杨正祥 李航 沈庆冉

[摘要]目的：探討盐酸米诺环素软膏联合替硝唑治疗对慢性根尖周炎患者牙齿颜色、菌斑及疼痛的影响。方法：选取2018年1月-2020年1月于笔者医院口腔科就诊的127例慢性根尖周炎患者，以随机数字表法分为常规组（64例）和盐酸米诺环素组（63例）。两组均接受基础治疗及根管治疗，常规组主要以氢氧化钙进行根管消毒，盐酸米诺环素组主要以盐酸米诺环素软膏进行根管消毒，两组根管治疗后均予以替硝唑片口服，共治疗4周。观察两组治疗4周后的疗效、疼痛程度，治疗前、治疗4周后的牙周微生态环境、炎症因子水平及治疗期间不良反应发生情况。结果：治疗4周后，盐酸米诺环素组总有效率92.06%，高于常规组的78.13%（P<0.05）;盐酸米诺环素组Ⅰ级疼痛例数较常规组多，NRS疼痛评分则低于常规组（P<0.05）。治疗4周后，两组GI、PLI、MD、PPD均低于治疗前，且盐酸米诺环素组低于常规组（P<0.05）;两组牙龈沟液中IL-6、TNF-α、IL-1β水平均低于治疗前，且盐酸米诺环素组低于常规组（P<0.05）。治疗期间，盐酸米诺环素组不良反应发生率为7.93%，与常规组的9.38%比较无统计学差异（P>0.05）。结论：盐酸米诺环素软膏联合替硝唑可抑制慢性根尖周炎患者牙周炎症、改善牙周微生态环境，进而有效改善牙齿颜色、菌斑及疼痛程度，临床疗效显著，且联合用药不增加不良反应发生率，值得临床推广应用。

[关键词]慢性根尖周炎;根管治疗;替硝唑片;盐酸米诺环素软膏;牙周微生态环境;疼痛程度

[中图分类号]R781.4+2    [文献标志码]A    [文章编号]1008-6455（2020）09-0141-04

Effects of Minocycline Hydrochloride Ointment Combined with Tinidazole on Tooth Color，Plaque and Pain in Patients with Chronic Apical Periodontitis

YANG Zheng-xiang1，LI Hang2，SHEN Qing-ran1

（1.Department of Stomatology， the First People's Hospital of Longquanyi District，Chengdu 610100，Sichuan，China;2.Children's  Health Department of Chengdu Longquanyi District Maternal and Child  Health Hospital，Chengdu 610100，Sichuan，China）

Abstract：Objective To investigate the effect of minocycline hydrochloride ointment combined with tinidazole on tooth color， plaque and pain in patients with chronic periapical periodontitis. Methods 127 patients with chronic periapical periodontitis who visited our hospital from January 2018 to January 2020 were selected and randomly divided into the routine group （64 cases） and the minocycline hydrochloride group （63 cases）. Both groups received basic treatment and root canal treatment. The routine group was mainly treated with calcium hydroxide for root canal disinfection. The minocycline hydrochloride group was mainly treated with minocycline hydrochloride ointment for root canal disinfection. Tinidazole tablets were taken orally for 4 weeks after root canal treatment in both groups. The curative effect and pain degree of the two groups after 4 weeks of treatment， periodontal microecological environment， inflammatory factor level and adverse reactions during treatment before and after 4 weeks of treatment were observed. Results After 4 weeks of treatment， the total effective rate in the minocycline hydrochloride group was 92.06%， which was higher than 78.13% in the routine group （P<0.05）. The number of cases with grade I pain of the minocycline hydrochloride group was higher than that of the routine group， and the NRS pain score is lower than that of the routine group （P<0.05）. After 4 weeks of treatment， GI， PLI， MD， PPD of the two groups were lower than before treatment， and the minocycline hydrochloride group was lower than the routine group （P<0.05）. The levels of IL-6， TNF-α and IL-1β in gingival crevicular fluid of the two groups were lower than those before treatment， and the minocycline hydrochloride group were lower than the routine group （P<0.05）. During the treatment， the incidence of adverse reactions in the minocycline hydrochloride group was 7.93%， and there was no statistical difference between the minocycline hydrochloride group and the routine group （9.38%）（P>0.05）. Conclusion Minocycline hydrochloride ointment combined with tinidazole can effectively inhibit periodontitis in patients with chronic periapical periodontitis， improve periodontal microecological environment， and further effectively improve tooth color， plaque and pain degree. The clinical effect is significant， and the combination does not increase the incidence of adverse reactions， which is worthy of promotion.

Key words：chronic periapical periodontitis;root canal therapy; tinidazole tablets;minocycline hydrochloride ointment;periodontal microecological environment; the degree of pain

慢性根尖周炎为口腔科常见疾病。目前，根管治疗是慢性根尖周炎的主要疗法，该疗法需行髓腔预备、根管消毒、根管填充，术后予以抗厌氧菌药替硝唑治疗则可进一步杀除患牙中厌氧微生物、并维持治疗效果[1-2]。根管消毒是治疗慢性根尖周炎的关键，其中根管消毒常用材料氢氧化钙具有强碱性、可杀灭根管内细菌，但其抗菌活性较弱，无法对某些侵入到牙本质小管深部的细菌产生清除作用[3]。……