640例单牙种植术对血压和心率影响的队列研究

doi:10.19723/j.issn.1671-167X.2021.02.026

摘要/Abstract

摘要：

目的: 探索单牙种植术中的血压和心率变化及其影响因素。方法: 对北京大学口腔医院修复科2016年收治的640例单牙种植术病例进行队列研究,分析种植术中血压和心率波动与患者特征(性别、年龄)和手术方式(即刻种植、翻瓣、植骨)共5种暴露因素的关联性。结果: 单牙种植术中,收缩压的平均波动幅度为9.47%±6.45%(最大值46.04%),舒张压的平均波动幅度为12.18%±9.39%(最大值88.00%),心率的平均波动幅度为 10.59%±7.68%(最大值49.12%)。年龄和植骨手术对血压波动幅度的影响、性别和即刻种植手术对心率波动幅度的影响有统计学意义(P<0.05)。术中血压异常升高的发生率为4.69%,其中收缩压≥180 mmHg和/或舒张压≥110 mmHg者共4例(0.63%);术中心率异常升高的发生率为6.72%。分层分析表明,男性患者中的老年病例(≥60岁)以及翻瓣植骨手术病例发生术中血压异常升高的风险较高[分别为P<0.05,RR=3.409(95%CI:1.155~10.062)和P<0.05,RR=2.382(95%CI:1.126~5.040)]。术中心率异常升高与患者特征及手术方式之间的关联性无统计学意义(P>0.05)。结论: 单牙种植术中存在一定的血压波动和心率波动风险,老年男性患者和翻瓣植骨手术是术中血压异常升高的危险因素。

关键词: 牙种植, 血压, 心率, 危险因素, 队列研究

Abstract:

Objective: To investigate the blood pressure and heart rate changes and influencing factors during single dental implant surgery. Methods: A retrospective cohort study was conducted. Six hundred and forty cases underwent single dental implant placement in Department of Prosthodontics, Peking University School and Hospital of Stomatology from January 2016 to December 2016 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 patient characteristics (gender, age) and surgical procedures (immediate placement, flap elevation, bone grafting). The correlation between blood pressure and heart rate variability during single dental implant surgery and the patient characteristics and surgical procedures were analyzed. Results: The average systolic blood pressure variability was 9.47%±6.45% (maximum 46.04%), the average diastolic blood pressure variability was 12.18%±9.39% (maximum 88.00%), and the average heart rate variability was 10.59%±7.68% (maximum 49.12%). The effects of age and bone grafting on blood pressure variability, and of gender and immediate placement on heart rate variability, were statistically significant (P<0.05), respectively. The incidence of abnormal intraoperative blood pressure rise was 4.69%, of which there were 4 cases (0.63%) of systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥110 mmHg. The incidence of abnormal intraoperative heart rate rise was 6.72%. Hierarchical analysis showed a higher risk of abnormal intraoperative blood pressure rise in the elderly (≥60 years) male patients [P<0.05, RR=3.409 (95%CI: 1.155-10.062) ] and flap elevation with bone grafting cases [P<0.05, RR=2.382 (95%CI: 1.126-5.040)], respectively. There was no statistically significant association between abnormal heart rate rise and patient characteristics or surgical procedures (P>0.05). Conclusion: There was a certain risk of blood pressure and heart rate variability during dental implant surgery. Elderly male patients and flap elevation with bone grafting were risk factors of abnormal intraoperative blood pressure rise.

Key words: Dental implantation, Blood pressure, Heart rate, Risk factors, Cohort studies

中图分类号:

R783

刘晓强,杨洋,周建锋,刘建彰,谭建国. 640例单牙种植术对血压和心率影响的队列研究[J]. 北京大学学报（医学版）, 2021, 53(2): 390-395.

LIU Xiao-qiang,YANG Yang,ZHOU Jian-feng,LIU Jian-zhang,TAN Jian-guo. Blood pressure and heart rate changes of 640 single dental implant surgeries[J]. Journal of Peking University (Health Sciences), 2021, 53(2): 390-395.

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Groups		Hemodynamic changes/%
Groups		Systolic blood pressure	Diastolic blood pressure	Heart rate
Gender	Female (n=356)	8.97 ± 6.14	12.41 ± 9.06	11.26 ± 8.15
	Male (n=284)	9.87 ± 6.67	11.89 ± 9.79	9.74 ± 6.96
	t	-1.781	-0.700	-2.534
	P	0.075	0.484	0.012
Age	≥60 years (n=89)	11.55 ± 8.30	12.33 ± 13.07	9.30 ± 7.32
	<60 years (n=551)	9.13 ± 6.04	12.16 ± 8.67	10.79 ± 7.72
	t	2.637	0.123	-1.704
	P	0.010	0.902	0.089
Immediate placement	Yes (n=69)	9.87 ± 6.29	13.55 ± 9.41	13.03 ± 9.21
	No (n=571)	9.42 ± 6.48	12.01 ± 9.38	10.29 ± 7.43
	t	0.551	1.280	2.382
	P	0.582	0.201	0.020
Flap surgery	Yes (n=593)	9.56 ± 6.57	12.16 ± 9.38	10.46 ± 7.48
	No (n=47)	8.39 ± 4.73	12.46 ± 9.68	12.16 ± 9.75
	t	1.571	-0.216	-1.164
	P	0.121	0.829	0.250
Bone grafting	Yes (n=197)	10.89 ± 7.46	13.43 ± 9.90	11.29 ± 8.06
	No (n=443)	8.84 ± 5.85	11.62 ± 9.11	10.27 ± 7.49
	t	3.412	2.250	1.555
	P	0.001	0.025	0.120

Groups		Abnormal blood pressure rise, n		Abnormal heart rate rise, n
Groups		(+)	(-)	(+)	(-)
Gender	Female (n=356)	15	341	22	334
	Male (n=284)	15	269	21	263
	χ²	0.403		0.372
	P	0.525		0.542
Age	≥60 years (n=89)	7	82	7	82
	<60 years (n=551)	23	528	36	515
	χ²	2.336		0.217
	P	0.126		0.642
Immediate placement	Yes (n=69)	4	65	3	66
	No (n=571)	26	545	40	531
	χ²	0.213		0.694
	P	0.644		0.405
Flap surgery	Yes (n=593)	28	565	39	554
	No (n=47)	2	45	4	43
	χ²	0.021		0.260
	P	0.884		0.610
Bone grafting	Yes (n=197)	14	183	16	181
	No (n=443)	16	427	27	416
	χ²	3.728		0.894
	P	0.054		0.344

Groups		Abnormal blood pressure rise, n		Abnormal heart rate rise, n
Groups		(+)	(-)	(+)	(-)
Female	≥60 years (n=39)	1	38	1	38
	<60 years (n=317)	14	303	21	296
	χ²	0.295		0.988
	P	0.587		0.320
	RR (95%CI)	0.570 (0.073-4.454)		0.371 (0.049-2.836)
Male	≥60 years (n=50)	6	44	6	44
	<60 years (n=234)	9	225	15	219
	χ²	5.475		1.880
	P	0.019		0.170
	RR (95%CI)	3.409 (1.155-10.062)		1.991 (0.732-5.415)

Groups	Abnormal blood pressure rise, n		Abnormal heart rate rise, n
Groups	(+)	(-)	(+)	(-)
Flap elevation and bone grafting (n=186)	14	172	13	173
Others (n=454)	15	439	28	426
χ²	5.439		0.149
P	0.020		0.700
RR (95%CI)	2.382 (1.126-5.040)		1.143 (0.579-2.259)