口服洛索洛芬钠片在拔除阻生齿中的超前镇痛

Preemptive analgesia with loxoprofen sodiumorally in extraction of impacted teeth

目的:研究口服非甾体类抗炎药洛索洛芬钠片在下颌阻生第三磨牙拔除术中超前镇痛的临床效果。方法:2017年6—8月北京大学口腔医院第一门诊部向拔除下颌阻生第三磨牙的患者发放术后疼痛调查问卷。根据患者实际初次口服洛索洛芬钠片的时机,患者被分为3组:未服药组(术前、术后均未口服洛索洛芬钠片)、术前服药组(术前30 min口服洛索洛芬钠片60 mg)和术后服药组(术后30 min口服洛索洛芬钠片60 mg)。统计指标为手术时间,术后2、4、12、24、48 h的疼痛视觉模拟评分(visual analogue scales,VAS),离院后服用洛索洛芬钠的人数以及药物不良反应。结果:3组手术时间均为15.0(5.0,30.0)min,3组手术时间差异无统计学意义(P=0.848)。未服药组术后2、4、12、24、48 h的评分分别为1.75(0.1,10.0)、6.25(1.5,10.0)、2.00(0.1,8.0)、2.00(0.1,6.0)和0.5(0.1,5.5),差异有统计学意义(P<0.001),术后4 h评分高于其他时间点(P<0.005)。在术后4 h,术前服药组评分[2.0(0.1,10.0)]和术后服药组评分[2.0(0.1,5.0)]均低于于未服药组评分[6.25(1.5,10.0)],差异有统计学意义(P<0.001)。离院后服用洛索洛芬钠片的人数未服药组9人(40.9%),术前服药组5人(21.8%),术后服药组7人(33.3%)。术前服药组药物不良反应发生率(3/23,13.0%)和术后服药组药物不良反应发生率(4/21,19.0%)低于未服药组药物不良反应发生率(8/22,36.4%)。结论:两种超前镇痛的方案,即术前30 min口服洛索洛芬钠片60 mg和术后30 min口服洛索洛芬钠片60 mg,在下颌阻生第三磨牙拔除中都可以有效减轻术后疼痛。

Objective ; To investigate the effectiveness o f preemptive analgesia w i th loxoprofen sodium orally , which was a kind of non-steroid an t i-in flammatory d ru g s, in extractions o f man dibular impacted third teeth. Methods ： There were questionnaires about postoperative pain fo r patients whose mandibular impacted third teeth were extracted from July 2017 to August 2017 in First C l in ic a l Div is io n o f Peking University School and Hospital of Stomatology. Al l the patients d id th e ir routine c l in ic a l examinations and imaging examinations. Af ter their man dibular impacted th ird teeth were ex trac te d, the questionnaires were sent to them. The questionnaires were f i l le d in by the patients on th e ir own and returned one week later. There were 120 questionnaires that were sent and 105 questionnaires re tu rn e d, o f w h ich 98 ques-tionnaires were fi l led in completely. A ccord in g to the in c lus ive c r ite r ia and exclusion c r i te r ia , 66 ques-tionnaires were total ly selected in this study. A ccord in g to the t ime when the patients took th e ir loxoprofen sodium orally firstly , the patients were divide d into 3 groups. The f irs t group was fo r patients who didn ’ t take loxoprofen sodium dur ing their extractions （non-medicine g ro u p） . The second group was fo r patients who took 60 mg loxoprofen sodium 30 min before th e ir extractions （pre op erat ive g ro u p） . The th ird group was for patients who took 60 mg loxoprofen sodium 30 m in after th e ir extractions （postoperat ive g ro u p）.The operation t ime among the 3 groups was analyzed by K ru s k a l-Wa l l is method. The postoperative time points were 2,4, 12,24 and 48 h af ter operation. The scores o f visual analogue scales （V A S ） fo r post-operative pain in each group at diffe re nt postoperative t ime points were analyzed by Friedman method. A t each postoperative t ime point, VAS scores in the diffe re nt groups were analyzed by K ru s k a l-W a l l is me-thod. The numbers of the patients tak in g loxoprofen sodium home and drug adverse reactions were also analyzed. Results ： The operation t ime o f the 3 groups was 15. 0 （5.0,30. 0） min and had no signif icantdifferences （P =0. 848） . VAS scores o f non-medicine group 2,4, 12,24 and 48 h af ter operation were1.75 （0. 1,10.0） , 6.25 （1.5,10.0） , 2.00 （0. 1,8.0） , 2.00 （0.1,6.0） and 0.5 （0.1,5.5） sepa-rately and had signif icant differences （P 〈 0. 001） . The VAS score at 4 h af ter operation was higher than the VAS scores at other time points after operation （ P 〈0. 005）. Four hours after the operations, the VAS scores of preoperative group [2.0 （0.1,10.0）] and postoperative group [2.0 （0. 1,5.0）] were lower significantly than those of non-medicine group [6.25 （1.5,10.0）] （ P 〈 0. 001） . The numbers of the patients taking loxoprofen sodium home were 9（40. 9 % ） in non-medicine g ro u p,5（21.8 % ） in pre-operative group and 7（33.3%） in postoperative group. The number o f the patients who had drug adverse reactions in preoperative group （n =3,13. 0% ） and in postoperative group （7i = 4,19.0% ） was less than the number of the patients who had drug adverse reactions in non-medicine group （71=8,36.4%）. Conclusion ： There were two protocols o f preemptive analgesia w ith loxoprofen sodium ora lly in extractions of mandibular impacted third teeth, wh ich were tak in g 60 mg loxoprofen sodium ora lly 30 min before the extractions and taking 60 mg loxoprofen sodium ora l ly 30 m in after the extractions. Both o f the two pre-emptive analgesia protocols could decrease the postoperative pain s ig n if ic a n t ly.