施行全身麻醉後口腔組織損傷的發生率

Incidence of Oral Tissue Trauma after the Administration of General Anesthesia

背景：實施全身麻醉時，免不了要在病人口腔內作各項操作和放置不同的器具，因此，有可能造成口腔組織或牙齒的傷害，本研究的目的，在探討施行全身麻醉後，口腔組織損傷的發生率及可能與其有關的危險因子。方法：本前瞻性研究，包括404位在氣管插管全身麻醉下，接受各種不同外科手術的成年病人，在手術前後，由口腔外科大夫對每一位病人的口腔和牙齒情況，作詳細檢查並記錄，據此計算口腔組織損傷的發生率，並記錄損傷的類型。結果：28位病人(6.9％)，有若干程度的口腔組織損傷，主要包括軟組織撕裂傷、牙齒斷裂、贋複體損毀、牙齒脫落、皮下瘀血和舌頭麻痺等，其中有缺牙、牙冠、及牙根病者，可能是加深此一損傷發生的危險因素。結論：口腔組織損傷並非罕見，理應視為全身麻醉術的風險之一，麻醉醫師如果能對人體口腔的病理變化，有更多的了解和認識，或許可以預防口腔組織和牙齒的傷害，並避免醫療糾紛的發生。

Background: Administration of general anesthesia necessitates certain amounts of manipulation or instrumentation within the mouth that may cause some oral tissue injuries. The purpose of this study was to determine the incidence of oral tissue trauma after receiving general anesthesia. Some possible risk factors were explored. Methods: Four hundred and four adult patients receiving surgical procedures under general anesthesia facilitated by endotracheal intubation were included in this prospective survey. In each patient detailed oral and dental conditions were evaluated and recorded by an oral surgeon before and after operation. The extent of oral tissue trauma were computed and the type and character of the injury were recorded. Results: Twenty-eight patients (6.9%) were found to sustain various degrees of oral trauma that included soft tissue laceration, tooth fracture, prosthesis damage, tooth avulsion, ecchymosis and numbness of tongue. Preexistence of missing tooth, crown, and residual root were some possible risk factors that might predispose to complication. Conclusions: Oral tissue trauma as it seems to be a common anesthetic complication that should be considered as a recognized hazard of general anesthesia. Understanding and recognizing oral anatomical condition and pathological change before anesthesia may help the anesthesiologists in preventing oral and dental complications and thus to avoid legal suits.