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中华口腔医学研究杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 397 -405. doi: 10.3877/cma.j.issn.1674-1366.2024.06.009

综述

唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望
宋玟焱1, 杜美君1, 陈佳丽1, 石冰1, 黄汉尧1,()   
  1. 1.口腔疾病研究国家重点实验室,国家口腔疾病临床医学研究中心,四川大学华西口腔医院唇腭裂外科,成都 610041
  • 收稿日期:2024-08-24 出版日期:2024-12-01
  • 通信作者: 黄汉尧
  • 基金资助:
    国家自然科学基金(82301148)中国博士后科学基金(2024T170605)四川省博士后科研项目(TB2022005)四川省卫生健康委员会科技项目(24QNMP060)四川大学高等教育教学改革工程研究项目(SCU10379)

Research progress and prospective of biomaterial-based therapeutic approaches in pain management during the perioperative period of cleft lip and palate surgery

Wenyan Song1, Meijun Du1, Jiali Chen1, Bing Shi1, Hanyao Huang1,()   

  1. 1.State Key Laboratory of Oral Diseases,National Clinical Research Center for Oral Diseases,Department of Oral &Maxillofacial Surgery,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China
  • Received:2024-08-24 Published:2024-12-01
  • Corresponding author: Hanyao Huang
引用本文:

宋玟焱, 杜美君, 陈佳丽, 石冰, 黄汉尧. 唇腭裂手术围手术期疼痛管理的研究进展及基于生物材料治疗新方法的展望[J]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 397-405.

Wenyan Song, Meijun Du, Jiali Chen, Bing Shi, Hanyao Huang. Research progress and prospective of biomaterial-based therapeutic approaches in pain management during the perioperative period of cleft lip and palate surgery[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(06): 397-405.

唇腭裂是最常见的先天性缺陷之一,目前手术仍是唯一有效的治疗方法。然而,唇腭裂手术围手术期的疼痛会引发患儿的不良情绪和生理反应,不仅影响患儿的正常喂养,还可能因疼痛导致过度哭闹而引发伤口裂开。因此,唇腭裂手术围手术期的疼痛管理与手术治疗的最终效果密切相关。本文将从唇腭裂手术围手术期疼痛的发生机制、止痛药物的选择、麻醉方式及其效果等方面,综述当前疼痛管理的研究进展。随着生物治疗技术的发展,生物材料在疼痛管理中的应用也展现出巨大的潜力,本文将对基于生物材料的新型治疗方法在唇腭裂手术围手术期疼痛管理中的应用前景进行展望。

Cleft lip and palate is one of the most common congenital anomalies. Currently,surgery remains the only effective treatment method of it. However,the pain experienced by children during the perioperative period of cleft lip and palate surgery can induce adverse emotional and physiological responses,not only affecting the normal feeding of the children,but also potentially leading to wound dehiscence due to excessive crying caused by pain. Therefore,the management of pain during the perioperative period of cleft lip and palate surgery is closely related to the final outcome of the surgical treatment. This article reviews the current research progress in pain management from the aspects of the mechanism of pain during the perioperative period of cleft lip and palate surgery,the selection of analgesic drugs,anesthesia methods,and their effects. With the development of biotherapeutic technology,the application of biomaterials in pain management also shows great potential. Thus,this article dicusses the application prospects of novel therapeutic methods based on biomaterials in the pain management during the perioperative period of cleft lip and palate surgery.

表1 人体神经纤维类型与痛觉
表2 阿片类药物的分类及其常见药物
表3 唇腭裂手术相关各神经阻滞麻醉方法
神经阻滞 走行 方法学
眶下神经阻滞 经眶下裂入眶,行经眶下沟、眶下管,由眶下孔出眶。 1.患者仰卧,头部处于正中位置并得到良好支撑[31,34]
2.左手食指扪及眶下孔,右手持注射器使之与皮肤呈45°[25,35]
3.鼻翼基底部旁7.5 mm[24]处进针
4.注射相应局部麻醉药物
5.按摩该区域防止血肿
鼻外神经阻滞 在鼻骨下缘下方出鼻,在鼻背外侧约6.5~8.5 mm处穿过上外侧软骨的上缘[36] 1.自远端鼻骨的神经出孔处(高于上外侧软骨,距鼻背中线约7 mm[25,36])进针
2.注射相应局部麻醉药物
颧上上颌神经阻滞 通过圆孔离开颅骨,穿过翼腭窝,并通过眶下裂进入眼眶。 1.从颧弓上缘和眶后缘形成的额颌角处垂直入针[37]
2.接触蝶骨大翼后,部分抽出
3.向约前方20°、下方10°,并刺入35~38 mm以进入翼腭窝[38]
4.注射相应局部麻醉药物
腭大神经阻滞 沿着翼腭管向下延伸,并通过腭大孔出现在硬腭,与鼻腭神经末端在前面相通。 1.患者头后仰,大张口,上颌与地面呈60°
2.自腭大孔表面标志入针
3.注射相应局部麻醉药物
腭小神经阻滞 腭中神经穿过腭小孔,腭后神经穿过翼腭管下降,并通过腭小孔出现。 1.患者头后仰,大张口,上颌与地面呈60°
2.自腭小孔表面标志入针
3.注射相应局部麻醉药物
鼻腭神经阻滞 从上颌神经节发出,经过翼腭窝,穿过切牙管,最终出现在鼻中隔上。 1.患者头后仰,大张口,注射针与腭中线处于同一平面
2.自切牙孔表面标志入针
3.注射相应局部麻醉药物
图1 腭部解剖结构及神经分布
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