本文選題：笑氣 + 高速氣渦輪手機��； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的目前,下頜阻生智齒的拔除是口腔頜面外科門診中最常見的手術(shù)之一,是臨床常見病和多發(fā)病。然而在口腔門診患者中存在很多牙科焦慮癥患者,對口腔治療尤其是拔牙感到緊張、害怕,甚至逃避治療�；颊叩木o張、焦慮、不配合給醫(yī)生的治療帶來困難,同時也使患者在心理上備受煎熬。笑氣/氧氣吸入鎮(zhèn)靜技術(shù)是一種安全有效、可提高患者痛閾、減輕疼痛,并減輕或消除焦慮,使患者達到放松、舒適、合作的鎮(zhèn)靜技術(shù)。而高速氣渦輪手機作為目前口腔頜面外科門診拔牙最常用的微創(chuàng)拔牙器械,已經(jīng)得到了基本的普及。本文主要探討濃度分別為40%、60%的笑氣吸入清醒鎮(zhèn)靜法結(jié)合高速氣渦輪手機在牙科焦慮癥患者下頜阻生第三磨牙拔除術(shù)中的臨床效果。方法選擇2015年7月—2016年8月于安徽省口腔醫(yī)院口腔頜面外科門診拔除下頜阻生第三磨牙牙科焦慮癥患者120例,納入標準符合:(1)患者全身健康情況為美國麻醉醫(yī)師協(xié)會評分指標Ⅰ級~Ⅱ級;(2)有牙科焦慮癥狀,表現(xiàn)為對診療過程恐懼、緊張、逃避等;(3)下頜阻生第三磨牙需符合牙根發(fā)育完成、中位或低位阻生、近中傾斜等條件;(4)下頜第二磨牙無松動、無傾斜,對拔牙過程不產(chǎn)生影響;(5)無藥物過敏史;(6)無智力障礙,無溝通障礙,能正確判斷疼痛強度;(7)無拔牙禁忌證,患者經(jīng)知情同意志愿參加本實驗并簽署知情同意書。120例患者隨機分為三組,每組40例:A組(40%笑氣濃度+局麻),B組(60%笑氣濃度+局麻),C組對照組只在局麻下拔牙。拔牙過程中三組患者均在心電監(jiān)護儀下監(jiān)測心率和血氧飽和度,觀察記錄手術(shù)前、中、后各項生命體征變化,術(shù)后對各組患者進行VAS疼痛評分以及Ramsay鎮(zhèn)靜評分,并對結(jié)果進行統(tǒng)計分析。結(jié)果1.生物學指標觀察結(jié)果采用重復測量數(shù)據(jù)的方差分析法得出A組患者與B組患者三個時間點的HR、Sp O2差異無顯著性(P0.05),C組患者與A、B組患者三個時間點的HR、Sp O2均有顯著性差異(P0.05)。2.鎮(zhèn)靜程度觀察結(jié)果A組患者與B組患者在局麻時的Ramsay評分無顯著性差異(P0.05),但是B組患者的鎮(zhèn)靜程度與A組相比較高。C組患者與A、B組患者在局麻時的Ramsay評分均有顯著性差異(P0.05)。三組患者的Ramsay評分在拔牙時均有顯著性差異(P0.05)。3.疼痛程度觀察結(jié)果三組患者的VSA評分在局麻時均有顯著性差異(P0.05),A組患者與B組患者在拔牙時的VAS評分無顯著性差異(P0.05),但是B組患者的鎮(zhèn)痛程度與A組患者相比較好。C組患者與A、B組患者在拔牙時的VAS評分均有顯著性差異(P0.05)因此,試驗組和對照組在手術(shù)過程中,生命體征變化評估以及鎮(zhèn)靜鎮(zhèn)痛的效果比較差異均有統(tǒng)計學意義(P0.05)。結(jié)論笑氣吸入清醒鎮(zhèn)靜技術(shù)具有減輕焦慮、鎮(zhèn)痛鎮(zhèn)靜作用,能使患者更好地配合治療,有利于手術(shù)的進行,且60%笑氣濃度較40%效果更佳,值得臨床推廣應(yīng)用。
[Abstract]:Objective at present, extraction of mandibular impacted wisdom teeth is one of the most common operations in oral and maxillofacial surgery. However, there are many dental anxiety patients in oral outpatients, who feel nervous, afraid and even avoid treatment for oral treatment, especially tooth extraction. Nervousness, anxiety, and lack of coordination make it difficult for doctors to treat, and they suffer psychologically. Nitrous oxide / oxygen inhalation sedation technique is a safe and effective sedative technique, which can increase pain threshold, relieve pain, relieve or eliminate anxiety, and make patients relax, comfortable and cooperate. As the most commonly used minimally invasive tooth extraction device in oral and maxillofacial surgery clinic, high speed gas turbine phone has been widely used. The purpose of this study was to investigate the clinical effect of 40% nitrous oxide inhaled conscious sedation combined with high speed gas turbine cell phone in the extraction of mandibular impacted third molar in patients with dental anxiety. Methods from July 2015 to August 2016, 120 patients with mandibular impacted third molar dental anxiety were selected from oral and maxillofacial surgery clinic of Anhui Oral Hospital. The general health status of the patients was evaluated by the American Association of Anesthesiologists, grade 鈪，

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