静脉给药镇静技术在2 582例口腔外科门诊手术中的临床应用

doi:10.19723/j.issn.1671-167X.2020.01.029

摘要/Abstract

摘要：

目的:分析镇静给药镇静技术用于口腔外科门诊手术患者基本资料,了解其流行病学特点,评价该技术用于口腔外科手术的效果及安全性,并总结相关经验。方法:统计北京大学口腔医院口腔颌面外科2010年1月至2018年12月间行静脉镇静下口腔颌面外科手术患者的病例资料,对其性别、年龄、疾病种类、围手术期的生命体征监测数值、镇静、镇痛用药情况、手术和镇静时长、术中镇静效果及术后顺行性遗忘情况进行总结分析。结果:9年间进行静脉镇静下口腔外科手术共2 582人次,患者年龄段集中于3.5岁至10岁及21~40岁。疾病种类最多的为多生牙,占38%(981/2 582), 阻生智牙占30%(775/2 582),其他疾病共占32%。围手术期患者心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、呼吸频率(respiratory rate,RR)、脑电双频指数(bispectral index,BIS)的数值在患者入室、局部麻醉、手术切开、手术开始10 min及术毕的差异有统计学意义。单独使用咪达唑仑静脉镇静占69%(1 781/2 582);单独使用丙泊酚占7%(181/2 582);咪达唑仑联合丙泊酚复合镇静占24%(620/2 582)。使用的静脉麻醉性镇痛药物主要为芬太尼、氟比洛芬酯、酮咯酸氨丁三醇,分别占33%(852/2 582)、 23%(594/2 582)、 6%(157/2 582), 未使用静脉镇痛药患者占35%(907/2 582)。手术总时长平均(31.2±20.8) min,镇静给药总时长平均(38.4±19.2) min;术中总体镇静效果较好,Ramsay镇静评分多为2~4分;术后患者对局部麻醉注射、手术切开、牙钻声音的顺行性遗忘率分别为94%(2 431/2 582)、 92%(2 375/2 582)、 75%(1 452/1 936)。结论:静脉镇静下口腔颌面外科门诊手术治疗安全有效,提高了手术的舒适性,应进一步推广应用。

关键词: 静脉镇静, 镇痛, 麻醉, 口腔外科手术

Abstract:

Objective: To analyze the clinical data of patients undergoing intravenous sedation in oral and maxillofacial surgery, to understand the epidemiological characteristics, to evaluate the efficacy and safety of intravenous sedation for oral surgery, and to summarize our experience. Methods: We retrospectively reviewed the clinical data of patients undergoing intravenous sedation between January 2010 and December 2018 in the Department of Oral and Maxillofacial Surgery, Peking University School of Stomatology. The gender, age, source, disease types, the values of perioperative vital signs, the use of sedatives and analgesics, duration of surgery and sedation, effect of sedation during the operation and the postoperative anterograde amnesia were analyzed. Results: A total of 2 582 patients experienced oral surgery by intravenous sedation. The peak age was 3.5 to 10 years and between 21 to 40 years. Supernumerary teeth (38%, 981/2 582) and impacted third molars (30%, 775/2 582) were the major disease types, and other types of disease accounted for 32 percent (826/2 582). The values of heart rate(HR),mean arterial pressure(MAP),respiration rate(RR) and bispectral index(BIS) showed statistically significant differences at the time of before sedation, local anesthesia injection, surgical incision, 10 min after operation and the end of operation. In the study, 69%(1 781/2 582) cases received midazolam alone, 7%(181/2 582) cases received propofol alone, and 24%(620/2 582) cases received midazolam and propofol combined for intravenous sedation. Fentanyl (33%, 852/2 582)was the most common intravenous analgesic we used, followed by flurbiprofen axetil (23%, 594/2 582) and ketorolac tromethamine (6%, 157/2 582). Besides, 35% (907/2 582)patients didn't use any intravenous analgesic during the surgery. The average operation time was (31.2±20.8) min, and the average sedation time was (38.4±19.2) min. During the surgery procedure, most of the patients scored on a scale of 2 to 4 according to the Ramsay sedation score (RSS). The postoperative anterograde amnesia rates of local anesthesia injection, surgical incision and dental drill during surgery were 94% (2 431/2 582), 92% (2 375/2 582) and 75% (1 452/1 936). Conclusion: Intravenous sedation on the oral and maxillofacial surgery is effective and safe, can make the patients more comfortable, and should be further promoted and applied.

Key words: Intravenous sedation, Analgesia, Anesthesia, Oral and maxillofacial surgery

中图分类号:

R782.05

王菲,赵阳阳,关明,王晶,许向亮,刘宇,翟新利. 静脉给药镇静技术在2 582例口腔外科门诊手术中的临床应用[J]. 北京大学学报（医学版）, 2020, 52(1): 181-186.

Fei WANG,Yang-yang ZHAO,Ming GUAN,Jing WANG,Xiang-liang XU,Yu LIU,Xin-li ZHAI. Application of intravenous sedation in 2 582 cases of oral and maxillofacial surgery[J]. Journal of Peking University(Health Sciences), 2020, 52(1): 181-186.

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Items	T0	T1	T2	T3	T4
BIS	96.76±0.95	75.57±3.53^*	76.12±2.84^*	75.02±3.17^*	80.37±2.75^*#&§
HR/(beat/min)	88.31±20.58	79.87±14.94^*	82.44±13.80^*#	81.16±14.98^*#	82.98±17.89^*#
MAP/mmHg	94.68±9.95	84.43±8.54^*	83.66±11.14^*	81.96±9.44^*	82.72±8.93^*
RR/(beat/min)	18.65±3.87	16.89±4.33^*	17.37±2.02^*	17.82±3.18^*	17.02±2.27^*
SpO₂/%	99.12±0.84	99.03±0.67	98.87±1.06	99.11±0.66	99.02±1.14

Items	RSS=1	RSS=2	RSS=3	RSS=4	RSS=5
Supernumerary tooth	21	215	591	143	11
Impected wisdom tooth	9	215	453	94	4
Odontogenic cyst	3	76	115	36	2
Others	18	236	269	62	9