芬太尼耳穴注射超前镇痛对阻生智齿拔除术后镇痛效果的影响

Analgesic effects of auricular point injection with fentanyl after the extraction of the impacted mandibular third molars

目的探讨小剂量芬太尼耳穴注射超前镇痛对阻生智齿拔除术镇痛效果的影响。方法选择拟行阻生智齿拔除术患者96例,随机分为观察组、对照1组、对照2组,每组32例。三组患者均采用基础手术方法拔牙。在手术前,对照1组不给予镇痛药。对照2组患者于手术前15 min于前臂三角肌处肌肉注射芬太尼。观察组手术前15 min施行芬太尼耳穴注射。观察三组患者拔牙难度、手术时间及术中、术后不同时间段镇痛效果和术前、术中血压、心率变化情况。结果三组患者拔牙难度及手术时间比较,差异无统计学意义(P>0.05)。对照2组术中及术后血压升高,心率增快,与观察组、对照1组比较差异有统计学意义(P<0.05)。对照1组和对照2组手术后各时段VAS评分均≥5分,且口服镇痛药者均高于观察组,差异有统计学意义(P<0.01)。结论小剂量芬太尼耳穴注射超前镇痛用于阻生智齿拔除术术后镇痛效果确切,且无其他不良反应,值得推广。

Objective To observe the preemptive analgesic effects of the small-dose injection with fentanyl at the auricular points in the extraction of the impacted mandibular third molars. Methods A total of 96 patients of selective extraction of the impacted mandibular third molars were randomized into an observation group,No. 1 control group and No.2 control group,32 cases in each one. The basic extraction was used in the three groups. Before operation,no analgesic was applied in No. 1 control group. In No. 2 control group,15 min before operation,the intramuscular injection of fentanyl was used on the forearm deltoid. In the observation group,15 min before operation,the auricular point injection of fentanyl was adopted. The extraction difficulty,operation time,analgesic effects during and after operation,blood pressure before and during operation and the changes of heart rate were observed in the three groups. Results The differences were not significant in the extraction difficulty and operation time among the three groups(P 〉 0. 05）. The blood pressure was increased and the heart rate was speeded up during and after operation in No. 2 control group,indicating the significant differences as compared with the observation group and No. 1 control group. VAS scores ≥ 5 points at each time points after operation in the No. 1 and No. 2 control groups,as well as those with oral administration of analgesic were all higher than the observation group,indicating the significant differences(P 〈 0. 01）. Conclusion The preemptive analgesia of the small-dose injection with fentanyl at the auricular points in the extraction of the impacted mandibular third molars is definite and has no adverse reaction. Hence,this therapy deserves to be promoted.