Effect of Informed Consent on the Stress of Dental Treatment

为了解知情同意在实验性牙科治疗中的减压效果，采用心理测试、血流动力学和血浆儿茶酚胺作为记录压力的指标。受试者为28名志愿者，均为在校学生和医生，平均年龄24.9岁。他们被分成两组；一组在实验前被详细告知了这一程序(I.C.组)，另一组根本不被告知(n-I.C.组)。采用状态-特质焦虑量表(STAI)和100 mm视觉模拟量表(VAS)测量焦虑。一旦坐在牙科椅子上，受试者在实验前再次完成STAI和VAS以评估焦虑。I.C.组的受试者在被告知实验情况后，完成了STAI和VAS。所有受试者均仰卧在牙科椅子上休息。留置21号静脉导管，采集静息血样，测量血压、脉搏和指端血流量。受试者取上颌骨印迹或用3%普罗托卡因0.9ml和加压素在上中切牙的唇齿区进行渗透麻醉。实验前状态焦虑显著高于正常静息期。在取模过程中，I.C.组在取模后15min与静息状态相比，收缩压显著降低，且两组间差异有统计学意义。在渗透麻醉期间，n-I.C.组的指端血流量显著减少。目前的数据表明，交感神经活动表明，知情同意有助于减轻实验性牙科治疗期间的压力。

To clarify stress reducing effect of informed consent on experimental dental treatment, psychological test, hemodynamics and plasma catecholamine were used as indication of stress during impression taking and infiltration anesthesia. The subjects were 28 volunteers, who weredental students and doctors (mean age 24.9 years). They were divided into two groups ; one group was informed about the procedure in detail before the experiment (I.C.group), while the other group was not informed at all (n-I.C.group). Anxiety was measured using State-Trait Anxiety Inventory (STAI) and a 100 mm visual analogue scale (VAS). Once seated in the dental chair, the subjects completed the STAI again and the VAS to evaluate anxiety before the experiment. Subjects in the I.C.group completed the STAI and the VAS after they were informed about the experiment. All subjects rested in a supine position on the dental chair. A 21 gauge intravenous catheter was inserted, blood samples at rest were collected and blood pressure, pulse and fingertip blood flow were measured. The subjects were taken impression of maxilla or received infiltration anesthesia using 0.9 ml 3% propitocaine with felypressin into the area of the labial gingiva at the upper central incisor.1. In the n-I.C.group, state anxiety before the experiment increased significantly compared with that in the normal resting stage.2. During taking impression, systolic blood pressure in the I.C.group decreased significantly at 15 minutes after taking impression compared with that in the resting condition, and showed a significant difference between the two groups.3. During infiltration anesthesia fingertip blood flow decreased significantly in the n-I.C.group.The present data suggest that informed consent is useful for reducing stress during experimental dental treatment as indicated by the sympathetic activity.