认知行为疗法对下颌埋伏阻生第三磨牙患者牙科焦虑症的影响

Effect of cognitive behavioral therapy on dental anxiety in patients with impacted mandibular third molars

目的 观察认知行为疗法(CBT)对下颌埋伏阻生第三磨牙患者牙科焦虑症的影响。方法 选取2019年1月至2020年12月该院收治的拔除下颌埋伏阻生第三磨牙初诊时牙科焦虑量表(DAS)评分大于或等于15分患者80例,按照就诊ID卡的末位分成2组,单号为对照组,双号为研究组,每组40例。对照组给予常规护理配合,研究组采用CBT进行行为管理。采用DAS、牙科畏惧量表(DFS)、视觉模拟疼痛量表(VAS)、HOUPT行为量表、Frankl临床行为分级评估2组患者牙科焦虑情况、疼痛程度、治疗完成情况、术中配合程度等。记录2组患者初诊(T1)、手术日(T2)、局部麻醉(T3)、术中(T4)、术后6 h(T5)、术后7 d(T6)、术后90 d(T7)心率、收缩压(SBP)、舒张压(DBP)、脉搏血氧饱和度及手术时间等。结果 2组患者T1时DAS评分、DFS评分、预期术中VAS评分、心率、SBP、DBP、脉搏血氧饱和度,T4时VAS评分比较,差异均无统计学意义(P>0.05);研究组患者T2、T7时DAS、DFS评分,T2时心率、SBP、DBP、预期术中VAS评分,T3时VAS评分,T5时VAS评分,术后对止痛药物需求率均明显低于对照组,T4时HOUPT行为量表评分、Frankl临床行为分级均明显优于对照组,手术时间明显短于对照组,差异均有统计学意义(P<0.05)。结论 CBT对重度牙科焦虑症患者的治疗及焦虑的缓解效果是实用、有效的。

Objective To observe the effect of cognitive behavioral therapy(CBT) on dental anxiety(DA) in patients with impacted mandibular third molars(IMTM).Methods From January 2019 to December 2020,a total of 80 patients with dental anxiety scale(DAS) scores were ≥15 points at the initial diagnosis of IMTM extracted in the hospital were selected.According to the bottom of the visit ID card,the patients were divided into two groups,the odd number was the control group,and the double number was the experimental group,with 40 patients in each group.The control group was given routine nursing intervention and the experimental group was given CBT for behavior management.The DAS,Dental Fear Scale(DFS),Visual Analog Pain Scale(VAS),HOUPT Behavior Scale,and Frankl classification of clinical behavior were used to evaluate the dental anxiety,pain level,treatment completion,and intraoperative cooperation of the two groups of patients.The vital signs such as heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),oxygen saturation(SpO),and the operation time were recorded.The complete indexes were recorded at the initial visit(T1),before surgery(T2),local anesthesia(T3),during operation(T4),six hours after surgery(T5),seven days after surgery(T6) and ninety days after surgery(T7).Results The differences of the DAS scores,DFS scores,anticipated VAS pain scores,HR,SBP,DBP,SpOat T1 and the Intraoperative VAS pain scores at T4 were not significant between the two groups(P>0.05).The DAS scores and DFS scores of the experimental group were significantly lower than those of the control group at T2 and T7.The HR,SBP,DBP and anticipated VAS pain scores of the experimental group were significantly lower than those of the control group at T2.The local anesthesia VAS scores at T3,postoperative VAS pain scores at T5,and postoperative analgesic needs of the experimental group were significantly lower than those of the control group.The HOUPT Scale scores and the Frankl Scale scores at T4 of the experimental group were significantly better than those of the control group,and the operation time of the experimental group was significantly shorter than that of the control group,with statistical significance(P<0.05).Conclusion CBT is a pragmatic and effective method of facilitating dental treatment in patients who suffer from high level of DA.