抗菌药物对下颌阻生第三磨牙拔除后炎性并发症影响的临床观察

Effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar

目的 评估抗菌药物对下颌阻生第三磨牙拔除术后炎性并发症的影响.方法 96例患者的192颗下颌双侧阻生第三磨牙,每例患者分两次拔除.左侧96颗下颌阻生第三磨牙分为抗菌药物（用药组）和安慰剂（安慰剂组）,每组48颗,右侧同样分组.采用随机、双盲、交叉、自身对照的方法每组分别在术前1h及术后3d口服阿莫西林胶囊（有过敏史者服用盐酸克林霉素）或安慰剂;术后14d拔除对侧下颌阻生第三磨牙时交换使用药物.随访记录术后第2、10天后出现干槽症、伤口化脓感染、前颊部感染和咽峡前间隙感染4种炎性并发症的情况以及疼痛、肿胀和开口困难等术后反应.结果 用药组2颗牙出现干槽症（2.1％）、1颗牙局部化脓感染（1.0％）、7例患者有其他反应（胃肠道反应2例、术后出血1例、溃疡1例、发热3例）;安慰剂组3颗牙出现干槽症（3.1％）,1颗化脓感染（1.0％）,11例其他反应（出血3例、溃疡1例、发热7例）;两组仅在术后第10天疼痛结果有差异,其余检测指标均无统计学意义（P＞0.05）.结论 下颌阻生第三磨牙拔除术围手术期使用抗菌药物不能有效预防或减少术后炎性并发症.

Objective To investigate the effect of antibiotics on postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.Methods Ninety-Six patients had their bilateral third molars removed through a split-mouth,double-blind, controlled, clinical trial in two visits.On one side amoxicillin （or clindamycin） was used （antibiotics group） from 1 h pre-operation to 3 d post-operation.On the other side,placebo was used （placebo group） the same time.Postoperative inflammatory complications including alveolar osteitis （AO）,surgical site infection （SSI）,pre-buccal site infection and anterior isthmus faucium space infection were monitored and recorded 2 d and 10 d after the surgery.The pain,swelling,and trismus were also recorded.Results All 96 patients completed the study.Two AO （2.1%）,one SSI （1.0%） and seven other infections were observed in the treatment group.Also three AO （3.1%）,one SSI （1.0%） and eleven other infections were observed in the placebo group.However,no statistically significant differences were found in the incidence of various postoperative inflammatory complications and reactions between the groups（P〉0.05）.There was no significant difference on the postoperative reaction,except pain on 10 d.Patients who had inflammatory infection recovered well with symptomatic anti-infection treatment.Conclusions The use of amoxicillin （or clindamycin） cannot effectively prevent and reduce the postoperative inflammatory complications after surgical extraction of the impacted mandibular third molar.