必须完成适当的紧急护理，尤其是在接受压力很大的口腔外科手术的患者中。由于过度的精神和身体压力，交感神经张力增高可能会引起房扑。尚无关于房扑患者的牙科护理的报告。在这里，我们描述了一例罕见的门诊抗心律失常治疗病例,该患者在开始dento-oral外科手术前出现了阵发性房扑的心电图表现.
一名60岁的男性患者被安排进行拔牙。他有心绞痛病史,糖尿病,和药物治疗的阵发性心房颤动。术前心电图显示左心室肥厚和ST-T段异常。就在拔牙之前，II导联心电图显示房扑；然而，他抱怨主观症状很少，如心前区不适或心悸。观察生命体征,心电图检查结果,以及病人的一般状况，通过连续输注立即给予低剂量地尔硫,以控制心率和预防房扑引起的室上性快速性心律失常.特别注意在静脉注射双丙吡胺和维拉帕米以及除颤器的制剂中预防任何严重的心血管疾病。静脉注射地尔硫逐渐恢复房扑转为心房颤动后的窦性心律，导致心动过速的预防，然后发现适合作为快速性心律失常的预防性治疗。
目前的情况表明，有可能在口腔手术期间使用我们的方法成功地管理一些这样的患者，这可能与精神和身体压力有关。因此,在鉴别诊断不可预见的严重疾病或阵发性心律失常（如房扑）的同时，完成初步急诊护理是至关重要的。
It is essential to accomplish the appropriate emergency care particularly in patients undergoing stressful dento-oral surgical procedures. Atrial flutter may be induced by sympathetic hypertonia due to excessive mental and physical stress. There is no report regarding dental care in patients with atrial flutter. Herein, we describe a rare
case of the antiarrhythmic management in an outpatient who presented with an electrocardiographic finding of paroxysmal atrial flutter before the initiation of the dento-oral surgical procedure.
A 60-year-old male patient was scheduled for a dental extraction. He had a history of angina pectoris, diabetes mellitus, and paroxysmal atrial fibrillation with medication. The preoperative electrocardiogram (ECG) revealed left ventricular hypertrophy and ST-T segment abnormality. Immediately before the dental extraction, II-lead ECG revealed atrial flutter; however, he complained of few subjective symptoms, such as precordial discomfort or palpitation. Observing the vital signs, ECG findings, and the general condition of the patient, low dose diltiazem was immediately administered by continuous infusion in order to control the heart rate and prevent atrial flutter-induced supraventricular tachyarrhythmia. Special attention was paid to prevent any critical cardiovascular condition under a preparation of intravenous disopyramide and verapamil and a defibrillator. The intravenous administration of diltiazem progressively restored the sinus rhythm after converting atrial flutter into atrial fibrillation, resulting in the prevention of tachycardia, and then was found to be appropriate as a prophylactic therapy of tachyarrhythmia.
The present
case suggests that it is possible to successfully manage some of such patients using our method during dento-oral surgery which is likely to be associated with mental and physical stress. Therefore, it is essential to accomplish an initial emergency care in parallel to the differential diagnosis of unforeseen serious medical conditions or paroxysmal arrhythmia such as atrial flutter.
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