洛索洛芬联合地塞米松应用于阻生齿拔除术的镇痛效果及安全性

Analgesic effect and safety of loxoprofen combined with dexamethasone in extraction of obstructed teeth

目的 探究不同给药时机口服洛索洛芬钠片联合地塞米松注射液对阻生齿拔除术患者术后疼痛影响。方法 选取2021年1月至2023年10月遂宁市中心医院收治的104例需拔除下颌阻生齿患者,按照随机数字表法分为A组(n=35,术前30 min口服洛索洛芬钠片60 mg)、B组(n=34,术前30 min局部注射地塞米松4 mg+术前30 min口服洛索洛芬钠片60 mg)、C组(n=35,术前30 min局部注射地塞米松4 mg+术后3 h口服洛索洛芬钠片60 mg),采用数字评定量表(NRS)评价患者术后30 min、2、4、6、12、24 h疼痛程度,记录24 h内应急镇痛药物使用人数和用量。结果 术后30 min时,A组、B组和C组NRS评分[分别为(0.39±0.15)分、(0.26±0.19)分和(0.31±0.12)分]比较差异无统计学意义(P>0.05);术后2 h时,B组和C组NRS评分[分别为(0.41±0.26)分和(0.65±0.22)分]低于A组[(0.96±0.59)分],差异具有统计学意义(t=1.305、1.582,均P<0.05),但C组和B组比较差异无统计学意义(t=0.691、0.740,均P>0.05);术后6 h时,B组NRS评分[(1.03±0.22)分]低于A组和C组[分别为(1.96±0.73)分和(1.45±0.58)分],差异具有统计学意义(t=1.262、1.578,均P<0.05)];A组、B组和C组术后追加应急镇痛药物的总用量分别为(1.5±0.6)粒、(0.7±0.2)粒和(1.4±0.6)粒,B组术后24 h内追加应急镇痛药物的患者例数低于A组和C组,差异具有统计学意义(t=1.267、1.498,均P<0.05);B组术后出现2例头晕,C组出现1例下唇麻木,不良反应发生率组间比较差异无统计学意义(5.88%vs 2.86%,χ^(2)=1.427,P=0.275),A组无明显不良反应,3组均未发生张口困难、伤口感染、出血、创面延期愈合等不良反应。结论 地塞米松联合术前30 min口服洛索洛芬对阻生齿拔除术患者镇痛效果较好,有效延长术后镇痛时间,并发症较少,是一种安全有效的镇痛方法。

Objective To explore the effects of oral loxoprofen sodium tablets combined with dexamethasone injection at different administration times on postoperative pain in patients undergoing impacted tooth extraction.Methods A total of 104 patients undergoing extraction of impacted mandibular teeth in Suining Central Hospital from January 2021 to October 2023 were enrolled in this study and divided into three groups according to the random number table method.In group A(n=35),loxoprofen sodium was taken orally 30 minutes before surgery.In group B(n=34),local injection of dexamethasone 4 mg 30 minutes before surgery+oral administration of loxoprofen sodium tablets 60 mg 30 minutes before surgery was conducted.In group C(n=35),local injection of 4 mg of loxoprofen sodium tablets 30 minutes before surgery and injection of dexamethasone 4 mg+oral administration of loxoprofen sodium tablets 60 mg 3 h after surgery was exerted.The patient's pain level at 30 min,2,4,6,12,and 24 h after surgery was evaluated using a numerical rating scale(NRS)and recorded.Results At 30 minutes after surgery,the NRS scores of group A,group B and group C were(0.39±0.15)points,(0.26±0.19)points,(0.31±0.12)points,respectively,and there was no statistically significant difference in NRS scores among the three groups(P>0.05).At 2 h after surgery,the NRS scores of group B and group C were lower than those of group A((0.41±0.26)points,(0.65±0.22)points vs(0.96±0.59)points,all P<0.05).However,there was no statistically significant difference between Group C and Group B(t=0.691,0.740,both P>0.05).At 6 h after surgery,the NRS scores of group B were lower than those of group A and group C,and the difference was statistically significant((1.03±0.22)points vs(1.96±0.73)points,(1.45±0.58)points,t=1.262,1.578,both P<0.05).The total amount of emergency analgesic drugs added after surgery in group A,group B and group C was(1.5±0.6)pills,(0.7±0.2)pills and(1.4±0.6)pills,respectively.The number of patients in group B who added emergency analgesic drugs within 24 h after surgery was lower than that in group A and group C,and the difference was statistically significant(t=1.267,1.498,P<0.05).There were 2 cases of dizziness in group B and 1 case of numbness in the lower lip in Group C after surgery,showing no significant difference between the two groups(5.88%vs 2.86%,χ^(2)=1.427,P=0.275).No adverse reactions such as difficulty in opening mouth,wound infection,bleeding or delayed wound healing occurred in all the three groups. Conclusion Dexamethasone combined with oral loxoprofen 30 minutes before surgery has a better analgesic effect on patients undergoing impacted tooth extraction since it can effectively prolong postoperative analgesia time and has fewer complications. Therefore, this is a safe and effective analgesic method.