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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (1): 93-98. doi: 10.19723/j.issn.1671-167X.2024.01.015

• 论著 • 上一篇    下一篇

牙种植同期植骨术围术期高血压的相关危险因素

刘晓强1,周寅2,*()   

  1. 1. 北京大学口腔医学院·口腔医院修复科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
    2. 北京大学口腔医学院·口腔医院麻醉科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，北京 100081
  • 收稿日期:2022-10-10 出版日期:2024-02-18 发布日期:2024-02-06
  • 通讯作者: 周寅 E-mail:zhouyin@bjmu.edu.cn
  • 基金资助:
    中华口腔医学会青年临床科研基金(CSA-SIS2022-18);北京大学第一医院科研种子基金(2019SF36)

Risk factors of perioperative hypertension in dental implant surgeries with bone augmentation

Xiaoqiang LIU1,Yin ZHOU2,*()   

  1. 1. Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
    2. Department of Anesthesiology, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
  • Received:2022-10-10 Online:2024-02-18 Published:2024-02-06
  • Contact: Yin ZHOU E-mail:zhouyin@bjmu.edu.cn
  • Supported by:
    the Chinese Stomatological Association Research Fund(CSA-SIS2022-18);Research Seed Fund of Peking University First Hospital(2019SF36)

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摘要：

目的: 探索牙种植同期植骨术中, 围术期高血压的特点及相关危险因素。方法: 对北京大学口腔医院某门诊科室2021年9月至2022年8月的728例牙种植及植骨术患者进行回顾性队列研究, 分析研究对象围术期高血压与性别、年龄、手术时长、植骨术式4种暴露因素的关联性。结果: 牙种植同期植骨术中, 收缩压平均波动幅度为9.93%±6.63%(最大值50.41%), 舒张压平均波动幅度为12.45%±8.79%(最大值68.75%), 平均动脉压平均波动幅度为10.02%±6.61%(最大值为49.48%)。围术期高血压的发病率为26.77%。男性、年龄≥60岁、手术时长＞60 min是围术期高血压的危险因素(P＜0.05), 相对危险度(95%CI)分别为1.74(1.21~2.50)、2.35(1.54~3.58)和1.65(1.15~2.38)。引导性骨再生术、上颌窦内提升术、上颌窦外提升术3种植骨术式围术期高血压发病率差异无统计学意义(P＞0.05), 但不同植骨方式下围术期高血压的影响因素不同。引导性骨再生术围术期高血压的危险因素为男性、年龄≥60岁和手术时长＞60 min(P＜0.05);上颌窦内提升术围术期高血压的危险因素为年龄≥60岁(P＜0.05);而对于上颌窦外提升术, 男性、年龄≥60岁、手术时长＞60 min都不是围术期高血压的危险因素(P＞0.05)。结论: 牙种植同期植骨术中存在一定的围术期高血压风险, 男性、年龄≥60岁和手术时间＞60 min对围术期高血压的影响程度与植骨方式有关。

关键词: 牙种植, 骨再生, 血压, 危险因素, 队列研究

Abstract:

Objective: To investigate the characteristics and risk factors of perioperative hypertension during dental implant surgeries with bone augmentation. Methods: A retrospective cohort study was conducted. Seven hundred and twenty-eight cases underwent dental implant placement and bone augmentation in Peking University School and Hospital of Stomatology from September 2021 to August 2022 were recruited in this study according to the inclusion and exclusion criteria. They were divided into different groups according to the exposure factors which were gender, age, surgical time, and surgical approach. The correlation between perioperative hypertension and the exposure factors was analyzed. Results: The average systolic blood pressure variability was 9.93%±6.63% (maximum 50.41%), the average diastolic blood pressure variability was 12.45%±8.79% (maximum 68.75%), and the average mean arterial pressure variability was 10.02%±6.61% (maximum 49.48%). The incidence rate of perioperative hypertension was 26.77%. Male, age ≥ 60 years, and surgical time > 60 minutes were risk factors for perioperative hypertension (P < 0.05), and the relative risks (95%CI) were 1.74 (1.21-2.50), 2.35 (1.54-3.58), and 1.65 (1.15-2.38), respectively. There was no significant difference in the incidence of perioperative hypertension among the guided bone regeneration, sinus floor elevation with transalveolar approach, and sinus floor elevation with lateral window approach (P>0.05). However, the risk factors varied according to bone augmentation approaches. For the patients underwent guided bone rege-neration, the risk factors for perioperative hypertension included male, age ≥ 60 years, and surgical time > 60 minutes (P < 0.05). For the patients underwent maxillary sinus lift with transalveolar approach, the risk factor for perioperative hypertension was age ≥60 years (P < 0.05). For the patients underwent maxillary sinus lift with lateral window approach, male, age ≥60 years, and surgical time >60 minutes were not risk factors for perioperative hypertension (P>0.05). Conclusion: There was a certain risk of perioperative hypertension in oral implantation with bone augmentation. The influence of male, age ≥60 years and surgical time > 60 minutes on perioperative hypertension was related to the approach of bone augmentation.

Key words: Dental implantation, Bone regeneration, Blood pressure, Risk factors, Cohort studies

中图分类号: 

  • R782.12

表1

围术期血压变化特点和影响因素(n = 728)"

Items Hemodynamic changes/%
Systolic blood pressure Diastolic blood pressure Mean arterial pressure
Gender
  Male (n=318) 9.23±5.83 11.84±7.87 9.51±5.92
  Female (n=410) 10.47±7.16 12.93±9.42 10.42±7.07
  t -2.574 -1.710 -1.887
  P 0.010 0.088 0.060
Age
  ≥60 years (n=166) 10.79±6.94 11.68±7.57 9.93±6.28
  ＜60 years (n=562) 9.67±6.53 12.68±9.11 10.05±6.70
  t -1.915 1.438 0.202
  P 0.056 0.152 0.840
Surgical time
  ＞60 min (n=380) 10.44±7.16 12.37±8.70 10.11±6.82
  ≤60 min (n=348) 9.37±5.96 12.54±8.89 9.92±6.37
  t -2.209 0.264 -0.402
  P 0.028 0.792 0.688
Bone augmentation
  GBR (n=540) 9.74±6.59 12.30±8.50 9.87±6.62
  SFE-TA (n=143) 10.63±6.83 13.09±9.84 10.59±6.52
  SFE-LW (n=45) 10.01±6.48 12.23±8.70 9.95±6.75
  F 1.023 0.471 0.665
  P 0.360 0.625 0.515

表2

术前血压正常者围术期高血压特点和影响因素(n = 609)"

Items Perioperative hypertension χ2 P RR (95%CI)
(+) (-)
Gender 9.147 0.002 1.74 (1.21-2.50)
  Male (n=253) 84 (33.20) 169 (66.80)
  Female (n=356) 79 (22.19) 277 (77.81)
Age 16.267 ＜0.001 2.35 (1.54-3.58)
  ≥60 years (n=118) 49 (41.53) 69 (58.47)
  ＜60 years (n=491) 114 (23.22) 377 (76.78)
Surgical time 7.304 0.007 1.65 (1.15-2.38)
  ＞60 min (n=311) 98 (31.51) 213 (68.49)
  ≤60 min (n=298) 65 (21.81) 233 (78.19)

Bone augmentation approach
 0.242 0.886 -
  GBR (n=457) 120 (26.26) 337 (73.74)
  SFE-TA (n=117) 33 (28.21) 84 (71.79)
  SFE-LW (n=35) 10 (28.57) 25 (71.43)

表3

引导性骨再生术围术期高血压的特点和影响因素(n = 457)"

Items Perioperative hypertension χ2 P RR (95%CI)
(+) (-)
Gender 6.827 0.009 1.75 (1.15-2.67)
  Male (n=179) 59 (32.96) 120 (67.04)
  Female (n=278) 61 (21.94) 217 (78.06)
Age 10.184 0.001 2.22 (1.35-3.64)
  ≥60 years (n=85) 34 (40.00) 51 (60.00)
  ＜60 years (n=372) 86 (23.12) 286 (76.88)
Surgical time 7.291 0.007 1.80 (1.17-2.77)
  ＞60 min (n=245) 77 (31.43) 168 (68.57)
  ≤60 min (n=212) 43 (20.28) 169 (79.70)

表4

上颌窦内提升术围术期高血压的特点和影响因素(n = 117)"

Items Perioperative hypertension χ2 P RR (95%CI)
(+) (-)
Gender 2.600 0.107 1.95 (0.86-4.44)
  Male (n=57) 20 (35.09) 37 (64.91)
  Female (n=60) 13 (21.67) 47 (78.33)
Age 7.083 0.008 3.42 (1.34-8.77)
  ≥60 years (n=24) 12 (50.00) 12 (50.00)
  ＜60 years (n=93) 21 (22.58) 72 (77.42)
Surgical time 1.002 0.317 1.53 (0.66-3.56)
  ＞60 min (n=38) 13 (34.21) 25 (65.79)
  ≤60 min (n=79) 20 (25.32) 59 (74.68)

表5

上颌窦外提升术围术期高血压的特点和影响因素(n = 35)"

Group Perioperative hypertension P RR (95%CI)
(+) (-)
Gender >0.999 1.08 (0.25-4.70)
  Male (n=17) 5 (29.41) 12 (70.59)
  Female (n=18) 5 (27.78) 13 (72.22)
Age 0.694 1.36 (0.26-6.94)
  ≥60 years (n=9) 3 (33.33) 6 (66.67)
  ＜60 years (n=26) 7 (26.92) 19 (73.08)
Surgical time >0.999 1.00 (0.16-6.26)
  ＞60 min (n=28) 8 (28.57) 20 (71.43)
  ≤60 min (n=7) 2 (28.57) 5 (71.43)
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ISSN 1671-167X
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