目的 分析采用清胃散加减联合一次性根管治疗急性牙髓炎对患者疼痛、炎症改善情况,并观察其远期疗效.方法 选取 2020年 1 月~2022 年 12 月 78 例因急性牙髓炎接受治疗的患者为研究对象,依据治疗方法的差异性将患者分为单一组(n= 40,单纯的一次性根管治疗)和联合组(n=38,术后增加清胃散加减治疗),比较两组患者治疗前后疼痛评分、中医证候积分及血清C反应蛋白(C-reactive protein,CRP)、白介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor α,TNF-α)及白细胞分化抗原-14(Leukocyte differentiation antigen-14,CD14)等炎症因子指标改善情况,对所有患者进行为期半年的随访,对比分析两组患者牙周指数改善情况和治愈率.结果 治疗前,两组患者疼痛评分及IL-8、TNF-α、CRP、CD14 水平比较,差异无统计学意义(P>0.05);治疗 2 周后,与治疗前比较,两组患者疼痛评分及IL-8、TNF-α、CRP、CD14 水平均降低,且与单一组比较,联合组患者疼痛评分及IL-8、TNF-α、CRP、CD14 水平更低(P<0.05).两组治疗后牙痛、舌象、脉象等中医症候评分与治疗前相比均明显降低(P<0.05),且治疗两周后联合组中医症候评分显著低于单一组,差异具有统计学意义(P<0.05).治疗前,两组患者牙周袋探诊深度(Periodontal pocket probing depth,PD)、牙龈指数(gingival index,GI)、菌斑指数(plaque index,PLI)比较,差异无统计学意义(P>0.05);治疗 6 个月后,与治疗前比较,两组患者PD、GI、PLI均降低,且治疗 6 个月后与单一组比较,联合组患者PD、GI、PLI均降低(P<0.05).与单一组比较,联合组治愈率明显升高(P<0.05).结论 与单一的一次性根管治疗比较,术后增加清胃散加减治疗急性牙髓炎患者可有效缓解疼痛,改善炎症反应,且能够促进术后牙周恢复,提升远期疗效.
Objective To analyze the improvement of pain and inflammation in patients with acute pulpitis treated with modified Qingwei Powder combined with disposable root canal,and to observe its long-term effect.Methods 78 patients with acute pulpitis treated in a hospital from January 2020 to December 2022 were selected as the research object.According to the differences of treatment methods,the patients were divided into single group(n = 40,simple one-time root canal treatment)and combined group(n = 38,with addition and subtraction of Qingwei powder after operation).The improvement of pain scores,traditional Chinese medicine syndrome scores,serum C-reactive protein,interleukin-8,tumor necrosis factor-α,and leukocyte differentiation antigen-14 inflammatory factor indicators before and after treatment were compared between the two groups.All patients were followed up for half a year.The improvement of periodontal index,and cure rate were compared and analyzed between the two groups.Results Before treatment,there was no statistically significant difference in pain scores,IL-8,TNF-α,CRP,and CD14 levels between the two groups(P>0.05).After 2 weeks of treatment,compared with before treatment,the pain scores and levels of IL-8,TNF-α,CRP,and CD14 in both groups decreased,and compared with the single group,the combined group had lower pain scores and levels of IL-8,TNF-α,CRP,and CD14(P<0.05).The scores of traditional Chinese medicine symptoms such as toothache,tongue and pulse in the two groups were significantly lower than those before treatment(P<0.05),and the scores of traditional Chinese medicine symptoms in the combined group were significantly lower than those in the single group(P<0.05).Before treatment,there was no significant difference in PD,GI and PLI between the two groups(P>0.05);After 6 months of treatment,compared with before treatment,PD,GI and PLI in the two groups decreased,After 6 months of treatment,compared with the single group,PD,GI and PLI in the combined group decreased(P<0.05).Compared with the single group,the cure rate in the combined group was significantly higher(P<0.05).Conclusion Compared with single one-time root canal therapy,the addition and subtraction of Qingwei Powder in the treatment of acute pulpitis can effectively alleviate pain,improve inflammatory response,promote postoperative periodontal recovery and improve long-term curative effect.