Thesis or Dissertation 健全な若年成人における局所麻酔時の音楽鎮静法の効果 : 心拍変動解析を用いた自律神経機能評価

小田中, 瞳 

目的:歯科治療に対して恐怖心を有している患者は多く,その中でも局所麻酔は全身的偶発症の発生頻度が高いため,局所麻酔時の恐怖心や不安感を軽減させることは,安心・ 安全な歯科治療を行うために重要である.そのための簡便な方法の一つとして音楽鎮静法があるが,歯科領域ではまだ十分には検討されていない.そこで,本研究の目的は,健全 な若年成人に対して局所麻酔を行った際の音楽鎮静法の効果について筆者らが開発したモニターシステムを用いて自律神経機能の変化によって評価することである. 対象と方法:22 名(26.5±1.9 歳)の健全な若年成人ボランティアを対象とした.同一被 験者に対して音楽鎮静法を行わない非音楽鎮静群と音楽鎮静法を行う音楽鎮静群を設けた.非音楽鎮静群と音楽鎮静群を行う順序は中央割付法でランダム化して決定した.最初 に質問票(DAS)を用いて歯科治療に対する恐怖心を評価した.次に非音楽鎮静群では, 麻酔前座位(5 分間),麻酔前仰臥位(5 分間),局所麻酔(1/80000 エピネフリン添加塩酸 リドカイン)(2 分間),麻酔後仰臥位(5 分間)を順に行った際の血圧,心拍数および自律神経機能について本モニターシステムを用いて評価した.音楽鎮静群では音楽鎮静開始後 に同様の評価を行った.また,麻酔前後の不安感について VAS による評価を行った.自律 神経機能は,心電図の R-R 間隔を高周波成分(HF)と低周波成分(LF)に周波数解析す ることで,交感神経機能(LF/HF)を評価した.統計学的分析は,Friedman test, Wilcoxon signed-rank test を用いて行った(p<0.05). 結果:血圧,心拍数および VAS は,各段階でほとんど変化がなく,有意な差は認められ なかった.LF/HF は,両群ともに局所麻酔薬注入時に麻酔前座位時よりも有意に低い値を示した.また,麻酔前座位時および麻酔前仰臥位時に非音楽鎮静期よりも音楽鎮静期で有意に低い値を示した. 結論: 健全な若年成人では,音楽鎮静法を行った際は,音楽鎮静法を行わなかった際と 比較して局所麻酔前の座位時および仰臥位時において交感神経機能が低下する.
Purpose: Many patients experience fear and anxiety towards dental treatment. It is important to reduce the fear and anxiety of local anesthesia for safe and secure dental treatment, because systemic complications frequently occur during local anesthesia. Music sedation is thought to be a convenient method for supporting safe and secure dental treatment. However, this method has not been fully investigated in the dental field. The purpose of this study was to evaluate the effect of music sedation during local anesthesia for healthy young adults by measuring the variance of autonomic nervous function (ANF) using a novel system we developed. Methods: The study subjects were 22 healthy young volunteers (mean age 26.5 ± 1.9 years). Amusic sedation phase and no music sedation phase were performed on each subject. The sequence of these phases was randomly allocated to the subjects using a central allocation method. First, subject anxiety towards dental treatment was evaluated using Corah’s Dental Anxiety Scale. In the no music sedation phase, the monitoring system was used to assess blood pressure (BP), heart rate (HR), and ANF for 5 minutes prior to anesthesia (pre-anesthesia) in both the sitting and supine positions, 2 minutes during administration of local anesthesia, and 5 minutes after anesthesia (post-anesthesia) in the supine position. In the music sedation phase, the same measurements were taken in each stage after the beginning of music sedation. Furthermore, subject anxiety pre- and post-anesthesia was evaluated using a visual analog scale (VAS). ANF was evaluated by analyzing the low-frequency (LF) and high- frequency (HF) spectral components of ECG R-R intervals. The ratio of LF to HF (LF/HF) reflects sympathetic nervous function (SNF). Statistical analyses were conducted using the Friedman test and Wilcoxon signed-rank test with a significance level of 5%. Results: BP, HR, and VAS showed little variance throughout the procedure. LF/HF showed a significantly lower value during local anesthesia than in the pre-anesthesia sitting position and a significantly lower value during the pre-anesthesia sitting position and supine position in the music sedation phase compared with the no music sedation phase. Conclusion: In healthy young adults, SNF decreases significantly in the sitting and supine positions before local anesthesia with music sedation compared with no music sedation.
Hokkaido University(北海道大学). 博士(歯学)

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