局部浸润麻醉在全身麻醉下重度低龄儿童龋治疗中血流动力学及镇痛效果的临床研究
Clinical study on hemodynamics and analgesic effect of local infiltration anesthesia in the treatment of severe early childhood caries under general anesthesia
作者：卢晓爔, 杨宽, 张百泽, 张亚秋, 王军辉, 韩欣欣, 陈宇江, 王小竞
Author：Lu Xiaoxi, Yang Kuan, Zhang Baize, Zhang Yaqiu, Wang Junhui, Han Xinxin, Chen Yujiang, Wang Xiaojing
收稿日期：2025-05-27 年卷（期）页码：2025,43(4):493-493-498
期刊名称：华西口腔医学杂志
Journal Name：West China Journal of Stomatology
关键字：重度低龄儿童龋,全身麻醉,局部麻醉,疼痛管理,血流动力学,
Key words：severe early childhood caries,general anesthesia,local anesthesia,pain management,hemodynamics,
基金项目：国家口腔疾病临床医学研究中心重点项目(LCA2020-10);空军军医大学第三附属医院教育教学研究重点课题(41717-2122)
中文摘要
目的 探讨全身麻醉下重度低龄儿童龋（SECC）治疗联合应用局部麻醉的临床应用疗效。 方法 选取2023年3—12月于空军军医大学第三附属医院儿童口腔科进行全身麻醉下SECC治疗的108例6岁以下儿童为研究对象，美国麻醉医师协会（ASA）分级为Ⅰ类或Ⅱ类，通过调取术中病例及术后回访记录将研究对象分为对照组（n=54）和实验组（n=54）。对照组采用静吸复合经鼻气管插管全身麻醉方式，实验组在实施全身麻醉的基础上，采用2%利多卡因对每颗采用所研究4种术式（间接牙髓治疗术、牙髓切断术、根管治疗术、牙拔除术）的治疗牙进行局部麻醉。记录并分析2组患儿基本信息、术前麻醉深度、术中不同术式的血流动力学变化和术后疼痛情况及不良反应。 结果 2组患儿基本信息和术前麻醉深度差异无统计学意义（P>0.05），除间接牙髓治疗术外，在其余3种术式（牙髓切断术、根管治疗术、牙拔除术）中，实验组的3项观察指标均显著小于对照组（P<0.05），实验组根据改良面部疼痛量表（FPS-R）评分需采取镇痛措施的比率在术后清醒时和术后2 h显著小于对照组（P<0.05），术后24 h组间差异无统计学意义（P>0.05）。实验组根据父母疼痛测量量表（PPPM）评分需采取镇痛措施的比率在术后清醒时显著小于对照组（P<0.05），术后2 h和术后24 h组间差异无统计学意义（P>0.05）。2组患儿术后24 h不良反应发生率的组间差异无统计学意义（P>0.05）。 结论 全身麻醉下SECC治疗联合使用局部麻醉后，术中血流动力学变化较小，术后疼痛反应较轻，值得临床推广。
英文摘要
ObjectiveThis study aimed to explore the clinical efficacy of severe early childhood caries (SECC) treatment combined with local anesthesia under general anesthesia.MethodsA total of 108 children under 6 years old who underwent SECC dental treatment under general anesthesia at the Department of Pediatric Dentistry, Third Affiliated Hospital of Air Force Medical University from March to December 2023 were selected as the study subjects, with American Society of Anesthesiologists (ASA) classification of classⅠor Ⅱ. The study subjects were divided into a control group (n=54) and an experimental group (n=54) by retrieving intraoperative cases and postoperative follow-up records. The control group was given general anesthesia through inhalation combined with nasotracheal intubation, whereas the experimental group was given local anesthesia with 2% lidocaine on each treated tooth on the basis of general anesthesia. The basic information, preoperative anesthesia depth, hemodynamic changes during different surgical procedures, postoperative pain, and adverse reactions in the two groups were recorded and analyzed.ResultsNo statistically significant difference was found in the basic information and preoperative anesthesia depth between the two groups (P>0.05). Among the three procedures (pulpotomy, root canal treatment, and tooth extraction), the three observed indicators in the experimental group were significantly lower than those in the control group (P<0 .05). the proportion of patients in the experimental group who needed to take analgesic measures in accordance with the modified facial pain scale (fps-r) score was significantly lower than that in the control group at postoperative wakefulness and 2 h after surgery (P<0 .05). meanwhile, no statistically significant difference was observed between the groups at 24 h after surgery (P>0.05). The proportion of patients in the experimental group who needed to take analgesic measures on the basis of the parent posto-perative pain measurement (PPPM) score was significantly lower than that in the control group when they were awake after surgery (P<0 .05). no statistically significant difference was found between the groups at 2 and 24 h after surgery (P>0.05). Moreover, no statistically significant difference was observed in the incidence of adverse reactions between the two groups at 24 h after surgery (P>0.05).ConclusionThe combination of local anesthesia during SECC dental treatment under general anesthesia results in minimal changes in intraoperative hemodynamics and mild postoperative pain response, hence worthy of clinical promotion.
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