抗菌药物控制下颌阻生第三磨牙拔除术后局部感染的前瞻性随机对照研究

摘要/Abstract

摘要： 目的评估抗菌药物控制下颌阻生第三磨牙拔除术后局部感染的效果。方法采用前瞻性、随机、对照、单盲方法将1600例符合拔除下颌阻生第三磨牙的患者分为4组,包括空白对照组（CG组）、0.12%葡萄糖酸氯己定组（CHX组）、阿莫西林组（AMX组）和0.12%葡萄糖酸氯己定+阿莫西林组（CHX+AMX组）,每组400例。CG组不予用药;CHX组术后第2天连续含漱用药5 d;AMX组术后连续口服用药3 d;CHX+AMX组为2组用药同时使用。随访、记录术后第1、3、7、14天患者出现干槽症（AO）、术区感染（SSI）以及疼痛、肿胀、开口受限等术后反应。采用SPSS19.0软件包对数据进行统计学处理。结果共1452例患者纳入最终研究,其中35例AO（2.41%）、65例SSI（4.47%）;CG组11例AO（3.03%）、22例SSI（6.06%）;CHX组10例AO（2.78%）、17例SSI（4.72%）;AMX组8例AO（2.21%）、15例SSI（4.14%）;CHX+AMX组6例AO（1.63%）、11例SSI（3.00%）。4组术后感染及术后反应指标显示均无显著差异（P>0.05)。结论下颌阻生第三磨牙拔除术后使用抗菌药物不能降低局部感染率。

关键词: 阿莫西林, 葡萄糖氯己定, 第三磨牙, 感染

Abstract: PURPOSE: To investigate the effects of antimicrobial agents on preventing local infection following impacted mandibular third molar extraction. METHODS: In this prospective, randomized , comparative, single-blind clinical trial, a total of 1 600 patients were randomized into 4 groups: control group (CG) with no treatment; chlorhexidine gluconate group (CHX) with 0.2% chlorhexidine gluconate rinse for 5 days postoperatively; amoxicillin group (AMX）with amoxicillin administration for 3 days postoperatively; chlorhexidine gluconate+amoxicillin group (CHX+AMX) with 0.2% chlorhexidine gluconate rinse for 5 days and amoxicillin administration for 3 days postoperatively. Postoperative complications including alveolar osteitis (AO) and surgical site infection (SSI) as well as postoperative reactions including pain,swelling and trismus were recorded 1, 3, 7 and 14 d after surgery. SPSS19.0 software package was used for statistical analysis. RESULTS: A total of 1 452 patients completed the study with 35 AO（2.41%）and 65 SSI（4.47%）. Eleven AO（3.03%）and 22 SSI（6.06%）were observed in CG group; 10 AO（2.78%）and 17 SSI（4.72%）were observed in CHX group; 8 AO（2.21%）and 15 SSI（4.14%）were observed in AMX group; 6 AO（1.63%）and 11 SSI（3.00%）were observed in CHX+AMX group. However,no significant difference was found in the rate of local infection and postoperative reactions among the four groups (P>0.05). CONCLUSIONS: The application of amoxicillin and 0.12% chlorhexidine gluconate can not reduce the rate of postoperative local infection after impacted mandibular third molar extraction.

Key words: Amoxicillin, Chlorhexidine gluconate, Third molar, Infection

中图分类号:

R782.11

鲍馥羚, 唐海阔, 李泓钰, 黄洪章. 抗菌药物控制下颌阻生第三磨牙拔除术后局部感染的前瞻性随机对照研究[J]. 中国口腔颌面外科杂志, 2016, 14(6): 532-537.

BAO Fu-ling, TANG Hai-kuo, LI Hong-yu, HUANG Hong-zhang. A prospective randomized clinical trial of using antimicrobial agents to prevent local infection following impacted mandibular third molar extraction[J]. China J Oral Maxillofac Surg, 2016, 14(6): 532-537.

参考文献

[1] 唐海阔, 侯劲松. 浅谈牙拔除术后抗菌药物的使用 [J]. 国际口腔医学杂志, 2014(05): 497-499.
[2] Ren YF, Malmstrom HS. Effectiveness of antibiotic prophylaxis in third molar surgery: a meta-analysis of randomized controlled clinical trials [J]. J Oral Maxillofac Surg, 2007, 65(10): 1909-1921.
[3] López-Cedrún JL, Pijoan JI, Fernández S, et al. Efficacy of amoxicillin treatment in preventing postoperative complications in patients undergoing third molar surgery: a prospective, randomized, double-blind controlled study [J]. J Oral Maxillofac Surg, 2011, 69(6): e5-14.
[4] Lacasa JM, Jiménez JA, Ferrás V, et al. Prophylaxis versus pre-emptive treatment for infective and inflammatory complications of surgical third molar removal: a randomized, double-blind, placebo-controlled, clinical trial with sustained release amoxicillin/clavulanic acid (1000/62.5 mg) [J]. Int J Oral Maxillofac Surg, 2007, 36(4): 321-327.
[5] Halpern LR, Dodson TB. Does prophylactic administration of systemic antibiotics prevent postoperative inflammatory complications after third molar surgery? [J]. J Oral Maxillofac Surg, 2007, 65(2): 177-185.
[6] Caso A, Hung LK, Beirne OR. Prevention of alveolar osteitis with chlorhexidine: a meta-analytic review [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 99(2): 155-159.
[7] Delilbasi C, Saracoglu U, Keskin A. Effects of 0.2% chlorhexidine gluconate and amoxicillin plus clavulanic acid on the prevention of alveolar osteitis following mandibular third molar extractions [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2002, 94(3): 301-304.
[8] 薛芃, 侯锐, 尚磊, 等. 抗菌药物对下颌阻生第三磨牙拔除后炎性并发症影响的临床观察[J]. 中华口腔医学杂志, 2014, 49(10): 603-606.
[9] Arteagoitia MI, Barbier L, Santamaria J, et al. Efficacy of amoxicillin and amoxicillin/clavulanic acid in the prevention of infection and dry socket after third molar extraction. A systematic review and meta-analysis[J]. Med Oral Patol Oral Cir Bucal, 2016, 21(4): e494-504.
[10] Arteagoitia I, Ramos E, Santamaria G, et al. Amoxicillin/clavulanic acid 2000/125 mg to prevent complications due to infection following completely bone-impacted lower third molar removal: a clinical trial [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015, 119(1): 8-16.
[11] Siddiqi A, Morkel JA, Zafar S. Antibiotic prophylaxis in third molar surgery: A randomized double-blind placebo-controlled clinical trial using split-mouth technique [J]. Int J Oral Maxillofac Surg, 2010, 39(2): 107-114.
[12] Xue P, Wang J, Wu B, et al. Efficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: a split-mouth, double-blind, self-controlled, clinical trial [J]. Br J Oral Maxillofac Surg, 2015, 53(5): 416-420.
[13] Kaczmarzyk T, Wichlinski J, Stypulkowska J, et al. Single-dose and multi-dose clindamycin therapy fails to demonstrate efficacy in preventing infectious and inflammatory complications in third molar surgery [J]. Int J Oral Maxillofac Surg, 2007, 36(5): 417-422.
[14] Duvall NB, Fisher TD, Hensley D, et al. The comparative efficacy of 0.12% chlorhexidine and amoxicillin to reduce the incidence and magnitude of bacteremia during third molar extractions: a prospective, blind, randomized clinical trial [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 115(6): 752-763.

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