儿童龋病充填中两种预防牙科畏惧症方法的最小成本分析

目的 用卫生经济学中最小成本分析法对治前教育和局部麻醉两种方法在龋病充填治疗中预防牙科畏慎症（DF）的效果进行评价。方法 下颌第一恒磨牙合面患龋的150名7-12岁小学生参加试验，知情同意后随机分为3组，每组50例（男、女各25例），A组（治前教育）在医生的带领下，提前1h观看龋病防治的科教录像片，熟悉诊室的环境、器械和设备，咨询所提出的问题；B组（局部麻醉）提前15min进行下齿槽神经阻滞麻醉；C组（空白对照）不做任何针对DF的干预。3组均接受常规的充填治疗。比较各组的DF发生率并进行最小成本分析。结果 3组DF的发生率分别为10%、18%、和42%，差异有显著性（X^2=15.5031,P=0.0004），但两干预组间差异不显著。3组的人均成本投入分别为83.99元，87.09元和87.76元，以治前教育组最低。结论 龋病充填治疗时，用治前教育法预防DF比局部麻醉法优越。

Cost-minimization analysis of two methods during the prevention of dental fear during caries filling treatments

OBJECTIVE: To determine the economic effects on the prevention of dental fear (DF) by pre-operation-education or local anesthesia method during the process of tooth filling. METHODS: One hundred and fifty school children of age 7 to 12, participating in this study, suffered from occlusal caries on their mandibular first molars. They were divided into 3 groups, with 25 boys and 25 girls each. Group A (pre-operation-education) was showed video tape on caries to, familiarized with clinic environment, including dental chairs and instruments; Group B (local anesthesia) received injection of 1.8 ml of 2% lidocaine for local anesthesia about 15 minutes before treatment; Group C (blank) received no intervention for DF. Thereafter, all subjects received same filling treatment. During that process, each DF case was evaluated blindly based on Venham's clinical ratings of anxiety and cooperation. Cost-minimization analysis was then studied. RESULTS: Significant difference was found between groups, but not between group A and B in DF rate (5/50, 9/50 and 21/50, chi(2) = 15.503 1, P = 0.000 4). The costs of each case in 3 groups were 83.99 Yuan, 87.09 Yuan and 87.76 Yuan respectively. CONCLUSION: Between pre-operation-education and local anesthesia methods, the former was worth promoted for it's better clinical effect in DF prevention with lower cost.