音乐疗法协同笑气吸入镇静技术缓解重度儿童牙科畏惧症临床应用研究

Clinical study of music therapy and nitrous oxide inhalation sedation against severe dental fear in children

目的探讨音乐疗法协同笑气吸入镇静技术缓解重度儿童牙科畏惧症的有效性。方法于2015年12月至2016年12月在中国人民解放军总医院儿童口腔科筛选需口腔治疗但经儿童畏惧调查-牙科分量表(children′s fear survey schedule-dental subscale,CFSS-DS)确定畏惧程度为4~5级的4~10岁重度牙科畏惧患儿60例作为研究对象。患儿随机分为两组:试验组患儿(30例)进行音乐疗法协同笑气吸入镇静技术治疗;对照组患儿(30例)仅进行笑气吸入镇静技术治疗。在口腔治疗前、笑气使用前、治疗中分别测量两组患儿心率、血压、血氧饱和度等生理指标。治疗过程中,麻醉医生记录镇静起效时间、治疗持续时间及患儿复苏时间。结果对照组30例患儿中有21例(70.0%)完成治疗,9例因畏惧无法缓解而中止治疗;试验组中26例(86.7%)完成治疗,4例中止治疗。试验组笑气镇静起效时间和口腔治疗持续时间明显少于对照组。试验组患儿治疗中情绪稳定,依从性良好,与治疗前、笑气使用前比较,心率、收缩压无显著增高甚至明显降低,舒张压和血氧饱和度无明显变化。结论音乐疗法显著提高笑气缓解CFSS-DS 4级以上牙科畏惧症患儿紧张情绪的有效性和工作效率,提高患儿口腔诊疗依从性,是一种有效、简便的行为管理辅助方法。

Objective To explore synergistic effect of music therapy and nitrous oxide inhalation sedation for child dental fear（CDF） in children with CFSS-DS grade of 4 or above.Methods A total of 60 children in need of oral treatment （aged 4-10 years）were included in the study,who were classified as severe CDF by children＇s fear survey schedule-dental subscale（CFSS-DS）at Department of Pediatric Stomatology in General Hospital of PLA from December 2015 to December 2016.The children were randomly selected to accept music therapy and nitrous oxide inhalation （the experimental group）,or nitrous oxide inhalation only （the control group）,30 children in each group.Heart rate,blood pressure and oxygen saturation were recorded before treatment,before using nitrous oxide inhalation and during treatment.Sedation onset time,treatment duration and recovery time were also recorded.Results In the control group,21 children completed treatment,while 9 children stopped the treatment due to fear.In the experimental group,26 completed the treatment while 4 stopped.The onset time of nitrous oxide and duration of operation in the experimental group were significantly less than the control group.In the course of therapy,children in the experimental group possessed emotional homeostasis and good conpliance.Their heart rate and systolic pressure in operation were not significantly increased,and even significantly reduced.The diastolic pressure and oxyhemoglobin saturation had no significant change.Conclusion Nitrous oxide inhalation and synergistic effect of music therapy has significant effects on children with CFSS-DS grade of 4 or above.It can improve patient compliance and is a safe and acceptable approach for behavior management of children with CDF.