不同年龄段儿童全麻口腔治疗术后不良反应的研究

Post-discharge adverse events after dental treatment under general anesthesia in pediatric patients

摘要:

目的： 探究全麻下儿童口腔治疗术后不良反应的发生率，并比较其在不同年龄段儿童中的分布差异。方法： 收集2019年1月至2020年2月于郑州大学第一附属医院口腔门诊全麻下行口腔治疗术的患儿110例，其中男72例（65.5%），女38例（34.5%），美国麻醉医师协会（American Society Anesthesiologists Physical Status，ASA）分级Ⅰ或Ⅱ级。根据患儿年龄分为2组：幼儿组（1~3岁）58例、学龄前组（4~6岁）52例。查询术后24 h电话随访记录，汇总不良反应的发生情况，包括有无哭闹、牙痛、口腔不适、情绪不稳、发热、嗜睡、牙龈渗血、口唇红肿、流涎、张口呼吸以及患儿对看牙经历是否有恐惧记忆等，并比较其在不同年龄组中的分布差异。结果： 在本研究中，62.7%的患儿有1种或以上不良反应上报，幼儿组和学龄前组的不良反应发生率分别为55.2%和71.1%（P>0.05）。哭闹（41.3%）和对看牙经历有恐惧记忆（40.4%）分别为幼儿组和学龄前组发生率最高的不良反应。幼儿组对看牙经历有恐惧记忆、情绪不稳易激惹发生率和牙痛的发生率分别为13.8%、6.9%和8.6%，均低于学龄前组（分别为40.4%、21.2%、23.1%），差异有统计学意义（P<0.05）。幼儿组治疗牙数、拔牙数、牙髓治疗数分别为（11.5±2.9）颗、（1.6±1.4）颗、（5.3±3.3）颗，均低于学龄前组[分别为（13.3±3.5）颗、（3.2±1.1）颗、（7.5±4.1）颗]，差异有统计学意义（P<0.05），2组全冠治疗颗数分别为（3.5±2.3）颗、（4.6±3.7）颗，差异无统计学意义（P>0.05）。结论： 全身麻醉下的口腔治疗，术中镇静镇痛效果是肯定的。但是全麻术后不适，如哭闹、就医经历不良记忆和牙痛的发生率较高，应该给予必要的关注。对于幼儿，应加强对其哭闹的安抚，学龄前患儿由于牙齿数量较多，牙齿情况较为复杂，因此发生不良事件的概率更高，应着重加强围术期遗忘和镇痛效果。

Abstract:

Objective: To study the incidence of post-discharge adverse events occurring after dental treatment under general anesthesia in pediatric patients aged 1-6 years and compare their distribution differences in different age groups. Methods: A total of 110 children, including 72 boys (65.5%) and 38 girls (34.5%), American Society Anesthesiologists physical statusⅠorⅡ, who received oral treatment under general anesthesia in the Stomatological Clinic of The First Affiliated Hospital of Zhengzhou University from January 2019 to February 2020 were collected. According to the age of the children, they were divided into two groups: infant group (1-3 years, 58 cases) and preschool group (4-6 years, 52 cases). The telephone follow-up records of first 24 hours after surgery were inquired to summarize the incidence of adverse events, including crying, toothache, oral discomfort, emotional instability, fever, drowsiness, bleeding gums, red lips, salivation, mouth breathing and whether the children had any memory of the dental experience, etc, and their distribution differences in different age groups were compared. Results: In this study, 62.7%of children had one or more adverse events reported. The incidence of adverse events in the infant group and preschool group were 55.2%and 71.1%, respectively (P>0.05). Crying (41.3%) and bad memory of dental visits (40.4%) were the highest incidence of adverse events in the infant group and preschool group, respectively. The incidence of memory, emotional instability and irritability and toothache in the infant group were 13.8%, 6.9%and 8.6%, respectively, which were all lower than those in the preschool group (40.4%, 21.2%, 23.1%, respectively), with statistical differences (P<0.05). The number of treated teeth, the number of extracted teeth, and the number of endodontic treatments in the infant group were (11.5±2.9), (1.6±1.4) and (5.3±3.3), respectively, which were significantly lower than those in the preschool group [(13.3±3.5), (3.2±1.1) and (7.5±4.1), respectively] (P<0.05). The number of total coronary treatments in the two groups was (3.5±2.3) and (4.6±3.7), respectively, without significant difference (P>0.05). Conclusion: In oral treatment under general anesthesia, the effect of intraoperative sedation and analgesia is positive. However, the incidence of discomforts occurring after general anesthesia, such as crying, bad memory of medical experience and toothache, is relatively high, and necessary attention should be given. For infants and young children, the comfort of their crying should be strengthened. Due to the large number of teeth and complex dental conditions in preschool children, the probability of adverse events is higher, and the effect of perioperative forgetting and analgesia should be strengthened.