Московский государственный медико-стоматологический университет им. А.И. евдокимова, Москва, россия В данной статье авторским коллективом представлены основные принципы выбора местного обезболивания у пациентов с сопутствующей патологией на основании данных анамнеза, анализа взаимодействия фармакологических препаратов со средствами местной анестезии и седации, определения функционального состояния пациента и возможности проведения лечения в амбулаторных условиях, коррекции тревожности и боли, а также оказания стоматологической помощи с непрерывным контролем гемодинамических показателей. Было показано, что соблюдение данного алгоритма является профилактикой неотложных состояний у пациентов с фактором риска в условиях амбулаторного стоматологического приема. Ключевые слова: выбор местного обезболивания, сбор анамнеза, контентный анализ, коррекция тревожности пациента. Local anesthesia selection algorithm in patients with concomitant disease. Part 2. e.N. aNiSiMOva, S.T. SOkhOv, N.Y. LeTuNOva, i.v. OrekhOva, M.v. grOMOvik, e.a. eriLiN, N.a. rYazaNTSev Moscow State university of Medicine and Dentistry named after a.i. evdokimov, Moscow, russia A group of authors presents the rationale for local anesthesia selection in patients with concomitant disease based on case history; interaction analysis of drugs with local anesthetic and sedation agents; estimation of patient functional status; patient anxiety correction; dental care with hemodynamics monitoring. It was found that adhering to this algorithm promotes the prevention of urgent conditions in outpatient settings.
The aim of this study was to establish clinical significance of oral inflammatory diseases in ischaemic stroke (IS), how aware doctors and nurses are of this problem, and the safety and possibility of performing dental hygiene in patients with acute IS. Materials and methods. We examined 100 patients who had suffered an ischaemic stroke in the internal carotid artery territory within 6 to 48 hours. The efficacy of dental hygiene and the risk of developing chronic oral sepsis were evaluated using the Patient Hygiene Performance Index (PHP) and Chronic Oral Sepsis Risk index (COSR). Quality of life was assessed using the short version of the Oral Health Impact Profile (OHIP-14). The sociological study included 100 patients with ischaemic stroke, 38 nurses, and 18 neurologists. Results. The severity of IS at study inclusion was 8 (3; 15) points on the NIHSS, while the Barthel Index score was 70 (45; 90) points. The modified Rankin Scale score was 13 points. The PHP index was 2.28 0.05 and the COSR index was 20.13 0.50. The OHIP-14 results (a total score of 28.1 6.8 points) also indicated unsatisfactory quality of dental health. The results of sociological studies revealed low level of awareness regarding dental care during acute IS among doctors. After professional oral care, treatment of oral inflammatory diseases, and removal of significantly damaged teeth, patients with IS had a decrease in the PHP index to 1.17 0.05 and the COSR index to 7.36 0.50, which corresponds to a satisfactory level of dental hygiene by the end of the acute stroke period. The impact of dental health on quality of life parameters as measured by the OHIP-14 scale (22.4 7.2 points) was satisfactory. Conclusion. The most important aspect of early dental care in patients with IS is increasing the quality of oral health.
The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.
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