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中华口腔医学研究杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 85 -91. doi: 10.3877/cma.j.issn.1674-1366.2021.02.004

所属专题： 文献；

临床研究

经皮穴位电刺激对不可逆性牙髓炎患者下牙槽神经阻滞的影响
王浩然1, 管俊杰2, 王映3, 李娜4, 王静秋5, 葛良玉4, 孟箭6,†()   
  1. 1. 蚌埠医学院　233000；徐州市中心医院　221000
    2. 南京中医药大学附属徐州市中心医院，徐州　221000
    3. 蚌埠医学院　233000
    4. 徐州市中心医院　221000
    5. 扬州大学医学院　225000
    6. 徐州市中心医院　221000；南京中医药大学附属徐州市中心医院，徐州　221000
  • 收稿日期:2021-01-19 出版日期:2021-04-01
  • 通信作者: 孟箭

Effect of transcutaneous acupoint electrical stimulation on inferior alveolar nerve block in patients with irreversible pulpitis

Haoran Wang1, Junjie Guan2, Ying Wang3, Na Li4, Jingqiu Wang5, Liangyu Ge4, Jian Meng6,†()   

  1. 1. Bengbu Medical College, Bengbu 233000, China; Xuzhou Central Hospital, Xuzhou 221000, China
    2. Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
    3. Bengbu Medical College, Bengbu 233000, China
    4. Xuzhou Central Hospital, Xuzhou 221000, China
    5. Medical College of Yangzhou University, Yangzhou 225000, China
    6. Xuzhou Central Hospital, Xuzhou 221000, China; Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, Xuzhou 221000, China
  • Received:2021-01-19 Published:2021-04-01
  • Corresponding author: Jian Meng
  • Supported by:
    National Clinical Research Center for Oral Diseases(NCRCO-202101); Health and Family Planning Commission of Jiangsu Province(H2017080); Xuzhou Medical Innovation (Technology Tackling) Team(XWCX201604); Xuzhou Science and Technology Project(KC17196); Graduate Research Innovation Program of Bengbu Medical College(Byycx20062)
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引用本文：

王浩然, 管俊杰, 王映, 李娜, 王静秋, 葛良玉, 孟箭. 经皮穴位电刺激对不可逆性牙髓炎患者下牙槽神经阻滞的影响[J]. 中华口腔医学研究杂志(电子版), 2021, 15(02): 85-91.

Haoran Wang, Junjie Guan, Ying Wang, Na Li, Jingqiu Wang, Liangyu Ge, Jian Meng. Effect of transcutaneous acupoint electrical stimulation on inferior alveolar nerve block in patients with irreversible pulpitis[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2021, 15(02): 85-91.

目的

评估应用经皮穴位电刺激（TEAS）对下颌磨牙不可逆性牙髓炎行开髓治疗时下牙槽神经阻滞（IANB）成功率、疼痛及焦虑状况的影响。

方法

将2020年10月至2021年1月来自徐州市中心医院口腔科的48例因不可逆性牙髓炎需行开髓治疗患者使用Stata 12.0按1∶1比例随机分为实验组（24例）和对照组（24例），将组别及处理方法的信息装入标有1~48序号的不透明信封，招募符合纳入标准的患者，在其接受TEAS治疗前由信息保管者交于针灸医生并实施信封内分组方案。实验组给予TEAS刺激患者双侧合谷穴与劳宫穴，强度为患者所能耐受的最大值。对照组刺激强度为0 mA。记录患者在TEAS刺激前（T0）、刺激结束后（T1）及开髓治疗期间（T2）的Heft-Parker视觉模拟量表（HP-VAS）值来计算疼痛评分，在T0、T1时使用焦虑视觉评分量表（VAS-A）记录患者的焦虑评分及患者IANB成功率。对于患者成功率使用卡方检验、其余数据使用两独立样本t检验。

结果

实验组IANB成功率（79.2%）显著高于对照组（33.3%），差异有统计学意义（χ2 = 10.243，P = 0.001）。与对照组T1的HP-VAS值（88.0 ± 6.0）mm相比，实验组T1[（66.2 ± 5.2）mm]更低，差异有统计学意义（t = 2.745，P = 0.009）；与对照组T2[（65.4 ± 5.6）mm]相比，实验组T2的HP-VAS值（43.7 ± 5.4）mm也低，差异有统计学意义（t = 2.786，P = 0.008）；与对照组T0的HP-VAS值（92.1±6.8）mm相比，对照组T1和T2的HP-VAS值均下降，差异有统计学意义（tT1 = 3.951，PT1 = 0.000；tT2 = 3.035，PT2 = 0.004）；对照组T1（88.0 ± 6.0）mm与T0（92.1 ± 6.8）mm相比，HP-VAS值差异无统计学意义（t = 0.446，P = 0.685）。T1时，对照组VAS-A值（3.0 ± 0.2）高于实验组（1.1 ± 0.2），差异有统计学意义（t = 6.379，P<0.001）；实验组患者经TEAS治疗后VAS-A值显著下降[T0（2.1 ± 0.4）cm、T1（1.1 ± 0.2）cm]，差异有统计学意义（t = 2.288，P = 0.027）。

结论

在开髓治疗前应用TEAS能缓解患者疼痛，改善焦虑状态，提高下颌磨牙不可逆性牙髓炎患者IANB成功率。

关键词: 牙髓炎, 下颌神经, 神经阻滞, 经皮穴位电刺激
Objective

To evaluate the effect of percutaneous acupoint electrical stimulation (TEAS) on the success rate of alveolar nerve block (IANB) , pain and anxiety in the treatment of irreversible pulpitis of mandibular molars.

Methods

A total of 48 patients from the Department of Stomatology, Xuzhou Central Hospital from October 2020 to January 2021 who had irreversible pulpitis were randomly divided into experimental group (24 cases) and control group (24 cases) at ratio of 1∶1 using STATA 12.0. The information of group and treatment method was put into an opaque envelope numbered 1 to 48, and the patients meeting the inclusion criteria were recruited. Before their TEAS treatment, the information keeper handed them over to the acupuncturist and implemented the grouping scheme in the envelope. The experimental group was given bilateral Hegu and Laogong acupoints stimulated by TEAS, and the intensity was the maximum that the patients could tolerate. The stimulus intensity in the control group was 0 mA. Heft-Parker Visual Analog Scale (HP-VAS) values were recorded before TEAS stimulation (T0) , after stimulation (T1) and during myelectomy (T2) to calculate pain scores. Visual Anxiety Scale (VAS-A) was used to record anxiety scores and IANB success rate of patients at T0 and T1. Chi-square test was used for the success rate of patients and two independent sample t test was applied for the remaining data.

Results

The success rate of IANB in the experimental group (79.2%) was significantly higher than that in the control group (33.3%) , the difference was statistically significant (χ2 = 10.243, P = 0.001) . The T1 pain score of the experimental group [ (66.2 ± 5.2) mm] was lower than that of the control group (88.0 ± 6.0) mm, and the difference was statistically significant (t = 2.745, P = 0.009) . Compared with the control group T2[ (65.4 ± 5.6) mm], the T2 pain score of the experimental group (43.7 ± 5.4) mm was also lower, the difference was statistically significant (t=2.786, P=0.008) .Compared with the control group, T0 pain score (92.1 ± 6.8) mm, T1 and T2 pain score of the control group decreased, the difference was statistically significant (tT1 = 3.951, PT1 = 0.000; tT2 = 3.035, PT2 = 0.004) . There was no significant difference in pain scores between T1 (88.0 ± 6.0) mm and T0 (92.1 ± 6.8) mm in the control group (t = 0.446, P = 0.685) . At T1, the anxiety score of the control group (3.0 ± 0.2) was higher than that of the experimental group (1.1±0.2) , and the difference was statistically significant (t = 6.379, P<0.001) . Anxiety scores in the experimental group were significantly decreased after TEAS treatment [T0 (2.1 ± 0.4) cm, T1 (1.1 ± 0.2) cm] (t = 2.288, P = 0.027) .

Conclusion

The application of TEAS before pulpitis can relieve pain, improve anxiety and improve the success rate of IANB in patients with irreversible pulpitis of mandibular molars.

Key words: Pulpitis, Mandibular nerve, Nerve block, Transcutaneous electrical acupoint stimulation
表1 本研究两组不可逆性牙髓炎患者的一般资料（n = 24）
项目 对照组 实验组 检验值 P值
性别[例（%）]     χ2 = 0.333 0.564
  女 11（45.8） 13（54.2）    
  男 13（54.2） 11（45.8）    
年龄（岁，±s） 44.9 ± 15.7 42.2 ± 17.5 t = 0.563 0.159
体质量指数（kg/m2，±s） 24.4 ± 3.3 24.2 ± 3.3 t = 0.21 0.835
术前疼痛（mm，±s） 92.1 ± 33.1 98.8 ± 31.5 t = -0.99 0.322
术前焦虑（mm，±s） 1.6 ± 1.7 2.1 ± 1.9 t = -1.011 0.317
MDAS分级[例（%）]     χ2 = 1.804 0.071
  Ⅰ级 17（70.8） 11（45.8）    
  Ⅱ级 6（25.0） 10（41.7）    
  Ⅲ级 1（4.2） 2（8.3）    
  Ⅳ级 0（0.0） 1（4.2）    
图1 两组不可逆性牙髓炎患者疼痛状况的比较（±s，24例/组）注：与对照组相比，aP<0.05；与T0相比，bP<0.05；HP-VAS为Heft-Parker视觉模拟量表
表2 两组不可逆性牙髓炎患者不同时期焦虑视觉模拟量表（VAS-A）值比较（±s）
组别 T0 T1 t值 P值
对照组 1.6 ± 0.4 3.0 ± 0. 2 3.436 0.001
实验组 2.1 ± 0.4 1.1 ± 0.2 2.288 0.027
t值 1.011 6.379    
P值 0.317 <0.001    
图2 两组不可逆性牙髓炎患者焦虑状况的比较（±s，24例/组）注：与对照组相比，aP<0.05；与T0相比，bP<0.05；VAS-A为焦虑视觉模拟量表
图3 经皮穴位电刺激镇痛的可能机制——电生理途径
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