两种联合局部麻醉法对下颌第一磨牙急性牙髓炎开髓治疗的镇痛效果比较

Anesthetic Efficacies of Two Combinations of Local Anaesthesia in Patients with Acute Pulpitis in the Mandibular First Molar

目的探讨下牙槽神经阻滞麻醉联合颊侧浸润或牙周膜注射对下颌第一磨牙急性牙髓炎开髓治疗的镇痛效果。方法40例下颌第一磨牙急性牙髓炎患者随机分为2组,均予以4%盐酸阿替卡因(含1∶100 000肾上腺素)1.7 mL行下牙槽神经阻滞麻醉,另取0.4 mL相同麻醉剂,A组加行颊侧浸润麻醉,B组加行牙周膜注射。阻滞麻醉后等待5 min并完成疼痛评估,然后行颊侧浸润或牙周膜注射,等待5 min并完成疼痛评估。另一名医生行开髓,作开髓疼痛评估。由牙医助理记录各种注射麻醉及开髓疼痛的视觉模拟量值。结果B组有1例因下牙槽神经阻滞麻醉失败被排除,39例纳入统计分析。2组年龄(t=1.42,P=0.22)、性别(χ2=1.97,P=0.60)、术前疼痛的差异(t=0.93,P=0.71)均无统计学意义。所有患者在下牙槽神经阻滞麻醉起效后行颊侧浸润或牙周膜注射均感到无痛或轻度疼痛。2组下牙槽神经阻滞麻醉疼痛差异无统计学意义(t=0.62,P=0.71),A组牙周膜注射和B组颊侧浸润疼痛差异无统计学意义(t=1.19,P=0.33)。A组麻醉成功率80.0%(16/20),B组麻醉成功率为84.2%(16/19),二者差异无统计学意义(χ2=2.45,P=0.33)。结论下牙槽神经阻滞麻醉联合颊侧浸润或牙周膜注射应用于下颌第一磨牙急性牙髓炎开髓治疗均可取得较高的麻醉成功率。

Objective To demonstrate the anesthetic efficacies of inferior alveolar nerve block （IANB） plus buccal infiltration （BI） and IANB plus periodontal ligament （PDL） injections in patients with acute pulpitis in the mandibular first molar. Methods Forty patients with acute pulpitis in the mandibular first molar from Department of Stomatology, Second Affiliated Hospital of Zhongshan University between February 2009 and May 2009 were enrolled. All patients were received conventional IANB containing 1.7 mL 4% articaine/HC1 with 1 ： 100 000 epinephrine, plus either BI or PDL injections containing 0.4 mL articaine/HCl with 1 ： 100 000 epinephrine. Endodontic access was performed 5 min after the second injection. The pain of the injections and endodontic access were recorded on a Heft-Parker visual analog scale （VAS）. Results According to the VAS scores, all patients experienced no or mild pain with BI and PDL injections after IANB taking effect. Anesthetic success occurred in 80.0% for IANB plus BI （IANB/BI） compared to 84.2% for IANB plus PDL injection （ IANB/PDL injection）. None of the observed differences between the two groups was significant （P 〉 0.05）. Conclusion Both injection combinations resulted in high anesthetic success in patients with acute pulpitis in the mandibular first molar.