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.

图/表 4

表1

表2

表3

表4

参考文献 20

[1]	Bystritsky A, Kronemyer D. Stress and anxiety: counterpart elements of the stress/anxiety complex[J]. Psychiatr Clin North Am, 2014,37(4):489-518. doi: 10.1016/j.psc.2014.08.002 pmid: 25455062
[2]	Fukayama H, Yagiela JA. Monitoring of vital signs during dental care[J]. Int Dent J, 2006,56(2):102-108. doi: 10.1111/j.1875-595x.2006.tb00081.x pmid: 16620039
[3]	Brand HS, Abraham-Inpijn L. Cardiovascular responses induced by dental treatment[J]. Eur J Oral Sci, 1996,104(3):245-252. pmid: 8831058
[4]	中国心胸血管麻醉学会, 北京高血压防治协会. 围术期高血压管理专家共识[J]. 临床麻醉学杂志, 2016,32(3):295-297.
[5]	Getsios D, Wang Y, Stolar M, et al. Improved perioperative blood pressure control leads to reduced hospital costs[J]. Expert Opin Pharmacother, 2013,14(10):1285-1293. pmid: 23656583
[6]	Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension[J]. J Hypertens, 2014,32(1):3-15. pmid: 24270181
[7]	Montebugnoli L, Servidio D, Miaton RA, et al. Heart rate variability: A sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure[J]. J Am Dent Assoc, 2004,135(12):1718-1723.
[8]	Kim YK, Kim SM, Myoung H. Musical intervention reduces patients’ anxiety in surgical extraction of an impacted mandibular third molar[J]. J Oral Maxillofac Surg, 2011,69(4):1036-1045. pmid: 20708320
[9]	Lin CS, Wu SY, Yi CA. Association between anxiety and pain in dental treatment: A systematic review and meta-analysis[J]. J Dent Res, 2017,96(2):153-162. doi: 10.1177/0022034516678168 pmid: 28106507
[10]	Salma RG, Abu-Naim H, Ahmad O, et al. Vital signs changes during different dental procedures: A prospective longitudinal cross-over clinical trial[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2019,127(1):30-39. pmid: 30219249
[11]	Alemany-Martinez A, Valmaseda-Castellon E, Berini-Aytes L, et al. Hemodynamic changes during the surgical removal of lower third molars[J]. J Oral Maxillofac Surg, 2008,66(3):453-461. pmid: 18280377
[12]	Matsumura K, Miura K, Takata Y, et al. Changes in blood pressure and heart rate variability during dental surgery[J]. Am J Hypertens, 1998,11(11 Pt 1):1376-1380. pmid: 9832183
[13]	Wada M, Miwa S, Mameno T, et al. A prospective study of the relationship between patient character and blood pressure in dental implant surgery[J]. Int J Implant Dent, 2016,2(1):21. pmid: 27807782
[14]	Nichols C. Dentistry and hypertension[J]. J Am Dent Assoc, 1997,128(11):1557-1562. pmid: 9368441
[15]	Campbell NRC, Zhang XH. Hypertension in China: Time to transition from knowing the problem to implementing the solution[J]. Circulation, 2018,137(22):2357-2359. pmid: 29844071
[16]	Silvestre FJ, Salvador-Martinez I, Bautista D, et al. Clinical study of hemodynamic changes during extraction in controlled hypertensive patients[J]. Med Oral Patol Oral Cir Bucal, 2011,16(3):e354-358. pmid: 21196862
[17]	Ogunlewe MO, James O, Ajuluchukwu JN, et al. Evaluation of haemodynamic changes in hypertensive patients during tooth extraction under local anaesthesia[J]. West Indian Med J, 2011,60(1):91-95. pmid: 21809720
[18]	范少光, 汤浩. 人体生理学[M]. 3版. 北京: 北京大学医学出版社, 2008.
[19]	Hollander MH, Schortinghuis J, Vissink A. Changes in heart rate during third molar surgery[J]. Int J Oral Maxillofac Surg, 2016,45(12):1652-1657. pmid: 27575392
[20]	Svorc P Jr, Bacova I, Svorc P, et al. Autonomic nervous system under ketamine/xylazine and pentobarbital anaesthesia in a Wistar rat model: A chronobiological view[J]. Prague Med Rep, 2013,114(2):72-80. doi: 10.14712/23362936.2014.25 pmid: 23777798

相关文章 15

[1]	魏慧, 张警丰, 姚中强, 赵金霞. 类风湿关节炎合并慢性病贫血患者的临床特征及相关因素[J]. 北京大学学报（医学版）, 2026, 58(2): 307-312.
[2]	赵杰, 付春, 赵秀娟, 薛海岩, 李纾, 王振洲, 朱凤雪. 胸部创伤患者在重症监护病房内发生呼吸机相关性肺炎的危险因素[J]. 北京大学学报（医学版）, 2026, 58(2): 351-358.
[3]	刘嘉昱, 祝宁, 张育祯, 高贤明, 张宇. 动态导航辅助环钻取骨的准确性[J]. 北京大学学报（医学版）, 2026, 58(2): 365-371.
[4]	郭芷均, 俎明, 马超, 张贺军, 张静, 丁士刚. 同时性多发早期胃癌漏诊病灶的临床病理特征[J]. 北京大学学报（医学版）, 2026, 58(2): 410-415.
[5]	杨咏涛, 田淯文, 单珅瑶, 李文博, 商相宜, 王艺蓁, 郭殊玮, 高梓翔, 温奥楠, 赵一姣, 王勇. 基于多视图立体视觉的无牙颌种植固定修复软组织数字印模的方法[J]. 北京大学学报（医学版）, 2026, 58(1): 126-132.
[6]	范梦, 王梦莹, 王斯悦, 彭和香, 王雪珩, 郭煌达, 侯天姣, 秦雪英, 陈大方, 胡永华, 李劲, 武轶群, 吴涛. 动脉硬化相关指标与死亡风险的前瞻性队列研究[J]. 北京大学学报（医学版）, 2025, 57(6): 1153-1159.
[7]	王宇蓝, 曾浩, 张玉峰. 口腔种植中血浆基质的临床转化现状与前沿探索[J]. 北京大学学报（医学版）, 2025, 57(5): 836-840.
[8]	李博闻, 张强, 孙益鑫. 儿童及青年漏斗胸患者Nuss术后发生脊柱侧弯的风险预测模型建立及验证[J]. 北京大学学报（医学版）, 2025, 57(5): 941-946.
[9]	杨小勇, 张帆, 马潞林, 刘承. 前列腺导管腺癌临床特征及腺外侵犯的影响因素[J]. 北京大学学报（医学版）, 2025, 57(5): 956-960.
[10]	于子杨, 郭厚佐, 蒋析, 韩玮华, 林野. 穿颧种植体上颌窦段成骨的影像学研究[J]. 北京大学学报（医学版）, 2025, 57(5): 967-974.
[11]	刘伟, 郭稳, 过哲, 李春艳, 李云龙, 刘思奇, 张亮, 宋慧. 痛风患者放射学阴性骨侵蚀的相关危险因素[J]. 北京大学学报（医学版）, 2025, 57(4): 735-739.
[12]	陆梦溪, 刘秋萍, 周恬静, 刘晓非, 孙烨祥, 沈鹏, 林鸿波, 唐迅, 高培. 基于社区人群队列的甘油三酯-葡萄糖指数与心血管病发病和死亡的关联[J]. 北京大学学报（医学版）, 2025, 57(3): 430-435.
[13]	杨龙傲, 金旭, 黄文初, 何丽华, 陈娟. 视屏作业人员视疲劳及干眼的流行病学调查[J]. 北京大学学报（医学版）, 2025, 57(3): 554-561.
[14]	郭华秋, 王哲, 杨雪, 白洁. 口腔急诊出血患者的临床特征与危险因素[J]. 北京大学学报（医学版）, 2025, 57(1): 142-147.
[15]	邓敏婷, 王楠, 夏斌, 赵玉鸣, 朱俊霞. 儿童及青少年挫入恒前牙自行再萌出的相关影响因素[J]. 北京大学学报（医学版）, 2025, 57(1): 148-153.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

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)