2种浓度利多卡因对下颌智牙拔除麻醉效果的影响  

Different concentration of lidocaine used for an exodontia of the impacted mandibular third molar

作　　者：翟沁凯[1] 高超 沈末伦 赵君[1] 叶虎[1] 储德强 郝新河[1] ZHAI Qinkai;GAO Chao;SHEN Mo-lun;ZHAO Jun;YE Hu;CHU De-qiang;HAO Xin-he(Department of Oral and Maxillofacial Surgery,Hefei Stomatology Hospital.Hefei 230001,Anhui Province,China)

机构地区：[1]合肥市口腔医院,安徽医科大学合肥口腔临床学院口腔颌面外科,安徽合肥230001

出　　处：《上海口腔医学》2020年第5期499-503,共5页Shanghai Journal of Stomatology

基　　金：安徽省重点研究与开发计划项目(201904a07020023);合肥市卫计委应用医学研究项目(hwk2018zc009);合肥市自主创新政策“借转补”资金项目(J2019Y03)。

摘　　要：目的:探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法:采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100000肾上腺素(低浓度组)或3 mL 2%利多卡因1∶100000肾上腺素(高浓度组)行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平(疼痛评估量表,NRS)、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0软件包对数据进行统计学分析。结果:21例患者(平均年龄24岁)完成试验,其中62%为女性。低浓度组的疼痛水平(1.09,95%CI,0.77~1.41)显著低于高浓度组(1.66,95%CI,1.33-1.99)(P=0.010)。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间(52~63 s)显著快于高浓度组(259~335 s)(P=0.000)。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异(P=0.751)。在疼痛NRS值为1~3的患者中,低浓度组,9例(100%)均在分牙时疼痛(下牙槽神经麻醉深度浅);高浓度组3例(43%)分牙时疼痛,4例(57%)翻瓣时疼痛(颊神经麻醉深度浅)(P=0.019)。高浓度组麻醉持续时间比低浓度组平均长61 min(52~69 min)(P=0.000)。结论:用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。PURPOSE:To investigate the anesthesia outcomes of 1%lidocaine with 1∶100000 epinephrine(EPI)for inferior alveolar nerve,lingual nerve and buccal nerve block,compared with 2%lidocaine with 1∶100000 EPI.METHODS:A study with a cross-over design,with each patient also serving as their own control,was implemented to estimate the clinical outcomes.Predictor variable was 1%lidocaine with 1∶100000 EPI versus 2%lidocaine with 1∶100000 EPI.Outcome variables were patients’responses to pain on injection,onset time of anesthetizing,efficacy of anesthesia,and the time to sensation return for the lower lip and tongue.Patients reported pain level at every experimental stage with a 10-point Numerical Rating Scale(NRS).Three weeks later,the patients were tested with the alternate drug combinations.The same outcomes were assessed.A verification of treatment difference was performed using SPSS 17.0 software package.RESULTS:Twenty-one patients were recruited and completed the study protocol.Sixty-two percent of the patients were women and 38%were men with a median age of 24 years[interquartile range(IQR),20-30 yr].Patients reported significantly lower pain scores with 1%lidocaine(1.09,95%CI,0.77-1.41)on injection,compared with 2%lidocaine(1.66,95%CI,1.33-1.99)(P=0.010).Patients undergoing 1%lidocaine with 1∶100000 EPI(52-63 s)had a markedly quicker onset time of anesthetizing than those using 2%lidocaine with 1∶100000 EPI(259-335 s,P=0.000).The efficacy of anesthesia between 2 groups was not significantly different(P=0.751).Among the patients with the pain values of 1~3,there were 9 patients(100%)perceiving slight pain when splitting teeth was performed in 1%lidocaine group,while 4 patients(57%)felt slight pain when elevating soft flaps was performed and 3 patients(43%)perceived mild pain when splitting teeth was performed in 2%lidocaine group(P=0.019).The time to sensation return for the lower lip and tongue was significantly different between the 2 drug formulations(P=0.000),with an extended period of average 61 min(5

关 键 词：利多卡因 下牙槽神经 阻滞麻醉 

分 类 号：R782.05[医药卫生—口腔医学]