冯红静　钱平安　陈文英

[摘要] 目的 分析音樂综合干预疗法对急性牙髓炎治疗中疼痛评分及应激因子的表达的影响，探讨其临床应用价值。方法 选取我院2014年2月～2017年2月收治的急性牙髓炎患者170例（202颗牙），按照随机数字表法将患者分别纳入观察组（n=85，97颗牙）和对照组（n=85，105颗牙），均给予一次性根管治疗，观察组治疗期间加用音乐综合干预疗法。比较两组患者术前、牙髓拔除前后疼痛视觉模拟量表（VAS）评分变化，并检测其治疗前后血清肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）变化，总结音乐综合干预疗法的临床效果。 结果 两组患者术前、牙髓拔除前后VAS评分均逐渐降低，观察组牙髓拔除前后VAS评分均低于对照组，差异有统计学意义（P<0.05）；观察组患者牙髓拔除前后总体疼痛程度亦低于对照组，差异有统计学意义（P<0.05）。两组患者术后血清TNF-α、CRP表达水平均较术前明显下降，观察组术后TNF-α、CRP表达水平均低于对照组，差异有统计学意义（P<0.05）。观察组术后1周临床总有效率为94.85%，略高于对照组的90.48%，但组间比较差异无统计学意义（P>0.05）。 结论 音乐综合干预疗法能够有效降低急性牙髓炎治疗中疼痛评分及应激因子表达水平，对于保证根管治疗的顺利进行具有积极意义，值得推广。

[关键词] 音乐综合干预疗法；急性牙髓炎；疼痛评分；应激因子

[中图分类号] R781.31 [文献标识码] B [文章编号] 1673-9701（2017）24-0085-04

[Abstract] Objective To analyze the effect of comprehensive intervention therapy on the pain score and the expression of stress factors in the treatment of acute pulpitis， and to explore its clinical value. Methods 170 patients（202 teeth）with acute pulpitis admitted in our hospital from February 2014 to February 2017 were enrolled. The patients were divided into the observation group（n=85， 97 teeth） and control group（n=85， 105 teeth） according to the random number table method. All patients were given a one-time root canal therapy. The observation group was also given music comprehensive intervention therapy during the treatment. The changes of visual analogue scale（VAS） were compared between the two groups before surgery， before and after pulp removal. And the levels of tumor necrosis factor-α（TNF-α） and C-reactive protein（CRP） were measured before and after treatment. The clinical effect of music comprehensive therapy was summarized. Results The VAS scores of the two groups were gradually decreased from pre-operation， before and after pulp removal. The VAS score of the observation group before and after pulp removal was lower than that of the control group， and the difference was statistically significant（P<0.05）. The overall pain of the observation group was lower than that of the control group before and after pulp removal， and the difference was statistically significant（P<0.05）. The levels of TNF-α and CRP in the serum of the two groups after surgery were significantly lower than those before the operation. The levels of TNF-α and CRP in the observation group after the surgery were lower than those in the control group， with significant difference（P<0.05）. The total effective rate was 94.85% in the observation group at 1 week after operation， which was slightly higher than that in the control group（90.48%）， but there was no statistically significant difference between the two groups（P>0.05）. Conclusion The music comprehensive intervention therapy can effectively reduce the pain score and the expression level of stress factors in the treatment of acute pulpitis， which is of great significance to ensure the smooth progress of root canal therapy and is worthy of promotion.endprint

[Key words] Music comprehensive intervention therapy； Acute pulpitis； Pain score； Stress factor

急性牙髓炎是由深龋、牙髓急性感染、根尖逆行感染引发的牙髓组织急性炎症，患者以牙髓剧烈疼痛为主要临床表现，且口服止痛药物无法缓解，需及时行根管治疗[1]。一次性根管治疗被证实在急性牙髓炎的治疗中具有确切的效果与良好的安全性，但多数患者对牙科治疗存在的恐惧心理往往导致疼痛阈值下降、应激状态加剧，甚至对麻醉与治疗效果造成影响[2]。既往有学者发现，音乐综合干预疗法能够转移患者注意力、引导肌肉放松，在减轻产妇分娩疼痛等方面得到了广泛应用[3]，但关于该方案在急性牙髓炎治疗中发挥的价值的报道较少。……