清胃散加减治疗儿童急性牙髓炎胃火炽盛证的近期和远期疗效观察
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摘要
目的:观察清胃散加减治疗儿童急性牙髓炎(AP)胃火炽盛证的疗效及对炎症因子的影响。方法:将106例患儿按随机数字表法分为对照组52例和观察组54例。对照组采用一次性根管治疗术,术后给予阿奇霉素干混悬剂,10 mg·kg~(-1),顿服,连续使用3 d。观察组在对照组治疗的的基础上加服清胃散加减治疗,1剂/d,连续观察7 d。于治疗前及治疗后1,3,5,7 d评价疼痛视觉模拟评分(VAS);于治疗前及治疗后3,7 d评价改良面部表情评分(FPS-R);治疗后评价疼痛程度分级情况;记录疼痛减轻时间和咀嚼功能恢复正常时间;进行治疗前后中医证候评分;检测治疗前后C-反应蛋白(CRP),肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β),IL-6,降钙素基因相关肽(CGRP)和P物质(SP)水平;随访6个月记录成功或失败情况。结果:观察组患儿治疗后3,5,7 d的VAS评分均低于对照组(P <0. 01);观察组患儿治疗后3,7 d的FPS-R评分均低于对照组(P <0. 01);观察组患儿治疗后7 d疼痛程度轻于对照组(P <0. 05);观察组患儿疼痛减轻时间和咀嚼功能恢复正常时间均短于对照组(P <0. 01);观察组患儿中医证候评分均低于对照组(P <0. 01);观察组患儿血清CRP,TNF-α,IL-1β,IL-6,CGRP和SP水平均低于对照组(P <0. 01);经6个月的随访,观察组成功率为81. 48%,对照组为78. 85%,组间比较差异无统计学意义。结论:对于AP一次性根管治疗术后患儿采用清胃散加减内服治疗,近期能抑制炎症因子和疼痛递质的表达,可显著改善疼痛等症状,缩短病程,有着较好的近期疗效,随访成功率较好,但有待进一步的提高。
Objective: To observe the efficacy of modified Qingweisan on acute pulpitis( AP) of children with syndrome of hyperactivity of gastric fire and its effect on inflammatory factors. Method: One hundred and six patients were randomly divided into control group( 52 cases) and observation group( 54 cases) by random number table. Patients in control group got one-off root canal therapy,and azithromycin for suspension after the therapy for a continued 3 days,10 mg·kg~(-1),3 times/days. In addition to the therapy of control group,patients in observation group were also given modified Qingweisan for 7 days,1 dose/day. Before treatment and at the 1 st,3 rd,5 thand 7 th days after treatment,visual analogue scale( VAS),faces rating scale-revised( FPS-R),verbal rating scale and traditional Chinese medicine( TCM) syndrome were scored before and after treatment. And pain relief time and time for masticatory function returned to normal were recorded. And levels of C-reactive protein( CRP),tumor necrosis factor-α( TNF-α),interleukin~(-1)β( IL-1β),IL-6,calcitonin gene-related peptide( CGRP) and substance P were detected. And a 6-month follow-up was carried out to record the success or failure. Result: At the 3 rd,5 th and 7 thdays after treatment,score of VAS in observation group was lower than that in control group( P < 0. 01). At the 3 rdand 7 thdays after treatment,score of FPS-R was lower than that in control group( P < 0. 01). At the 7 th days after treatment,degree of pain in observation group was lighter than that in control group( P < 0. 05). Pain relief time and time for masticatory function returned to normal in observation group were shorter than those in control group( P < 0. 01). Score of TCM syndrome was lower than that in in control group( P < 0. 01). And levels of CRP,TNF-α,IL-1β,IL-6,CGRP and SP were all lower than those in control group( P < 0. 01). According to6-month follow-up,success rate in observation group was 81. 48%,which was lower than 78. 85% in control group,with no statistical significant difference between two groups. Conclusion: Modified Qingweisan can inhibit expressions of inflammatory factors and pain transmitters,ameliorate the pain and shorten course of disease among children after disposable root canal therapy,with a satisfactory short-term effect.
Objective: To observe the efficacy of modified Qingweisan on acute pulpitis( AP) of children with syndrome of hyperactivity of gastric fire and its effect on inflammatory factors. Method: One hundred and six patients were randomly divided into control group( 52 cases) and observation group( 54 cases) by random number table. Patients in control group got one-off root canal therapy,and azithromycin for suspension after the therapy for a continued 3 days,10 mg·kg~(-1),3 times/days. In addition to the therapy of control group,patients in observation group were also given modified Qingweisan for 7 days,1 dose/day. Before treatment and at the 1 st,3 rd,5 thand 7 th days after treatment,visual analogue scale( VAS),faces rating scale-revised( FPS-R),verbal rating scale and traditional Chinese medicine( TCM) syndrome were scored before and after treatment. And pain relief time and time for masticatory function returned to normal were recorded. And levels of C-reactive protein( CRP),tumor necrosis factor-α( TNF-α),interleukin~(-1)β( IL-1β),IL-6,calcitonin gene-related peptide( CGRP) and substance P were detected. And a 6-month follow-up was carried out to record the success or failure. Result: At the 3 rd,5 th and 7 thdays after treatment,score of VAS in observation group was lower than that in control group( P < 0. 01). At the 3 rdand 7 thdays after treatment,score of FPS-R was lower than that in control group( P < 0. 01). At the 7 th days after treatment,degree of pain in observation group was lighter than that in control group( P < 0. 05). Pain relief time and time for masticatory function returned to normal in observation group were shorter than those in control group( P < 0. 01). Score of TCM syndrome was lower than that in in control group( P < 0. 01). And levels of CRP,TNF-α,IL-1β,IL-6,CGRP and SP were all lower than those in control group( P < 0. 01). According to6-month follow-up,success rate in observation group was 81. 48%,which was lower than 78. 85% in control group,with no statistical significant difference between two groups. Conclusion: Modified Qingweisan can inhibit expressions of inflammatory factors and pain transmitters,ameliorate the pain and shorten course of disease among children after disposable root canal therapy,with a satisfactory short-term effect.
引文
[1]王津,孙伟,姬爱平.急性牙髓炎疼痛定位准确性的临床调查[J].华西口腔医学杂志,2013,31(5):483-486.
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[4]孙景荣.儿童急性牙髓炎一次性根管治疗的临床疗效[J].全科口腔医学电子杂志,2016,3(23):32-33.
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[7]马晶,李晓光.清胃散口服液配合丁香油水门汀治疗急性牙髓炎疗效及对炎症反应的影响[J].现代中西医结合杂志,2018,27(9):956-959.
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[9]冯红静,钱平安,陈文英,等.音乐综合干预疗法对急性牙髓炎治疗中疼痛评分及应激因子表达的影响[J].中国现代医生,2017,55(24):85-88.
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[11] MiróJ,Huguet A. Evaluation of reliability,validity,and preference for a pediatric pain intensity scale:the catalan version of the faces pain scale-revised[J]. J Pain,2004,111(1/2):59-64.
[12]李仲廉.临床疼痛治疗学[M].天津:天津科技出版社,1999:42-43.
[13]王原明,高志彪,韩建民,等.清热止痛方治疗急性牙髓炎的疗效及其对根尖组织的影响[J].湖南中医药大学学报,2017,37(11):1288-1290.
[14]沈洁.一次法与分次法根管治疗术治疗急性牙髓炎的临床效果观察[J].广西医学,2017,39(7):1093-1094.
[15]孙红艳,吕安坤.西帕依固龈液治疗单纯性牙龈炎随机对照试验的Meta分析[J].中国实验方剂学杂志,2014,20(19):217-220.
[16]张齐梅,周聪,伍宝琴,等.中药控释药条联合清胃散颗粒治疗急性牙髓炎103例[J].河南中医,2015,35(6):1375-1377.
[17]王铎,丁伟山,赵佳,等.正常与炎症牙髓组织中肿瘤坏死因子-α含量的测定[J].山东大学学报:医学版,2005,43(1):88-90.
[18]罗瑜.盐酸米诺环素软膏对慢性根尖周炎患者血清TNF-α,IL-1β,IL-6水平的影响[J].现代医药卫生,2017,33(16):2451-2453.
[19]王伟,于西佼,杜毅.神经肽SP和CGRP在人慢性炎症牙髓中的表达研究[J].牙体牙髓牙周病学杂志,2016,26(4):197-201.
[20]王爱丽,肖悠美,朱太卿,等.加味蠲痹汤综合疗法治疗中风后风痰瘀阻证肩手综合征[J].中国实验方剂学杂志,2017,23(13):191-196.
[2]向珊珊.根管不同冲洗方法治疗儿童乳牙牙髓炎的对比分析[J].中国中西医结合儿科学,2015,7(1):35-36.
[3]梁刘凤,卢明智,王秋玲,等.根管不同冲洗方法治疗儿童乳牙牙髓炎的效果比较[J].实用临床医药杂志,2017,21(3):149-150.
[4]孙景荣.儿童急性牙髓炎一次性根管治疗的临床疗效[J].全科口腔医学电子杂志,2016,3(23):32-33.
[5]陈莉,张英.针灸治疗牙痛临床研究进展[J].上海针灸杂志,2015,34(5):483-486.
[6]杨秀英.中西医结合治疗可复性急性牙髓炎疗效观察[J].中国中医急症,2012,21(7):1153-1154.
[7]马晶,李晓光.清胃散口服液配合丁香油水门汀治疗急性牙髓炎疗效及对炎症反应的影响[J].现代中西医结合杂志,2018,27(9):956-959.
[8]孙克,张晓丹,杨铭,等.清胃散清胃热作用的实验研究[J].中成药,2008,30(6):812-815.
[9]冯红静,钱平安,陈文英,等.音乐综合干预疗法对急性牙髓炎治疗中疼痛评分及应激因子表达的影响[J].中国现代医生,2017,55(24):85-88.
[10]樊明文,周学东.牙体牙髓病学[M]. 3版.北京:人民卫生出版社,2008:103-104.
[11] MiróJ,Huguet A. Evaluation of reliability,validity,and preference for a pediatric pain intensity scale:the catalan version of the faces pain scale-revised[J]. J Pain,2004,111(1/2):59-64.
[12]李仲廉.临床疼痛治疗学[M].天津:天津科技出版社,1999:42-43.
[13]王原明,高志彪,韩建民,等.清热止痛方治疗急性牙髓炎的疗效及其对根尖组织的影响[J].湖南中医药大学学报,2017,37(11):1288-1290.
[14]沈洁.一次法与分次法根管治疗术治疗急性牙髓炎的临床效果观察[J].广西医学,2017,39(7):1093-1094.
[15]孙红艳,吕安坤.西帕依固龈液治疗单纯性牙龈炎随机对照试验的Meta分析[J].中国实验方剂学杂志,2014,20(19):217-220.
[16]张齐梅,周聪,伍宝琴,等.中药控释药条联合清胃散颗粒治疗急性牙髓炎103例[J].河南中医,2015,35(6):1375-1377.
[17]王铎,丁伟山,赵佳,等.正常与炎症牙髓组织中肿瘤坏死因子-α含量的测定[J].山东大学学报:医学版,2005,43(1):88-90.
[18]罗瑜.盐酸米诺环素软膏对慢性根尖周炎患者血清TNF-α,IL-1β,IL-6水平的影响[J].现代医药卫生,2017,33(16):2451-2453.
[19]王伟,于西佼,杜毅.神经肽SP和CGRP在人慢性炎症牙髓中的表达研究[J].牙体牙髓牙周病学杂志,2016,26(4):197-201.
[20]王爱丽,肖悠美,朱太卿,等.加味蠲痹汤综合疗法治疗中风后风痰瘀阻证肩手综合征[J].中国实验方剂学杂志,2017,23(13):191-196.