次氯酸钠溶液浓度及冲洗温度对不可逆性牙髓炎下颌磨牙根管治疗患者疼痛程度的影响

Effects of sodium hypochlorite solution concentration and irrigation temperature on pain level in patients undergoing root canal treatment for mandibular molars with irreversible pulpitis

目的分析次氯酸钠溶液浓度及冲洗温度对不可逆性牙髓炎下颌磨牙根管治疗患者疼痛程度的影响。方法回顾性分析于浙江大学附属第二医院临平院区接受下颌磨牙根管治疗的98例患者,将2020年12月至2021年11月接受根管治疗以30℃1.0%次氯酸钠溶液冲洗的32例患者纳入A组,2021年12月至2022年11月接受根管治疗的以30℃2.5%次氯酸钠溶液冲洗的32例患者纳入B组,2022年11月至2023年12月接受根管治疗的以55℃2.5%次氯酸钠溶液冲洗的34例患者纳入C组。比较3组患者牙周状态、炎症因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和超敏C反应蛋白(hs-CRP)]、疼痛感知[视觉模拟量表(VAS)]和不良反应。结果B组治疗后牙龈指数、牙周外观指数和出血指数分别为(1.41±0.37)分、(1.19±0.35)分、(1.40±0.37)分,均优于A组(P均<0.01)。治疗后,C组患者的牙龈指数、牙周外观指数和出血指数分别为(0.95±0.20)分、(0.88±0.21)分和(1.16±0.25)分,也均优于B组,P均<0.01。治疗后,B组TNF-α、IL-6和hs-CRP水平分别为(4.78±1.15)ng/L、(3.29±0.71)ng/L和(10.26±1.32)mg/L,均低于A组,P均<0.05,而C组TNF-α、IL-6和hs-CRP水平分别为(4.09±0.96)ng/L、(3.16±0.53)ng/L和(10.09±1.27)mg/L,均低于B组,P均<0.05。治疗后,B组VAS得分为(2.13±0.42)分比A组的(2.89±0.46)分低(t=6.902,P<0.001),而C组VAS得分为(1.85±0.31)分比B组更低(t=3.094,P=0.003)。3组相比打喷嚏等不良反应总发生率差异无统计学意义(Hc=0.790,P>0.05)。次氯酸钠浓度(1.0%)、温度(30℃)是不可逆性牙髓炎下颌磨牙根管治疗患者疼痛程度的独立危险因素(P<0.05)。结论55℃2.5%次氯酸钠溶液能有效改善不可逆性牙髓炎下颌磨牙根管治疗患者牙周状态,降低炎性因子水平,缓解疼痛,且安全性良好。

Objective To analyze the influence of sodium hypochlorite solution concentration and irrigation temperature on pain level in patients undergoing root canal treatment for mandibular molars with irreversible pulpitis.Methods A retrospective analysis was conducted on 98 patients who received root canal treatment for mandibular molars in Linping Hospital,Second Affiliated Hospital of Zhejiang University.A total of 32 patients who received root canal treatment with 30℃1.0%sodium hypochlorite solution irrigation from December 2020 to November 2021 were included in group A,and 32 patients who adopted root canal treatment with 30℃2.5%sodium hypochlorite solution irrigation between December 2021 and November 2022 were enrolled in group B,and 34 patients who used root canal treatment and were irrigated with 55℃2.5%sodium hypochlorite solution from November 2022 to December 2023 were included in group C.The periodontal status,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)],pain perception[Visual Analog Scale(VAS)]and adverse reactions were compared among the three groups.Results After treatment,the gingival index,periodontal appearance index,and bleeding index of patients in group B were(1.41±0.37)points,(1.19±0.35)points,and(1.40±0.37)points,respectively,which were better than those in group A(all P<0.01).After treatment,the gingival index,periodontal appearance index,and bleeding index of patients in group C were(0.95±0.20)points,(0.88±0.21)points,and(1.16±0.25)points,respectively,which were better than those in group B(all P<0.01).After treatment,the levels of TNF-α,IL-6,and hs CRP in group B were(4.78±1.15)ng/L,(3.29±0.71)ng/L,and(10.26±1.32)mg/L,respectively,all lower than those in group A(all P<0.01),while the levels of TNF-α,IL-6,and hs-CRP in group C were(4.09±0.96)ng/L,(3.16±0.53)ng/L,and(10.09±1.27)mg/L,respectively,all lower than those in group B,all P<0.01).After treatment,the VAS score of group B patients was(2.13±0.42)points,which was lower than that of group A(2.89±0.46)points(t=6.902,P<0.001);while the VAS score of group C was(1.85±0.31)points,which was lower than that of group B(t=3.094,P=0.003).There was no significant difference in the total incidence of adverse reactions such as sneezing between Group A,Group B and Group C(Hc=0.790,P>0.05).Concentration(1.0%)and temperature(30℃)were independent risk factors for the degree of pain in patients with irreversible pulpitis undergoing mandibular root canal treatment(P<0.05).Conclusion 55℃2.5%sodium hypochlorite solution can effectively improve the periodontal status,reduce the levels of inflammatory factors,and relieve the pain in patients undergoing root canal treatment for mandibular molars with irreversible pulpitis,and has good safety.