[摘要]目的：分析下牙槽神经阻滞对下颌骨骨折患者镇静程度及咬合不佳的影响。方法：选择2017年1月-2019年12月笔者医院收治的122例下颌骨骨折患者，采用随机数字表法分为对照组和观察组，每组61例。对照组采用常规全身麻醉，观察组在对照组麻醉的基础上采用下牙槽神经阻滞进行麻醉。比较两组一般资料和手术情况、两组拔管时和拔管后10min两组疼痛视觉模拟评分（VAS）和Ramsay镇静评分，比较两组术前、术后拔管时、拔管后10min平均动脉压（MAP）、心率（HR）和术后两组不良反应发生情况;术后随访1个月，比较两组手术前后咬合功能。结果：术后，观察组拔管时间显著短于对照组（P<0.05）。拔管后10min与拔管时比较，两组VAS评分升高，观察组低于对照组，麻醉失效时与拔管后10min和拔管时比较，两组VAS评分均降低，观察组低于对照组;拔管时、拔管后10min和麻醉失效时两组Ramsay评分均呈逐渐降低趋势（P<0.05），组间比较差异无统计学意义（P>0.05）。拔管时、拔管后10min观察组MAP、HR低于手术前，并低于对照组（P<0.05）;拔管后10min，对照组MAP、HR高于拔管时（P<0.05）。术后1个月，两组最大咬合接触面积、最大咬合力较治疗前均增大，观察组大于对照组;两组咬合力不对称指数较术前显著降低，观察组低于对照组（P<0.05）。术后，两组不良反应发生率均为4.92%，差异无统计学意义（P>0.05）。结论：与常规全身麻醉相比，联合下牙槽神经阻滞对下颌骨骨折患者进行麻醉能通过增强患者局部镇痛作用而有效减轻患者术后疼痛，降低术后患者MAP和HR，有助于患者咬合功能的恢复，且不会降低常规全身麻醉安全性，值得在临床推廣应用。

[关键词]下牙槽;神经阻滞;下颌骨;骨折;镇静程度;咬合度

[中图分类号]R782.4    [文献标志码]A    [文章编号]1008-6455（2021）01-0093-04

Effect of Inferior Alveolar Nerve Block on Sedation and Poor Occlusion in Patients with MandibularFracture

CAO Chen

（Department of Anesthesiology， Beijing Stomatological Hospital， Beijing 100050，China）

Abstract： Objective  To analyze the effect of inferior alveolar nerve block on the sedation degree and poor occlusion in patients with mandibular fracture. Methods A total of 122 patients with mandibular fractures admitted to our hospital from January 2017 to December 2019 were selected and randomly divided into control group and observation group with 61 cases each. The control group was anesthetized with conventional general anesthesia， and the observation group was anesthetized with inferior alveolar nerve block. The two groups were compared for general information and surgical conditions. Visual analogue pain scores （VAS） and Ramsay sedation scores were compared between the two groups at extubation and 10 min after extubation. Mean arterial pressure （MAP）， heart rate （HR） and adverse reactions were compared between the two groups before surgery， during extubation， and 10 min after extubation. Postoperative follow-up was conducted for 1 month to compare the occlusal function of the two groups before and after surgery. Results After operation， the extubation time in the observation group was significantly shorter than that in the control group （P<0.05）. VAS scores of the two groups increased at 10 min after extubation compared with that at extubation， and VAS scores of the observation group were lower than that of the control group. Ramsay scores of the two groups showed a gradually decreasing trend at the time of extubation， 10 min after cupping and anesthesia failure （P<0.05）， and there was no statistically significant difference between the two groups （P>0.05）. During extubation， 10 min after extubation， MAP and HR in the observation group were lower than those before surgery and lower than those in the control group （P<0.05）. 10 min after extubation， MAP and HR in the control group were higher than that at extubation （P<0.05）. One month after the operation， the maximum occlusal contact area and the maximum bite force of the two groups increased compared with that before treatment， and the observation group was larger than the control group （P>0.05）. The number of asymmetric fingers of bite force in the two groups was significantly lower than that before operation， and that in the observation group was lower than that in the control group （P>0.05）. After surgery， the incidence of adverse reactions in both groups was 4.92%， with no significant difference （P>0.05）. Conclusion Compared to conventional general anesthesia combined with alveolar nerve block anesthesia in patients with mandibular fractures can effectively relieve patients by enhancing local analgesia effect and patients with postoperative pain， reduce the postoperative patients with MAP and HR， help patients with occlusal function recovery， and will not reduce the conventional safety of general anesthesia， is worth popularizing in clinical.

Key words： the alveolar;nerve block; lower jaw; fracture; degree of calmness; degree of occlusion

下颌骨骨折行切开复位内固定术一般行全身麻醉，但是由于口腔神经敏感，全身麻醉术中使用镇痛药物剂量较大，且口腔部位手术中口腔分泌物较多，会对手术效果产生一定的影响[1]，同时全身麻醉术后患者恶心、呕吐等不良反应的发生率也较高[2]，为了防止患者窒息，全身麻醉术后通常需要等患者清醒后才能拔管，使拔管时间被延长，容易引起患者焦躁从而导致患者血流动力学指标的改变。因此……