快適な歯科治療を目指して―自律神経解析からみた歯科治療が患者におよぼす影響―

目的：牙医体验到患者在牙科治疗过程中变得不愉快。对于牙科患者来说，晕厥、圆周漂移是由于对治疗的恐惧感和焦虑、植针、疼痛而发生的。我们记录了患者在牙科治疗期间的自主神经活动。目的：探讨口腔外科手术(拔除第三磨牙，门诊患者行小手术)对患者自主神经活动的影响。将患者分为对照组(单纯监测组，C组)和静脉镇静组(咪达唑安组，S组)。无创性测量血压、心率、脉搏血氧分压(BP-88，Nippon Coline)、心率变异性(Tarawa/Win，CMS)。观察给药前(Pre)、给药后(仅S组)、Th…分别于局部麻醉时间(1a)、5min后(1a后)、拔牙时间(Ext)、治疗后(Post)进行比较。为了寻找低频成分(LF)和高频成分(HF)，我们将LF/HF作为交感神经活动，HF作为副交感神经活动。S组与C组比较。结果：C组各时间点血压无变化，S组血压下降，两组术后心率均呈上升趋势。C组自主神经活动无明显变化。S组拔除第三磨牙对患者自主神经活动的影响。在循环改变方面，考虑到局麻药的影响，两组患者术后心率都有所增加。此外，由于咪达唑仑镇静对循环的抑制作用，S组静脉镇静有助于降低血压。这种方法不能捕捉到牙科正在治疗的自主神经活动，或治疗的针痛和疼痛移动身体，并可能影响自主神经活动的记录。然而，当牙科治疗恐惧症患者在静脉穿刺时出现意识障碍时，我们能够观察到低血压，心动过缓循环抑制，以及自主神经活动时LF/HF略有下降，HF略有上升。在静脉镇静中需要进行静脉穿刺术以缓解应激，认为应多加考虑，以免出现不适症状。较少

Purpose: The dentists experience that the patient during dental treatment becomes unpleasant. For the dental patient It is thought that syncope, circle drifting occur by fear feeling for treatment and anxiety, needle implant, pain. We recorded autonomic nerve activity during dental treatment of the patient. We were aimed at reviewing whether autonomic nerve activity of the dentist patients took any kind of influence by the treatment.Methods: We investigated the influence that oral surgery treatment (extraction ofthird molar and minor surgery for the outpatients)gives autonomic nerve activity. We divided the patient into control group (only monitoring, groupC) and intravenous sedation group(by Midazoiam, group S). We observed systolic blood pressure and diastolic blood pressure by noninvasive measurement, heart rate, SpO2 (BP-88, Nippon Coline), heart rate variability (Tarawa/Win, CMS). We observed it pre-treatment (pre), after administration of sedative agent (sed: only S group), at th … More e time of a local anesthesia (la), local anesthesia five minutes later (post-la), extraction (ext), post-treatment (post). In search of a low frequency ingredient (LF) and a high frequency ingredient (HF),we evaluated LF/HF as sympathetic nervous activity, HF as parasympathetic nerve activity. We compared group S with group C.Results: The blood pressure did not have a change in group C by each measurement time, decreased sed in group S. The heart rate showed a rise tendency in post-la in both groups. The autonomic nerve activity did not accept a change in LF/HF and HF of each measurement time in group C. In group S, HF became a fall tendency by each measurement time after sed.Discussion: It was investigated the influence that the third molar extraction gave autonomous nerve activity of the patient. About a circulation change, the heart rate rise in post-la by both groups was thought about with influence of local anesthetibs. In addition, as a circulation inhibition effect by midazolam sedation, it was thought that the intravenous sedation was useful for decrease of blood pressure in sed in group S. The autonomous nerve activity that dentistry was under treatment was not able to be caught in this methods or a pain of a needte and a pain of treatment moved a body, and a record of autonomous nerve activity may have beenbninfluenced. However, when unconsciousness was caused at vein puncture with the dentistry treatment phobia patient, we were able to observe hypotension, bradycardrc circulation inhibition, and a slight LF/HF fall and a slight HF rise as autonomous nerve activity. To need vein puncture in intravenous sedation for stress relaxation, it was thought that consideration more was necessary so that an unpleasant symptom was not caused. Less