻醉对舌鳞癌围术期患者炎性和抗炎性细胞因子反应的影响。方法选择24例拟行舌鳞癌根治手术的患者,随机分为丙泊酚组（ P组）和异氟醚组（ I组）。P组手术中麻醉维持采用丙泊酚5～8 mg·kg-1·h-1;I组麻醉维持采用异氟醚,维持呼气末浓度为体积分数0.6%。于麻醉诱导前（ T0）、手术结束时（ T1）、术后24（h T2）和术后48（h T3）分别采集外周静脉血,用酶联免疫吸附法检测血清白细胞介素（ IL）- 6和IL- 10水平,并记录4个观测点的平均动脉压和直肠温度。结果两组患者T1、T2和T3时的IL- 6、IL- 10质量浓度均较术前明显增加（ P<0.05）,均于T1点达到峰值,术后24 h开始回落;I组IL- 6质量浓度在T1点时高于P组（ P<0.01）,而IL- 10质量浓度在T1、T2点时低于P组（ P<0.05）。两组患者的平均动脉压和直肠温度在4个观测点均无统计学差异（ P>0.05）。结论丙泊酚全静脉麻醉对舌癌根治术术后炎症反应比异氟醚轻,对预防严重并发症具有潜在的治疗意义。     

老年糖尿病患者拔牙术前血糖控制目标与预后相关性的初步分析

目的观察老年糖尿病患者在空腹血糖>8.88 mmol/L且≤10.00 mmol/L条件下行拔牙术的安全性。方法本研究为前瞻性队列研究,纳入2018年10月至2019年10月就诊于北京大学口腔医学院·口腔医院口腔颌面外科心电监护门诊的老年糖尿病拔牙患者100例,男性53例,女性47例,年龄(75.8±8.0)岁(65~95岁)。拔牙术前空腹血糖>8.88 mmol/L且≤10.00 mmol/L的50例患者为观察组;空腹血糖≤8.88 mmol/L的50例患者为对照组,两组糖化血红蛋白(glycosylated hemoglobin,HbA1c)均≤8.5%。分别观察拔牙术后24 h、1周拔牙窝处有无疼痛、肿胀、溢脓、瘘口及全身发热,观察术后1个月拔牙窝周围组织愈合情况。采用SPSS 25.0软件对拔牙术前血糖控制目标与预后的相关性进行统计学分析。结果观察组和对照组患者术前的空腹血糖分别为(6.92±0.99)和(9.88±0.68)mmol/L,HbAlc分别为(6.76±0.83)%和(7.69±0.75)%。两组患者的年龄、性别、糖尿病病史、拔牙牙位、牙龈指数、牙齿松动度等差异均无统计学意义(P>0.05)。术后24 h,对照组与观察组拔牙窝愈合良好的患者均占94%(47/50),两组均有3例患者拔牙窝局部疼痛,但可耐受,周围组织均无红肿表现。术后1周检查创口愈合良好,术后1个月创口完全愈合。两组患者拔牙术后创口愈合状况差异无统计学意义(P>0.05)。结论拔牙术前空腹血糖≤10.00 mmol/L且HbA1c≤8.5%可作为老年糖尿病患者常规拔牙或口腔小手术的安全参考值。