中老年心血管病患者口腔麻醉前后的血压和心率变化

目的:分析中老年心血管病患者在接受拔牙术时口腔麻醉前后的血压和心率变化情况。方法:收集在北京大学人民医院口腔科进行心电监护拔牙的中老年心血管病患者共1969例。使用心电监护仪测量患者在口腔麻醉前后的血压、心率,记录并统计分析血压、心率的变化情况。结果:所有患者在口腔麻醉后未出现危及生命的严重并发症。术前患者血压、心率的第95百分位数分别为165/95 mmHg(1 mmHg=0.133 kPa)、95次/min。在麻醉前血压≥165/95 mmHg的患者和<165/95 mmHg的患者中,分别9.9%(21/212)和0.4%(7/1757)的患者麻醉后血压≥180/110 mmHg,两者差异有统计学意义(P<0.01)。共28例(1.42%)患者麻醉后血压≥180/110 mmHg,其中17例患者休息后复测血压仍未下降,终止拔牙治疗。与麻醉前比较,麻醉后患者的平均心率显著升高[73(四分位数间距=16)次/min vs 74(四分位数间距=17)次/min,P<0.01]。结论:对于心血管病得到有效治疗且病情稳定的中老年患者,口腔麻醉安全、有效。建议中老年心血管病患者在血压<165/95 mmHg、心率<95次/min的情况下,接受全身情况综合评估后进行口腔麻醉。

Blood Pressure and Heart Rate Responses During Local Oral Anesthesia in Elderly Patients With Cardiovascular Diseases Undergoing Tooth Extraction

Objectives:To analyze the changes of blood pressure and heart rate in elderly patients with cardiovascular diseases after oral anesthesia.Methods:A total of 1969 elderly patients with cardiovascular diseases,who received tooth extraction in the Department of Stomatology,Peking University People's Hospital,were included in this study.Blood pressure and heart rate were monitored in these patients before and after oral anesthesia.Results:No serious complications occurred in all patients after oral anesthesia.The 95%thresholds of blood pressure and heart rate before operation were 165/95 mmHg(1 mmHg=0.133 kPa)and 95 beats/minute respectively.There were 212 and 1757 patients with blood pressure≥165/95 mmHg or<165/95 mmHg before anesthesia respectively,there were 9.9%(21/212)and 0.4%(7/1757)patients with blood pressure≥180/110 mmHg after anesthesia respectively(P<0.01).of all 1969 patients,28(1.42%)had blood pressure≥180/110 mmHg after anesthesia.Among the 28 patients,the blood pressure Of 17 patients did not reduce after rest,so the tooth extraction was terminated.After anesthesia,the average heart rate of all patients increased slightly(74[IQR=17]beats/minute vs 73[IQR=16]beats/minute,P<0.01).Conclusions:Oral anesthesia is safe and effective for elderly patients with stable cardiovascular disease.It is suggested that the patient's blood pressure should be below 165/95mmHg and heart rate should be below 95 beats/minute prior applying oral anesthesia.