Abstract:

Objective　To investigate the effect of afentanil combined with local nerve block in comfortable tooth extraction for children with dental phobia. Methods　A total of 116 children with dental phobia admitted to Xi 'an Third Hospital from July 2021 to October 2023 were selected for the randomized controlled trial, and were divided into a study group and a control group by the random number table method, with 58 cases in each group. There were 21 males and 37 females in the control group; they were (7.26±0.83) years old. There were 24 males and 34 females in the study group; they were (7.42±0.78) years old. The control group took local nerve block, and the study group afentanil combined local nerve block. The general conditions of operation (operation time, discharge time, anesthesia time, time remove laryngeal mask, and sevoflurane dosage), postoperative pain [evaluated by Visual Analogue Scale (VAS)], hemodynamics [mean artery pressure (MAP) and heart rate (HR)], stress response [cortisol (COR) and adrenocor ticotropic hormore (ACTH)], operator satisfaction, the use rate of vasoactive drugs, and incidences of restlessness and adverse reactions during recovery were compared between the two groups by t and χ² tests. Results　There were no differences in the operation time, discharge time, use rate of vasoactive drugs, and incidences of restlessness and adverse reactions between the two groups (all P>0.05). The anesthesia time in the study group was longer than that in the control group [(49.89±8.20) min vs. (42.14±7.68) min] (P<0.05); the time to remove laryngeal mask in the study group was shorter than that in the control group [(5.41±1.76) min vs. (7.20±2.45) min]; the sevoflurane dosage in the study group was lower than that in the control group [(36.11±4.63) ml vs. (42.27±5.81) ml]; there were statistical differences (t=5.253, 4.519, and 6.315; all P<0.05). One, 2, and 3 h after the surgery, the scores of VAS in the study group were lower than those in the control group [(2.72±0.49) vs. (3.45±0.56), (1.86±0.32) vs. (2.37±0.41), and (0.98±0.17) vs. (1.45±0.26)], with statistical differences (t=7.471, 7.467, and 11.523; all P<0.05). At T0, there were no statistical differences in the MAP and HR between the two groups (both P>0.05); at T1 and T2, the MAP and HR in the study group were lower than those in the control group, with statistical differences (t=3.260, 3.658, 2.511, and 3.581; all P<0.05). Before the surgery, there were no statistical differences in the serum levels of ACTH and COR between the two groups (both P>0.05); 2 h after the surgery, the serum levels of ACTH and COR in the study group were lower than those in the control group [(44.05±6.19) ng/L vs. (54.18±7.26) ng/L and (182.45±22.04) ng/L vs. (216.06±25.73) ng/L], with statistical differences (t=8.086 and 7.555; both P<0.05). The score of operator satisfaction in the study group was higher than that in the control group [(3.52±0.20) vs. (3.08±0.14)], with a statistical difference (t=13.726; P<0.05). The incidence of restlessness in the study group was lower than that in the control group [32.76% (19/58) vs. 51.72% (30/58)], with a statistical difference (χ²=4.275; P<0.05). Conclusion　Afentanil combined with local nerve block has analgesic effect in comfortable tooth extraction for children with dental phobia, can reduce stress response, help maintain hemodynamic stability, improve the operator satisfaction, reduce sevoflurane dosage, and is safe and reliable.

Key words:

Afentanil, Local nerve block, Dental phobia, Children, Comfortable tooth extraction, Analgesic effect

摘要：

目的　探讨阿芬太尼复合局部神经阻滞在牙科恐惧症儿童舒适化拔牙治疗中的效果。方法　采用随机对照试验，选取2021年7月至2023年10月西安市第三医院收治的116例接受舒适化拔牙的牙科恐惧症患儿作为研究对象，以随机数字表法分为研究组和对照组，各58例。对照组男21例、女37例，年龄（7.26±0.83）岁，接受局部神经阻滞治疗；研究组男24例、女34例，年龄（7.42±0.78）岁，接受阿芬太尼复合局部神经阻滞治疗。对比两组患儿手术一般情况（手术时间、离院时间、麻醉时间、喉罩拔除时间、七氟醚用量）、术后疼痛情况［采用视觉模拟评分法（VAS）］、血流动力学［平均动脉压（MAP）、心率（HR）］、应激反应［皮质醇（COR）、促肾上腺皮质激素（ACTH）］、术者满意度、血管活性药物使用率、苏醒期躁动及不良反应发生情况。统计学方法采用t检验、χ²检验。结果　两组患儿手术时间、离院时间、血管活性药物使用率及不良反应发生率比较，差异均无统计学意义（均P>0.05）。研究组麻醉时间长于对照组，喉罩拔除时间短于对照组，七氟醚用量低于对照组［（49.89±8.20）min比（42.14±7.68）min、（5.41±1.76）min比（7.20±2.45）min、（36.11±4.63）ml比（42.27±5.81）ml］，差异均有统计学意义（t=5.253、4.519、6.315，均P<0.05）。术后1 h、2 h、3 h，研究组VAS评分均低于对照组［（2.72±0.49）分比（3.45±0.56）分、（1.86±0.32）分比（2.37±0.41）分、（0.98±0.17）分比（1.45±0.26）分］，差异均有统计学意义（t=7.471、7.467、11.523，均P<0.05）。T0时，两组患儿MAP、HR水平比较，差异均无统计学意义（均P>0.05）；T1、T2时，研究组MAP、HR水平均低于对照组，差异均有统计学意义（t=3.260、3.658、2.511、3.581，均P<0.05）。术前，两组患儿血清ACTH、COR水平比较，差异均无统计学意义（均P>0.05）；术后2 h，研究组血清ACTH、COR水平均低于对照组［（44.05±6.19）ng/L比（54.18±7.26）ng/L、（182.45±22.04）ng/L比（216.06±25.73）ng/L］，差异均有统计学意义（t=8.086、7.555，均P<0.05）。研究组术者满意度评分高于对照组，苏醒期躁动发生率低于对照组［（3.52±0.20）分比（3.08±0.14）分、32.76%（19/58）比51.72（30/58）］，差异均有统计学意义（t=13.726，χ²=4.275；均P<0.05）。结论　阿芬太尼复合局部神经阻滞在牙科恐惧症儿童舒适化拔牙治疗中的镇痛效果确切，可减轻应激反应，维持血流动力学稳定，提高术者满意度，减少七氟醚用量，降低苏醒期躁动发生风险，且安全可靠。

关键词:

阿芬太尼, 局部神经阻滞, 牙科恐惧症, 儿童, 舒适化拔牙, 镇痛效果