Tiwana Paul S, Foy Susan P, Shugars Daniel A, Marciani Robert D, Conrad Shawn M, Phillips Ceib, White Raymond P
Department of Surgery and Hospital Dentistry, School of Dentistry, University of Lousville, Lousville, KY, USA.
J Oral Maxillofac Surg. 2005 Jan;63(1):55-62. doi: 10.1016/j.joms.2004.01.029.
To compare recovery for clinical and health-related quality of life (HRQOL) outcomes after third molar surgery in patients predicted to be at risk for delayed recovery, treated with or without intravenous (IV) corticosteroids at surgery.
Patients at least 18 years of age and with all 4 third molars below the occlusal plane were given IV corticosteroids just before third molar surgery. Clinical and HRQOL outcomes of these patients were compared with those of a nonconcurrent control group who did not receive corticosteroids. No antibiotics were administered. The control group was selected using the same criteria and treated under the same surgical protocol as the corticosteroid group. Differences between the groups were assessed with Cochran-Mantel-Haenszel row mean score statistics.
Sixty patients were in each cohort. The incidence of delayed clinical recovery, a postsurgery visit with treatment, was higher in the control group compared with the corticosteroid group. In the corticosteroid group, 6 patients (10%) had 1 postsurgery visit with treatment. In the control group without corticosteroids, 17 patients (28%) had at least 1 postsurgery visit with treatment (P = .01). Compared with the control group, nausea tended to bother patients less on postsurgery day 1 (P = .07); sleep was improved on postsurgery days 1 through 4 (P < .05). Though not statistically significant, corticosteroids reduced the patients reported recovery by at least 1 day for pain, lifestyle, and oral function.
Administration of IV corticosteroids before third molar surgery without antibiotics does not hamper clinical recovery even when healthy adult patients are predicted to have delayed recovery. Overall, IV corticosteroid administration had a limited, but beneficial effect on HRQOL outcomes.
比较预计有延迟恢复风险的患者在接受或未接受手术时静脉注射（IV）皮质类固醇治疗的情况下，第三磨牙手术后临床及健康相关生活质量（HRQOL）结果的恢复情况。
年龄至少18岁且所有4颗第三磨牙均在咬合平面以下的患者在第三磨牙手术前接受静脉注射皮质类固醇。将这些患者的临床和HRQOL结果与未接受皮质类固醇的非同期对照组进行比较。未使用抗生素。对照组按照与皮质类固醇组相同的标准选择，并按照相同的手术方案进行治疗。采用 Cochr an - Mantel - Haenszel行均值评分统计评估两组之间的差异。
每个队列有60名患者。对照组延迟临床恢复（术后需要就诊治疗）的发生率高于皮质类固醇组。在皮质类固醇组中，6名患者（10%）术后有1次就诊治疗。在未使用皮质类固醇的对照组中，17名患者（28%）至少有1次术后就诊治疗（P = 0.01）。与对照组相比，术后第1天恶心对患者的困扰较小（P = 0.07）；术后第1天至第4天睡眠得到改善（P < 0.05）。尽管无统计学意义，但皮质类固醇使患者报告的疼痛、生活方式和口腔功能恢复时间至少缩短1天。
即使预计健康成年患者会延迟恢复，在第三磨牙手术前静脉注射皮质类固醇且不使用抗生素并不妨碍临床恢复。总体而言，静脉注射皮质类固醇对HRQOL结果有有限但有益的影响。
