Lu Xiaoxi, Yang Kuan, Zhang Baize, Zhang Yaqiu, Wang Junhui, Han Xinxin, Chen Yujiang, Wang Xiaojing
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Oral Bioengineering Technology Research Center, Dept. of Pediatric Dentistry, School of Stomatology, The Fourth Military Medical University, Xi'an 710032, China.
Dept. of Orthodontics, Qingdao University Affiliated Hospital, School of Stomatology, Qingdao University, Qingdao 266003, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2025 Aug 1;43(4):493-498. doi: 10.7518/hxkq.2025.2025223.
This study aimed to explore the clinical efficacy of severe early childhood caries (SECC) treatment combined with local anesthesia under general anesthesia.
A total of 108 children under 6 years old who underwent SECC dental treatment under general anesthesia at the Department of Pediatric Dentistry, Third Affiliated Hospital of Air Force Medical University from March to December 2023 were selected as the study subjects, with American Society of Anesthesiologists (ASA) classification of classⅠor Ⅱ. The study subjects were divided into a control group (=54) and an experimental group (=54) by retrieving intraoperative cases and postoperative follow-up records. The control group was given general anesthesia through inhalation combined with nasotracheal intubation, whereas the experimental group was given local anesthesia with 2% lidocaine on each treated tooth on the basis of general anesthesia. The basic information, preoperative anesthesia depth, hemodynamic changes during different surgical procedures, postoperative pain, and adverse reactions in the two groups were recorded and analyzed.
No statistically significant difference was found in the basic information and preoperative anesthesia depth between the two groups (>0.05). Among the three procedures (pulpotomy, root canal treatment, and tooth extraction), the three observed indicators in the experimental group were significantly lower than those in the control group (<0.05). The proportion of patients in the experimental group who needed to take analgesic measures in accordance with the modified facial pain scale (FPS-R) score was significantly lower than that in the control group at postoperative wakefulness and 2 h after surgery (<0.05). Meanwhile, no statistically significant difference was observed between the groups at 24 h after surgery (>0.05). The proportion of patients in the experimental group who needed to take analgesic measures on the basis of the parent posto-perative pain measurement (PPPM) score was significantly lower than that in the control group when they were awake after surgery (<0.05). No statistically significant difference was found between the groups at 2 and 24 h after surgery (>0.05). Moreover, no statistically significant difference was observed in the incidence of adverse reactions between the two groups at 24 h after surgery (>0.05).
The combination of local anesthesia during SECC dental treatment under general anesthesia results in minimal changes in intraoperative hemodynamics and mild postoperative pain response, hence worthy of clinical promotion.
本研究旨在探讨全身麻醉下局部麻醉联合治疗重度幼儿龋（SECC）的临床疗效。
选取2023年3月至12月在空军军医大学第三附属医院儿童牙科接受全身麻醉下SECC牙科治疗的108例6岁以下儿童作为研究对象，美国麻醉医师协会（ASA）分级为Ⅰ或Ⅱ级。通过检索术中病例和术后随访记录，将研究对象分为对照组（=54）和试验组（=54）。对照组采用吸入麻醉联合经鼻气管插管，试验组在全身麻醉基础上对每颗治疗牙给予2%利多卡因局部麻醉。记录并分析两组的基本信息、术前麻醉深度、不同手术过程中的血流动力学变化、术后疼痛及不良反应。
两组基本信息和术前麻醉深度比较，差异无统计学意义（>0.05）。在三种手术（牙髓切断术、根管治疗和拔牙）中，试验组观察的三项指标均显著低于对照组（<0.05）。试验组根据改良面部疼痛量表（FPS-R）评分需要采取镇痛措施的患者比例在术后清醒时和术后2小时显著低于对照组（<0.05）。同时，术后24小时两组间差异无统计学意义（>0.05）。试验组根据家长术后疼痛测量（PPPM）评分需要采取镇痛措施的患者比例在术后清醒时显著低于对照组（<0.05）。术后2小时和24小时两组间差异无统计学意义（>0.05）。此外，术后24小时两组不良反应发生率差异无统计学意义（>0.05）。
全身麻醉下SECC牙科治疗时联合局部麻醉可使术中血流动力学变化最小，术后疼痛反应轻微，值得临床推广。
