患者对第三磨牙手术后恢复情况的认知。

Patients' perception of recovery after third molar surgery.

作者信息

Conrad S M, Blakey G H, Shugars D A, Marciani R D, Phillips C, White R P

机构信息

Department of Oral and Maxillofacial Surgery, School of Dentistry, University of North Carolina, Chapel Hill 27599-7450, USA.

出版信息

J Oral Maxillofac Surg. 1999 Nov;57(11):1288-94; discussion 1295-6. doi: 10.1016/s0278-2391(99)90861-3.

DOI:10.1016/s0278-2391(99)90861-3

PMID:10555792

Abstract

PURPOSE

This study evaluated patients' perceptions of recovery after third molar surgery.

METHODS

Two hundred forty-nine patients (age 13 to 37 years) at 2 clinical centers were enrolled in a prospective study before the surgical removal of third molars. Each patient was given a 21-item Health-Related Quality of Life instrument (HRQOL) to be completed each postoperative day (POD) for 14 days. The instrument was designed to assess patients' perception of recovery: pain, oral function, general activity measures, and other symptoms. Pain dimensions were recorded with a 7-point Likert-type scale; all other conditions were measured on 5-point Likert-type scales. The impact of each predictor variable such as age, gender, and length of surgery on recovery was assessed with Cochran-Mantel-Haenszel statistics, controlling for clinical center.

RESULTS

After the 14-day postoperative period, 201 of the original 249 patients returned the completed HRQOL instrument; the 48 patients who did not return their diary had third molar conditions and surgery similar to the 201 patients who responded. On POD 1, 63.5% of patients reported their worst pain as severe (score, 5 to 7/7) at some time during the day. By POD 7, only 15% of patients reported their worst pain as severe. Average pain levels were much less; 29% reported their average pain as severe (score, 5 to 7/7) on POD 1, decreasing to 5.5% by POD 7. Patients experienced substantial interference in oral function; chewing, 85%; mouth opening 78.5%, and speaking 37.5% on POD 1. By POD 6, oral function had improved; chewing, 19%, mouth opening, 15%; and speaking, 1.5%. General measures also were affected on POD 1; social activity, 61.5%; recreation, 70.5%; and daily routine, 60%. Patients assumed a more normal lifestyle by POD 5. Swelling seemed to be at its maximum on PODs 1 and 2 (day 1, 53%; day 2, 61%) and decreased markedly by POD 5 (10%). Food collection in the surgical sites posed the biggest problem for patients on POD 9 (20%). Age was not a predictor of prolonged recovery. However, surgery time 30 minutes or longer, or having all third molars below the occlusal plane, did prolong recovery. Females also reported a longer recovery period.

CONCLUSIONS

This information is valuable to patients deciding on third molar surgery and to clinicians providing informed consent.

摘要

目的

本研究评估了患者对第三磨牙手术后恢复情况的认知。

方法

2个临床中心的249例患者（年龄13至37岁）在第三磨牙手术切除前被纳入一项前瞻性研究。每位患者在术后14天内每天都要填写一份包含21项内容的健康相关生活质量量表（HRQOL）。该量表旨在评估患者对恢复情况的认知：疼痛、口腔功能、一般活动指标及其他症状。疼痛程度用7分李克特量表记录；所有其他情况用5分李克特量表测量。使用 Cochr an - Mantel - Haenszel 统计方法评估每个预测变量（如年龄、性别和手术时长）对恢复的影响，并对临床中心进行控制。

结果

术后14天，最初的249例患者中有201例返回了填写完整的HRQOL量表；未返回日记的48例患者的第三磨牙情况和手术与201例有回复的患者相似。术后第1天，63.5%的患者报告其一天中最严重的疼痛为重度（评分5至7/7）。到术后第7天，只有15%的患者报告其最严重的疼痛为重度！平均疼痛程度要低得多；术后第1天，29%的患者报告其平均疼痛为重度（评分5至7/7），到术后第7天降至5.5%。患者的口腔功能受到严重影响；术后第1天，咀嚼功能受影响的占85%，张口功能受影响的占78.5%，说话功能受影响的占37.5%。到术后第6天，口腔功能有所改善；咀嚼功能受影响的占19%，张口功能受影响的占15%，说话功能受影响的占1.5%。一般活动指标在术后第1天也受到影响；社交活动受影响的占61.5%，娱乐活动受影响的占70.5%，日常生活受影响的占60%。到术后第5天，患者的生活方式恢复得更为正常。肿胀似乎在术后第1天和第2天达到最大值（第1天为53%，第2天为61%），到术后第5天明显下降（10%）。术后第9天，手术部位食物残留是患者面临的最大问题（20%）。年龄不是恢复时间延长的预测因素。然而，手术时间30分钟或更长，或所有第三磨牙均低于咬合平面，确实会延长恢复时间。女性报告的恢复时间也更长。