제 3 대구치 발치시 환자의 호흡 패턴이 스트레스 변화 양상에 미치는 영향

EFFECT OF PATIENT'S BREATHING PATTERN ON THE STRESS CHANGES IN THIRD MOLAR EXTRACTION

  • 이상명 (한림대학교 전자공학과 의공학연구실) ;
  • 김형욱 (한림대학교 임상치의학 대학원) ;
  • 박양호 (한림대학교 임상치의학 대학원) ;
  • 김진철 (한림대학교 임상치의학 대학원) ;
  • 박준우 (한림대학교 임상치의학 대학원) ;
  • 이성준 (한림대학교 전자공학과 의공학연구실) ;
  • ;
  • 안재목 (한림대학교 전자공학과 의공학연구실)
  • Rhee, Sang-Myung (BME Lab., Department of Electronics, Hallym University) ;
  • Kim, Hyung-Wook (Hallym University Graduate School of Clinical Dentistry) ;
  • Park, Yang-Ho (Hallym University Graduate School of Clinical Dentistry) ;
  • Kim, Jin-Cheol (Hallym University Graduate School of Clinical Dentistry) ;
  • Park, Jun-Woo (Hallym University Graduate School of Clinical Dentistry) ;
  • Rhee, Sung-Jun (BME Lab., Department of Electronics, Hallym University) ;
  • Nyamdorj, Selenge (BME Lab., Department of Electronics, Hallym University) ;
  • Ahn, Jae-Mok (BME Lab., Department of Electronics, Hallym University)
  • 발행 : 2007.10.31

초록

Purpose: Heart rate variability(HRV) is the clinical consequence of various influences of the autonomic nervous system(ANS) on heart beat. HRV can estimate the potential physiologic rhythm from the interval between consecutive beats(RR interval or HRV data). It is known as RSA which represents respiration-related HR rhythmic oscillation. Previous studies demonstrated a specific breathing pattern(0.1Hz, 6breaths/min) to improve a physiological body condition related to the stress. In this paper, the level of stress would be evaluated in terms of three phases of the dental treatment, combined with 6breaths/min. Methods: These phases include before, during and after tooth extraction or anesthesia or something.36 patients' stresses were assessed using HRV stress analyzer in each phase in Kangdong Sacred Heart Hospital, and Chuncheon Sacred Heart Hospital, Hallym University Medical Center from Jun. to Sept. of 2007. HRV 5-min data collected were analyzed in time-domain and frequency-domain to evaluate the activity of autonomic nervous system(ANS) which represents the level of stress. Results: All HRV parameters including HF(high frequency), LF(low frequency) and LF/HF ratio showned a significant change affecting the ANS balance. There was a 6.4% difference between R(LF/HF)s on general breathing pattern for balance of Autonomic nervous system, but on controlled breathing pattern, 0.1Hz, was made narrow till 1.4%. The activity of ANS has increased by 1.4% on general breathing pattern, and by 2.9% on controlled breathing pattern, 0.1Hz. Conclusion: After analysis of preoperative stress changes and effect of breathing pattern of 0.1 Hz on the stress in 36 patients who have undergone third molar extraction, following was concluded. In the preoperative stage, the sympathetic change was the greatest?after the?anesthetic injection, and stress was relieved by controlling the breathing pattern to a frequency of 0.1Hz.

키워드

참고문헌

  1. Quek SL, Tay CK, Tay KH, Toh SL, Lim KC: Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey. Int J Oral Maxillofac Surg 2003;32(5):548-52 https://doi.org/10.1016/S0901-5027(03)90413-9
  2. Chiapasco M, De Cicco L, Marrone G: Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 1993;76(4):412-20 https://doi.org/10.1016/0030-4220(93)90005-O
  3. Garcia RI, Chauncey HH: The eruption of third molars in adults: a 10-year longitudinal study. Oral Surg Oral Med Oral Pathol 1989;68(1):9-13 https://doi.org/10.1016/0030-4220(89)90107-2
  4. Hugoson A, Kugelberg CF: The prevalence of third molars in a Swedish population. An epidemiological study. Community Dent Health 1988;5(2):121-38
  5. Venta I, Turtola L, Ylipaavalniemi P. Change in clinical status of third molars in adults during 12 years of observation. J Oral Maxillofac Surg 1999;57(4):386-9; discussion 89-91 https://doi.org/10.1016/S0278-2391(99)90273-2
  6. Leone SA, Edenfield MJ, Cohen ME: Correlation of acute pericoronitis and the position of the mandibular third molar. Oral Surg Oral Med Oral Pathol 1986;62(3):245-50 https://doi.org/10.1016/0030-4220(86)90001-0
  7. Piironen J, Ylipaavalniemi P: Local predisposing factors and clinical symptoms in pericoronitis. Proc Finn Dent Soc 1981;77(5):278-82
  8. Kugelberg CF, Ahlstrom U, Ericson S, Hugoson A: Periodontal healing after impacted lower third molar surgery. A retrospective study. Int J Oral Surg 1985;14(1):29-40 https://doi.org/10.1016/S0300-9785(85)80007-7
  9. Nitzan D, Keren T, Marmary Y: Does an impacted tooth cause root resorption of the adjacent one? Oral Surg Oral Med Oral Pathol 1981;51(3):221-4 https://doi.org/10.1016/0030-4220(81)90047-5
  10. Parameters of care for oral and maxillofacial surgery. A guide for practice, monitoring and evaluation (AAOMS Parameters of Care-92). American Association of Oral and Maxillofacial Surgeons. J Oral Maxillofac Surg 1992;50(7 Suppl 2):i-xvi, 1-174 https://doi.org/10.1016/0278-2391(92)90183-Z
  11. Rubin MM, Koll TJ, Sadoff RS: Morbidity associated with incompletely erupted third molars in the line of mandibular fractures. J Oral Maxillofac Surg 1990;48(10):1045-7; discussion 48 https://doi.org/10.1016/0278-2391(90)90286-B
  12. Tate TE: Impactions: observe or treat? W V Dent J 1994;68(4):19-23
  13. Brokaw WC: The third molar question: when and why should we recommend removal? Va Dent J 1991;68(4):18-21
  14. Mercier P, Precious D: Risks and benefits of removal of impacted third molars. A critical review of the literature. Int J Oral Maxillofac Surg 1992;21(1):17-27 https://doi.org/10.1016/S0901-5027(05)80447-3
  15. Lysell L, Rohlin M: A study of indications used for removal of the mandibular third molar. Int J Oral Maxillofac Surg 1988;17(3):161-4 https://doi.org/10.1016/S0901-5027(88)80022-5
  16. Sisk AL, Hammer WB, Shelton DW, Joy ED, Jr: Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 1986;44(11):855-9 https://doi.org/10.1016/0278-2391(86)90221-1
  17. Rood JP: Permanent damage to inferior alveolar and lingual nerves during the removal of impacted mandibular third molars. Comparison of two methods of bone removal. Br Dent J 1992;172(3):108-10 https://doi.org/10.1038/sj.bdj.4807777
  18. Brown TE, Beightol LA, Koh J, Eckberg DL: Important influence of respiration on human R-R interval power spectra is largely ignored. J Appl Physiol 1993;75: 2310-2317 https://doi.org/10.1152/jappl.1993.75.5.2310
  19. Karemaker JM: Heart rate variability: why do spectral analysis? Heart 1997 February;77(2):99-101
  20. Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability: Standards of measurement, physiological interpretation, and clinical use. European Heart Journal 1996;17:354-381 https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
  21. HeartMath Research center. Autonomic Assessment Report: A comprehensive Heart Rate Variability Analysis. 1996
  22. 이상명, 이성준, 안재목, 김점근: RSA분석과 자율신경기능을 평가하는 호흡주기 설정에 관한 연구. 의공학회지 2007;28:503-511
  23. Nakamura Y, Matsumura K, Miura K, Kurokawa H, Abe I, Takata Y: Cardiovascular and Sympathetic Responses to Dental Surgery with Local Anesthesia. Hypertens Res 2001;24(3):209-14 https://doi.org/10.1291/hypres.24.209
  24. Langewitz W, Ruddel H: Spectral analysis of heart rate variability under mental stress. J Hypertens 1989;7(suppl):S32-S33
  25. Pagani M, Somers V, Furlan R, Dell'Orto S, Conway J, Baselli G, et al.: Changes in autonomic regulation induced by physical training in mild hypertension. Hypertension 1988;12:600-10 https://doi.org/10.1161/01.HYP.12.6.600
  26. Bernardi L, Ricordi L, Lazzari P, Solda P, Calciati A, Ferrari MR, et al.: Impaired circadian modulation of sympathovagal activity in diabetes. A possible explanation for altered temporal onset of cardiovascular disease. Circulation 1992;86:1443-52 https://doi.org/10.1161/01.CIR.86.5.1443
  27. Matsumura K, Miura K, Takata Y, Abe I, Fujishima M: Changes in blood pressure and autonomic nervous system in dental treatment with use of local anesthesia. Cardiovasc Rev Rep 2000;21:35-39
  28. Matsumura K, Miura K, Takata Y, et al: Changes in blood pressure and heart rate variability during dental surgery. Am J Hypertens 1998;11:1376-1380 https://doi.org/10.1016/S0895-7061(98)00157-5
  29. Tsuchihashi T, Takata Y, Kurokawa H, et al: Blood pressure response during dental surgery. Hypertens Res 1996;19:189-194 https://doi.org/10.1291/hypres.19.189
  30. Miura K, Matsumura K, Nakamura Y, Kurokawa H, Kajiyama M, Takata Y: Suppression of cardiac sympathetic nervous system during dental surgery in hypertensive patients. Hypertens Res. 2000;23:207-12 https://doi.org/10.1291/hypres.23.207
  31. Motte S, Mathieu M, Brimioulle S, Pensis A, Rav L, et al.: Respiratory-related heart rate variability in progressive experimental heart failure. Am J Physiol Heart Circ Physiol. 2005;289:H1729-35 https://doi.org/10.1152/ajpheart.01129.2004
  32. Bernardi L, Rossi M, Ricordi L: Clinical assessment of respiratory sinus arrhythmia by computerized analysis of RR interval and respiration. G Ital Cardiol. 1992;22:517-29
  33. Kollai M, Mizsei G: Respiratory sinus arrhythmia is a limited measure of cardiac parasympathetic control in man. J Physiol 1990;424:329-42 https://doi.org/10.1113/jphysiol.1990.sp018070
  34. Strauss-Blasche G, Moser M, Voica M, McLeod DR, Klammer N, Marktl W: Relative timing of inspiration and expiration affects respiratory sinus arrhythmia. Clin Exp Pharmocol Physiol. 2000;27:601-6 https://doi.org/10.1046/j.1440-1681.2000.03306.x
  35. Angelone A, Coulter NA Jr: Respiratory sinus arrhythmia: A frequency dependent phenomenon. J Appl Physiol 1964;19:479-82 https://doi.org/10.1152/jappl.1964.19.3.479
  36. Hirsch JA, Bishop B: Respiratory sinus arrhythmia in humans: how breathing pattern modulates heart rate. Am J Physiol 1981;241:H620-9
  37. Hayano S. Mukai M, Sakakibara A, et al.: Effect of respiratory interval on vagal modulation of heart rate. Am J Physiol Heart Circ Physiol 1994;267:H33-H40
  38. Stern RM, Anschel C: Deep inspirations as stimuli for responses of the autonomic nervous system. Psychophysiology 1968;5:132-41 https://doi.org/10.1111/j.1469-8986.1968.tb02810.x
  39. Grossman P: Respiration, stress, and cardiovascular function. Psychophysiology. 1983;20:284-300 https://doi.org/10.1111/j.1469-8986.1983.tb02156.x
  40. Poyhonen M, Syvaoja S, Hartikainen J, Ruokonen E, Takala J: The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability. Acta Anaesthesiol Scand 2004;48:93-101 https://doi.org/10.1111/j.1399-6576.2004.00272.x
  41. Ohtari K, Kiryu T, Saitoh Y: Extraction of autonomic nervous system-related components from heart rate variability during cycle exercise by time-frequency analysis. Systems and computers in Japan 1999;30:47-56
  42. Schipke JD, Pelzer M, Arnold G: Effect of respiration rate on shortterm heart rate variability. J Clin Basic Cardiol 1999;2:92
  43. Malliani A, Pagani M, Lombardi F, Cerutti S: Cardiovascular neural regulation explored in the frequency domain. Circulation 1991;84:482-92 https://doi.org/10.1161/01.CIR.84.2.482