智障患者牙齒治療的麻醉方法

Anesthetic Management of Dental Procedures in Mentally Handicapped Patients

背景：對牙科醫師及麻醉醫師來說提供智障患者的牙科治療都是一個挑戰。本研究回溯性的對三年來本院對智障患者提供不同的麻醉方法，以使牙科醫師治療智障患者牙科的問題做描述性的分析。方法：我們回溯性收集由1997年12月1日到2000年11月30日在本院施行麻醉以便治療牙科問題的智障患者。我們收集患者的基本資料，術中，術後及回家的合併症予以追蹤記錄及比較。我們對患者的基本資料依麻醉方法以t-test做比較，患者術中，術後及回家的合併症以Chi-square test做比較。我們以P < 0.05為統計上的顯著差異。結果：三年之中，本科收集了1201位智障患者以麻醉方式治療其牙齒問題的案例。其中10位患者使用鼻罩併用靜脈靜鎮麻醉，112位患者使用靜脈麻醉，249位患者使用氣管插管麻醉，826位患者使用強化型喉頭罩插管麻醉。4位患者因為在治療期間改變麻醉方式而不列入比較範圍。使用鼻罩合併鎮靜麻醉及靜脈麻醉的智障患者有較高(P < 0.05)的術中低血氧(Sp02 < 90％)。氣管插管麻醉產生較高的術後及回家後合併症，但統計上並沒有差異(P > 0.05)，噁心，嘔吐是較大的合併症。結論：三年期間我們對1197位智障患者以四種麻醉方法以方便治療其牙齒問題。四種麻醉方法各有其優點及缺點。我們認為在術中使用強化型喉頭罩及氣管插管麻醉方法在治療智障患者上比另兩種方法安全。

Background: Providing dental care to a mentally handicapped patient is a challenge to both dentist and anesthesiologist. This study was aimed to describe the anesthetic methods which were used to facilitate dental treatments in mentally handicapped patients at a medical university hospital in Taiwan during a three-year period. Methods: The data referring to anesthetic techniques to facilitate dental treatments during the period from Dec. 1, 1997 to Nov. 30, 2000 were retrospectively collected. In the period, there were four different anesthetic techniques in application: nasal mask technique combined with intravenous sedation, total intravenous anesthesia, laryngeal mask intubating general anesthesia and endotracheal intubating general anesthesia. Basic characteristics of patients were compared with student t-test between groups according to anesthetic technique used. Intraoperative and postoperative complications and complaints collected were analyzed by chi-square test between anesthetic techniques. P value less than 0.05 was considered statistically significant. Results: The anesthetic records of 1201 mentally handicapped patients who underwent dental procedures over the three-year period were reviewed. Anesthesia was accomplished with nasal mask technique combined with intravenous sedation in 10 patients, with intravenous anesthesia in 112 patients, with endotracheal intubation anesthesia in 249 patients and with reinforced laryngeal mask anesthesia in 826 patients. Four patients were excluded from study because of changing of anesthetic method during the dental procedure. The use of nasal mask combined with intravenous sedation and intravenous anesthesia caused a higher incidence of intraoperative hypoxemia (P < 0.05) in comparison with the groups of endotracheal intubation anesthesia and reinforced laryngeal mask anesthesia. Although patients anesthetized by intravenous anesthetics had less postoperative complaints or complications but the difference was not statistically significant (P > 0.05) when group comparison was made. Patients who were anesthetized by volatile agents through endotracheal tube had the highest rate of postoperative complication although the difference was of no significance (P > 0.05) when comparison between groups was made. Conclusions: We provided four different anesthetic methods for 1197 mentally handicapped patients who underwent dental procedures in three years. All anesthetic methods had their advantages and disadvantages. Using reinforced laryngeal mask or endotracheal intubation for general anesthesia to facilitate dental procedures for such patients had greater intraoperative safety than other two methods. However, less postoperative complaints or complications were revealed with the methods of nasal mask combined with intravenous sedation and intravenous anesthesia.