黏膜下注射不同剂量地塞米松改善下颌第三磨牙拔除术后症状的疗效观察

目的研究不同剂量地塞米松黏膜下注射对下颌第三磨牙拔除术后症状的临床疗效。方法选取2016年8月—2016年11月复旦大学附属中山医院和上海市静安区牙病防治所收治的拔除下颌第三磨牙患者156例,随机分为对照组(53例)、地塞米松4 mg组(51例)和地塞米松8 mg组(52例)。对照组术前于下颌第三磨牙黏膜周围1 cm范围内注射生理盐水。地塞米松4 mg组术前于下颌第三磨牙黏膜周围1 cm范围内注射地塞米松磷酸钠注射液4 mg。地塞米松8 mg组术前于下颌第三磨牙黏膜周围1 cm范围内注射地塞米松磷酸钠注射液8 mg。观察3组的第三磨牙拔除术后症状严重度(Po SSe)量表评分,比较3组的术后肿胀程度和最大张口程度。结果治疗后,地塞米松4 mg组和地塞米松8 mg组饮食、言语、肿胀、疼痛、日常生活评分和总评分明显低于对照组,3组比较差异有统计学意义(P0.05);且地塞米松8 mg组这些观察指标下降程度明显优于地塞米松4 mg组,两组比较差异具有统计学意义(P0.05)。治疗后,地塞米松8 mg组1级肿胀占比明显高于对照组和地塞米松4 mg组,而3、4级肿胀明显低于对照组和地塞米松4 mg组,3组比较差异具有统计学意义(P0.05)。术后1周,地塞米松4 mg组和地塞米松8 mg组最大张口程度明显大于对照组,3组比较差异具有统计学意义(P0.05)。结论黏膜下注射地塞米松可改善下颌第三磨牙拔除术后症状,可减少术后肿胀程度,增加术后1周最大张口程度,且地塞米松8 mg优于地塞米松4 mg,具有一定的临床推广应用价值。

Clinical observation of submucosal injection with different doses of dexamethasone to improve postoperative symptoms of mandibular third molar extraction

Objective To study the clinical effect of submucosal injection of dexamethasone to improve postoperative symptoms of mandibular third molar extraction. Methods Patients (156 cases) with mandibular third molar extraction in Zhongshan Hospital of Fudan University and Shanghai Jingan Dental Clinic from August 2016 to November 2016 were randomly divided into control group (53 cases), dexamethasone 4 mg group (51 cases) and dexamethasone 8 mg group (52 cases). Patients in the control group were submucosal injected with normal saline within 1 cm range of mandibular third molar. Patients in the dexamethasone 4 mg group were submucosal injected with 4 mg Dexamethasone Sodium Phosphate Injection within 1 cm range of mandibular third molar. Patients in the dexamethasone 8 mg group were submucosal injected with 8 mg Dexamethasone Sodium Phosphate Injection within 1 cm range of mandibular third molar. After treatment, the postoperative symptom score (PoSSe) was evaluated, and postoperative swelling and maximum mouth opening degree among three groups were compared. After treatment, the scores of diet, speech, swelling, pain, daily life and total scores in the dexamethasone 4 mg and dexamethasone 8 mg group were lower than those in the control group, and there were difference among three groups (P < 0.05). The observational indexes in the dexamethasone 8 m group were significantly better than those in the dexamethasone 4 mg group, with significant difference between two groups (P < 0.05). After treatment, the 1 grade swelling percentage in dexamethasone 8 mg group was significantly higher than those in the control and dexamethasone 4 mg groups, but the 3 and 4 grade swelling percentage in dexamethasone 8 mg group was significantly lower than those in the control and dexamethasone 4 mg groups, and there was difference among three groups (P < 0.05). After 1 week of surgery, the maximum mouth opening degree in the dexamethasone 4 mg and dexamethasone 8 mg group were significantly bigger than that in the control group, and there was difference among three groups (P < 0.05). Conclusion Submucosal injection with dexamethasone in mandibular third molar can improve postoperative symptoms, can decrease postoperative swelling, increase maximum mouth opening degree after 1 week of surgery, and dexamethasone with dose of 8 mg is better than dexamethasone with dose of 4 mg, which has a certain clinical application value.