口腔医学研究

口腔医学研究 ›› 2024, Vol. 40 ›› Issue (10): 900-904.DOI: 10.13701/j.cnki.kqyxyj.2024.10.010

• 口腔麻醉学研究 • 上一篇    下一篇

塞来昔布超前镇痛联合笑气吸入用于拔除下颌阻生第三磨牙的临床研究

陈子瑶1, 刘畅1, 李敏2, 祖文轩3, 廖圣恺1, 王慧娴1, 陈永锋1*   

  1. 1.蚌埠医科大学第一附属医院口腔科 安徽 蚌埠 233000;
    2.蚌埠医科大学第一附属医院麻醉科 安徽 蚌埠 233000;
    3.蚌埠医科大学解剖教研室 安徽 蚌埠 233000
  • 收稿日期:2024-04-11 出版日期:2024-10-28 发布日期:2024-10-24
  • 通讯作者: *陈永锋,E-mail:chyf88hb@126.com
  • 作者简介:陈子瑶(1996~),女,安徽蚌埠人,硕士在读,研究方向:口腔医学。
  • 基金资助:
    2021年度安徽高校自然科学研究项目(编号:KJ2021A0772)

Clinical Study on Celecoxib Preemptive Analgesia Combined with Nitrous Oxide Inhalation for Extraction of Mandibular Impacted Third Molar Teeth

CHEN Ziyao1, LIU Chang1, LI Min2, ZU Wenxuan3, LIAO Shengkai1, WANG Huixian1, CHEN Yongfeng1*   

  1. 1. Department of Stomatology, the First Affiliated Hospital of Bengbu Medical University, Bengbu 233000, China;
    2. Department of Anesthesiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233000, China;
    3. Department of Anatomy, Bengbu Medical University, Bengbu 233000, China
  • Received:2024-04-11 Online:2024-10-28 Published:2024-10-24

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摘要： 目的: 评价塞来昔布超前镇痛联合笑气镇静镇痛用于拔除下颌阻生第三磨牙的临床效果。方法: 选取单侧下颌第三磨牙阻生患者120例,依据临床实际分为对照组、笑气组、塞来昔布组和试验组,每组30例。记录局部麻醉、术中及术后各时间点视觉模拟量表(visual analogue scale,VAS)评分;术前、术后改良牙科焦虑量表(modified dental anxiety scale,MDAS)评分;术后48 h首次使用镇痛药物间隔时间及用药总剂量;T0(术前5 min)、T1(局部麻醉)、T2(拔牙)及T3(术后5 min)平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)。结果: (1)与对照组相比,塞来昔布组术后4 h、6 h VAS评分,笑气组局部麻醉、手术时VAS评分,试验组局部麻醉、手术时及术后4 h、6 h VAS评分均显著降低(P<0.05);与塞来昔布组相比,笑气组局部麻醉、手术时VAS评分显著降低,试验组局部麻醉与手术时 VAS评分显著降低(P<0.05);与笑气组相比,试验组术后4 h、6 h VAS评分显著降低(P<0.05)。(2)4组患者术后MDAS评分均低于术前,但术前、术后MDAS评分差异无统计学意义(P>0.05)。(3)与对照组相比,塞来昔布组与试验组术后镇痛药物服用间隔时长显著增加,剂量显著减少(P<0.05);与笑气组相比,塞来昔布组和试验组术后镇痛药物服用间隔时长均显著增加,剂量显著减少(P<0.05)。(4)与对照组相比,另外3组MAP及HR在T0时差异无统计学意义,其余时间节点差异均有统计学意义(P<0.05)。结论: 塞来昔布超前镇痛联合笑气镇静镇痛在下颌阻生第三磨牙拔除术中术后具有显著的镇痛作用,并能减少应急镇痛药物用量,减轻患者术中血压波动,提高诊疗舒适度。

关键词: 超前镇痛, 塞来昔布, 笑气, 舒适化, 阻生第三磨牙

Abstract: Objective: To evaluate the clinical effect of celecoxib preemptive analgesia combined with nitrous oxide sedation in the extraction of mandibular impacted third molar teeth. Methods: A total of 120 patients who had unilateral impacted mandibular third molar were selected and divided into control group, nitrous oxide group, celecoxib group, and experimental group with 30 cases in each group. Control group was performed minimally invasive tooth extraction. Nitrous oxide group was inhaled nitrous oxide for tooth extraction. Celecoxib group received oral celecoxib 0.4 g for tooth extraction 30 minutes before surgery. The experimental group took celecoxib 0.4 g orally 30min before surgery, and then used nitrous oxide inhalation system for tooth extraction. Local anesthesia intraoperative and 2, 4, 6, 12, 24, 48 h postoperative visual analogue scale (VAS) scores were recorded. Modified dental anxiety scale (MDAS) before and after surgery were recorded. The interval of first analgesic administration 48 h after surgery and the total dose, mean arterial pressure (MAP) and heart rate (HR) in T0 (5 min before surgery), T1 (local anesthesia), T2 (tooth extraction), and T3 (5 min after surgery) were also recorded. Results: Compared with the control group, the scores of 4 and 6 h VAS in celecoxib group, the scores of local anesthesia and VAS during operation in nitrous oxide group, and the scores of local anesthesia, during operation, and 4 and 6 h VAS after operation in experimental group were significantly decreased (P<0.05). Compared with celecoxib group, the scores of local anesthesia and operative VAS in nitrous oxide group were significantly decreased, and those in experimental group were significantly decreased (P<0.05). Compared with nitrous oxide group, the 4 and 6 h VAS scores of experimental groups were significantly decreased (P<0.05). Postoperative MDAS scores of four groups were lower than those before surgery, and there was no statistical significance between preoperative and postoperative MDAS scores (P>0.05). Compared with the control group, the duration of drug administration between celecoxib group and experimental group was significantly increased, and the dose was significantly decreased (P<0.05). Compared with nitrous oxide group, the duration of drug administration in celecoxib group and experimental group was significantly increased, and the dose was significantly decreased (P<0.05). Compared with the control group, MAP and HR of the other three groups showed no statistical significance at T0, while node differences were statistically significant at other times (P<0.05). Conclusion: Celecoxib advanced analgesia combined with nitrous oxide sedation and analgesia has significant analgesic effect in mandibular impacted third molar extraction, which can reduce postoperative pain and the use of emergency analgesic drugs, reduce intraoperative blood pressure fluctuation of patients, and improve the comfort of diagnosis and treatment.

Key words: preemptive analgesia, celecoxib, nitrous oxide, comfort, impacted third molar