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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2015, Vol. 09 ›› Issue (06) : 470 -473. doi: 10.3877/cma.j.issn.1674-1366.2015.06.006

所属专题： 文献；

临床研究

上牙槽前、中神经阻滞麻醉技术在上颌牙周治疗中的应用
孙文娟1, 黄南楠1, 唐倩1,†(), 杨雨虹1   
  1. 1. 510630　广州，中山大学附属第三医院口腔科
  • 收稿日期:2015-08-03 出版日期:2015-12-01
  • 通信作者: 唐倩

Anterior middle superior alveolar block anesthetic technique in maxillary scaling and root planning

Wenjuan Sun1, Nannan Huang1, Qian Tang1,†(), Yuhong Yang1   

  1. 1. Department of Stomatology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
  • Received:2015-08-03 Published:2015-12-01
  • Corresponding author: Qian Tang
  • About author:
    Corresponding author: Tang Qian, Email: , Tel: 020-85253184
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孙文娟, 黄南楠, 唐倩, 杨雨虹. 上牙槽前、中神经阻滞麻醉技术在上颌牙周治疗中的应用[J]. 中华口腔医学研究杂志(电子版), 2015, 09(06): 470-473.

Wenjuan Sun, Nannan Huang, Qian Tang, Yuhong Yang. Anterior middle superior alveolar block anesthetic technique in maxillary scaling and root planning[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2015, 09(06): 470-473.

目的

研究采用计算机控制局部麻醉仪行上牙槽前、中神经阻滞麻醉（AMSA）在上颌牙周治疗中的临床效果。

方法

选取45例因牙周炎需要进行牙周治疗的患者，随机将上颌牙列左右两侧分为试验组及对照组，分别采用AMSA及局部浸润麻醉，麻醉药物均为4%阿替卡因。注射后采用10点视觉模拟标尺表（VAS）比较注射疼痛，通过临床评估及问卷调查评估麻醉效果、并发症情况、麻醉后唇颊不适程度及麻醉时间，分别采用t检验、卡方检验、Fisher精确检验及秩和检验进行统计学分析。

结果

试验组VAS值为1.86 ± 0.76，对照组为3.18 ± 1.05，试验组明显低于对照组（t = -9.487，P<0.001）。试验组成功率为82.2%，对照组为93.3%，差异无统计学意义（χ2 = 1.6571，P = 0.198）。试验组并发症发生率为2.2%，对照组为0，差异无统计学意义（P = 0.5）。试验组患者均无唇颊麻木不适感，而对照组中，患者均有不同程度的麻木不适感，麻醉后舒适程度试验组显著优于对照组（Z = -8.857，P<0.001）。试验组麻醉时间均为30~90 min，而对照组中83.3%为61~120 min，试验组麻醉时间明显短于对照组（Z = -5.748，P<0.001）。

结论

在上颌牙周治疗中，采用计算机控制局部麻醉仪进行AMSA具有一定优势，患者感觉舒适，更容易被接受。

关键词: 神经传导阻滞，上牙槽神经, 浸润麻醉，局部, 牙科刮治术, 牙根平滑术, 计算机控制局部麻醉仪
Objective

To evaluate the clinical effect of the anterior middle superior alveolar block (AMSA) injection using the computer-controlled local anesthetic delivery system for maxillary scaling and root planing.

Methods

Forty-five adult patients with periodontal disease were selected for the research. The maxillary region of each patient was divided into left part and right part to receive two different anesthetic techniques randomly. The local anesthesia was performed using 4% articaine with either AMSA or with the conventional infiltration technique. Pain response was recorded and evaluated with a standardized visual analogue scale (VAS) ranging from 0-10. The anesthetic efficacy, duration and side effect of both anesthetic techniques were evaluated with questionnaire and clinical assessment. The dates were analyzed by t-test, Chi-square test, Fisher exact test and Wilcoxon signed-rank test.

Results

The VAS was 1.86 ± 0.76 in the test group and 3.18 ± 1.05 in the control group, the test group showed significantly lower VAS scores compared to the control group (t = -9.487, P<0.001) . In the evaluation of efficacy and safety, no statistically significant differences were found. The achievement ratio was 82.2% in the test group and 93.3% in the control group (χ2 = 1.6571, P = 0.198) . The complication ratio was 2.2% in the test group and 0 in the control group (P = 0.5) . No patient reported facial anesthesia in the test group while all patients in the control group reported varying degrees of facial anesthesia. The anesthetic duration was ranged from 30 to 90 min in the test group and 61 to 120 min in the 83.3% subjects of the control group. The results showed higher satisfaction (Z = -8.857, P<0.001) and shorter duration (Z = -5.748, P<0.001) in the test group compared to the control group.

Conclusion

The AMSA injection delivered with the computer-controlled local anesthetic delivery system was found to be more comfortable and acceptable for patients than conventional local infiltration technique, and thus to be a promising anesthetic technique for maxillary scaling and root planing.

Key words: Nerve block, superior alveolar nerve, Infiltration anesthesia, local, Dental scaling, Root planning, Computer-controlled local anesthetic delivery system
表1 上牙槽前、中神经阻滞麻醉与局部浸润麻醉成功率比较
组别 例数 麻醉效果（例） 成功率（%） χ2值 P值
完全 良好 一般 差
试验组 45 19 18 6 2 82.2 1.6571 0.198
对照组 45 27 15 3 0 93.3 ? ?
表2 上牙槽前、中神经阻滞麻醉与局部浸润麻醉后上唇、面部麻木不适程度比较
组别 例数 无不适 轻度不适 中度不适 重度不适 极不适 Z值 P值
试验组 45 45 0 0 0 0 -8.857 < 0.001
对照组 45 0 19 22 4 0 ? ?
表3 上牙槽前、中神经阻滞麻醉与局部浸润麻醉时间比较
组别 例数 麻醉时间（min） Z值 P值
30 ~ 60 61 ~ 90 91 ~ 120 >120
试验组 37 18 19 0 0 -5.748 < 0.001
对照组 42 3 15 20 4 ? ?
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