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

doi:10.7518/hxkq.2025.2025223

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (4): 493-498.doi: 10.7518/hxkq.2025.2025223

• 儿童口腔医学诊疗新进展 • 上一篇下一篇

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

卢晓爔¹(), 杨宽², 张百泽¹, 张亚秋³, 王军辉¹, 韩欣欣¹, 陈宇江¹, 王小竞¹()

^1.口颌系统重建与再生全国重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔生物工程技术研究中心，第四军医大学口腔医院儿童口腔科，西安 710032
^2.青岛大学附属医院口腔正畸科，青岛大学口腔医学院，青岛 266003
^3.口颌系统重建与再生全国重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔生物工程技术研究中心，第四军医大学口腔医院麻醉科，西安 710032

收稿日期:2025-05-27 修回日期:2025-07-04 出版日期:2025-08-01 发布日期:2025-08-29
通讯作者: 王小竞 E-mail:15232115135@163.com;wxjing@fmmu.edu.cn
作者简介:卢晓爔，医师，博士，E-mail：15232115135@163.com
基金资助:
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)

Clinical study on hemodynamics and analgesic effect of local infiltration anesthesia in the treatment of severe early childhood caries under general anesthesia

Lu Xiaoxi¹(), Yang Kuan², Zhang Baize¹, Zhang Yaqiu³, Wang Junhui¹, Han Xinxin¹, Chen Yujiang¹, Wang Xiaojing¹()

^1.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Oral Bioengineering Technology Research Center, Dept. of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China
^2.Dept. of Orthodontics, Qingdao University Affiliated Hospital, School of Stomatology, Qingdao University, Qingdao 266003, China
^3.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Oral Bioengineering Technology Research Center, Dept. of Anesthesiology, School of Stomatology, The Fourth Military Medical University, Xi’an 710032, China

Received:2025-05-27 Revised:2025-07-04 Online:2025-08-01 Published:2025-08-29
Contact: Wang Xiaojing E-mail:15232115135@163.com;wxjing@fmmu.edu.cn
Supported by:
Key Project of National Clinical Research Center for Oral Diseases(LCA202010);Key Project of Education and Teaching Research at the Third Affiliated Hospital of Air Force Medical University(417172122)

摘要/Abstract

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。

关键词: 重度低龄儿童龋, 全身麻醉, 局部麻醉, 疼痛管理, 血流动力学

Abstract:

Objective This study aimed to explore the clinical efficacy of severe early childhood caries (SECC) treatment combined with local anesthesia under general anesthesia. Methods A 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. Results No 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). Conclusion The 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.

Key words: severe early childhood caries, general anesthesia, local anesthesia, pain management, hemodynamics

中图分类号:

R788

卢晓爔, 杨宽, 张百泽, 张亚秋, 王军辉, 韩欣欣, 陈宇江, 王小竞. 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[J]. 华西口腔医学杂志, 2025, 43(4): 493-498.

Lu Xiaoxi, Yang Kuan, Zhang Baize, Zhang Yaqiu, Wang Junhui, Han Xinxin, Chen Yujiang, Wang Xiaojing. Clinical study on hemodynamics and analgesic effect of local infiltration anesthesia in the treatment of severe early childhood caries under general anesthesia[J]. West China Journal of Stomatology, 2025, 43(4): 493-498.

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项目	对照组（n=54）	实验组（n=54）	χ²/t值	P值
男∶女	29∶25	26∶28	0.334	0.561
年龄/月	58.23±8.42	56.94±9.56	0.105	0.725
身高/cm	109.05±9.37	106.14±10.18	0.524	0.697
体重/kg	18.11±4.09	17.26±3.87	1.705	0.568
治疗牙数/颗	13.62±3.18	14.53±2.83	2.723	0.354
术前PSI	42.34±5.48	44.89±5.24	3.976	0.128
丙泊酚/mg	37.26±5.27	36.43±5.04	0.168	0.746
芬太尼/μg	36.50±4.37	35.96±4.76	0.089	0.839
顺式阿曲库铵/mg	1.79±0.33	1.71±0.26	1.347	0.625
地塞米松/mg	3.61±0.59	3.42±0.49	2.145	0.427

项目	对照组（n=54）	实验组（n=54）	t值	P值
间接牙髓治疗术
心率变化/（次/min）	1.26±0.81	1.04±0.75	1.038	0.304
收缩压变化/mmHg	0.89±0.75	0.70±0.77	0.891	0.377
舒张压变化/mmHg	0.59±0.63	0.48±0.58	0.671	0.505
牙髓切断术
心率变化/（次/min）	5.44±1.08	4.52±1.18	2.988	0.004
收缩压变化/mmHg	2.74±0.98	2.11±0.80	2.579	0.013
舒张压变化/mmHg	2.04±0.85	1.37±0.92	2.750	0.008
根管治疗术
心率变化/（次/min）	4.78±1.31	4.04±1.28	2.097	0.041
收缩压变化/mmHg	2.59±1.01	1.81±0.92	2.956	0.005
舒张压变化/mmHg	2.22±1.12	1.56±1.05	2.255	0.028
牙拔除术
心率变化/（次/min）	6.04±1.42	4.89±1.25	3.144	0.003
收缩压变化/mmHg	3.52±0.89	2.78±1.08	2.737	0.008
舒张压变化/mmHg	2.56±1.18	1.89±0.93	2.293	0.026

项目	对照组（n=54）	实验组（n=54）	χ²值	P值
FPS-R
术后清醒时	24（44.44%）	14（25.93%）	4.060	0.044
术后2 h	19（35.19%）	9（16.67%）	4.821	0.028
术后24 h	10（18.52%）	6（11.11%）	1.174	0.279
PPPM
术后清醒时	22（40.74%）	11（20.37%）	5.280	0.022
术后2 h	15（27.78%）	8（14.81%）	2.707	0.100
术后24 h	9（16.67%）	4（7.41%）	2.186	0.139
术后24 h不良反应	25（46.30%）	20（37.04%）	0.952	0.329

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

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