背景：身心障礙患者受限於生理或心理因素常常無法配合各項牙齒的治療，因此世界各國漸漸執行全身麻醉使病患的情緒及行為得到控制，使各項牙齒的治療得以執行。雖然過去的文獻已認為全身麻醉施行於身心障礙患者的牙齒治療為安全且有效的做法，然而這些文獻探討的多為身心障礙病患牙齒治療的全身麻醉藥物、人員與環境等措施，對於全身麻醉於病患產生的治療利益鮮少提及，雖然有部分文獻提出全身麻醉的施行可以提供身心障礙病患較好的牙齒根管治療成功率，然而這些研究皆為描述性統計研究，並無實驗對照組的比較，因此全身麻醉對於身心障礙患者的牙齒治療效果為何尚待更進一步的探討。
目的：探討全身麻醉於身心障礙患者之牙齒根管治療預後之效果
方法：本試驗為次級資料庫進行之回朔性研究，利用2005年01月01日至2018年12月31日之高雄醫學大學附設中和紀念醫院的研究資料庫「門診申報主檔」、「門診申報明細檔」及「病人基本資料檔」並結合資訊室資料之「牙科身心障礙計畫鑑別類別資料」進行分析，依據醫令代碼擷取根管治療時的紀錄與時間並判定該次根管治療是否為全身麻醉下進行，並追蹤牙齒於根管治療後是否接受再次根管治療、拔牙或植牙手術，並以Kaplan-Meier 法計算牙齒根管治療後的累計成功率，在進一步使用Cox迴歸方程式分析該群集資料來推估全身麻醉對於牙齒根管治療成功率的治療效果，並計算可能干擾因子之影響，包含病患本身的特性、身心障礙的類別及嚴重度還有共病因素的影響。
結果：共214位病患的497顆牙齒被納入研究，接受全身麻醉進行根管治療的有280顆牙齒其中15顆最後判定為治療失敗，無接受全身麻醉進行根管治療的有217顆牙齒其中47顆最後判定為治療失敗。以Kaplan-Meier 法計算牙齒根管治療後的累計成功率，以再次接受根管治療定義為失敗之根管治療累積成功率，全身麻醉組九年累計成功率為95.98％非全身麻醉組則為88.08％；以根管治療後接受拔牙定義為失敗之根管治療累積成功率，全身麻醉組九年累計成功率為91.23％非全身麻醉組則為85.99％；以牙齒接受根管治療後再次接受根管治療或接受拔牙定義為失敗之根管治療累積成功率，全身麻醉組九年累計成功率為87.68％非全身麻醉組則為74.51％，三個模組於Log-rank test與Breslow test皆具顯著差異。於Cox多變量廻歸計算裡以再次接受根管治療定義為失敗之模組計算，全身麻醉組的校正後風險比值為0.16（95% CI 0.06-0.37）；以根管治療後接受拔牙定義為失敗之模組計算，全身麻醉組的校正後風險比值為0.38（95% CI 0.16-0.89）；以再次接受根管治療或根管治療後接受拔牙定義為失敗之模組計算，全身麻醉組的校正後風險比值為0.24（95% CI 0.12-0.49）。
結論：依此研究之分析結果，身心障礙病患於全身麻醉下進行之牙齒根管治療呈現較佳的預後，分別表現在牙齒根管治療的九年累積成功率及校正後存活風險比值計算，身心障礙病患的根管治療於全身麻醉下相較於非全身麻醉病患呈現較佳的治療效果。
關鍵字：身心障礙患者、牙齒根管治療、全身麻醉、牙齒治療預後

In order to investigated the benefits of dental care under general anesthesia for disabled patients, a retrospective cohort study was designed with a secondary data analysis that adopted the data from Kaohsiung Medical University Hospital Research Database and electronic database of Kaohsiung Medical University Chung-Ho Memorial Hospital from January 2005 to December 2018. By analysis the the dental treatment of the teeth, the comorbidity and disability type and severity of the patients from the data, this study showed higher root canal treatment cumulative success rate in Kaplan-Meier survival analysis, and superior treatment outcome in general anesthesia group than no general anesthesia group. Thus, the root canal treatment of disability patients under general anesthesia associated with better success rate in this research.

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