评价改良浸润麻醉法应用于下颌阻生第三磨牙拔除术中的麻醉效果和安全性。

采用随机自身配对对照设计，纳入2023年8月至2024年8月于河北医科大学第三医院口腔颌面外科行双侧下颌阻生第三磨牙拔除术患者140例。采用随机数字表法确定患者一侧患牙接受改良浸润麻醉法，另一侧接受传统下牙槽神经阻滞麻醉法，2次手术间隔2周。比较患者2侧麻醉注射时、拔牙术中至术后7 d不同时间点的疼痛视觉模拟评分法（visual analogue scale，VAS）评分、麻醉及拔牙过程中血压及心率变化、麻醉起效时间、追加麻醉发生率、下唇麻木、舌麻木及麻醉相关不良反应。

2组VAS评分均随时间发生变化（P<0.001），改良浸润麻醉组麻醉注射时及拔牙术中VAS评分均低于下牙槽阻滞麻醉组（均P<0.001），术后各时间点VAS评分比较差异均无统计学意义（均P>0.05）。改良浸润麻醉组麻醉注射时收缩压及舒张压低于下牙槽阻滞麻醉组（均P<0.01），其余时间点2组血压及心率比较差异均无统计学意义（均P>0.05）。改良浸润麻醉组麻醉起效时间更短，追加麻醉发生率及下唇麻木、舌麻木、注射点渗血或血肿和回抽有血发生率均低于下牙槽阻滞麻醉组（均P<0.05）。2组均未发生张口受限、面瘫、暂时性复视或失明及全身不良反应等相关并发症。

改良浸润麻醉法用于下颌阻生第三磨牙拔除术可有效减轻麻醉注射及术中疼痛、缩短麻醉起效时间，并减少追加麻醉、下唇麻木、舌麻木和麻醉相关局部不良反应发生率，具有较好的安全性和临床应用价值。

To evaluate the anesthetic efficacy and safety of modified infiltration anesthesia for the extraction of impacted mandibular third molars.

A randomized split-mouth, self-controlled study was conducted. A total of 140 patients who underwent bilateral impacted mandibular third molar extraction in the Department of Oral and Maxillofacial Surgery, the Third Hospital of Hebei Medical University, between August 2023 and August 2024 were enrolled. One side was randomly assigned to receive modified infiltration anesthesia, while the contralateral side received conventional inferior alveolar nerve block anesthesia, with a 2-week interval between the two procedures. Pain intensity was assessed using the visual analogue scale (VAS) at different time points during anesthetic injection and up to 7 days postoperatively. Changes in blood pressure and heart rate during anesthetic injection and tooth extraction, anesthesia onset time, the incidence of supplemental anesthesia, lower lip and lingual numbness and anesthesia-related adverse reactions were compared between the two sides.

VAS scores changed significantly over time in both groups (P<0.001). Compared with the inferior alveolar nerve block group, the modified infiltration anesthesia group had significantly lower VAS scores during anesthetic injection and tooth extraction (both P<0.001), whereas no significant differences were observed at any postoperative time point (all P>0.05). Systolic and diastolic blood pressures during anesthesia injection were significantly lower in the modified infiltration anesthesia group than in the inferior alveolar nerve block group (both P<0.01), while no significant differences in blood pressure or heart rate were found between the two groups at the remaining time points (all P>0.05). The modified infiltration anesthesia group showed a shorter anesthesia onset time and lower incidences of supplemental anesthesia, lower lip numbness, lingual numbness, bleeding or hematoma at the injection site, and positive aspiration (all P<0.05). No cases of trismus, facial paralysis, transient diplopia or blindness, or systemic adverse reactions were observed in either group.

Modified infiltration anesthesia for impacted mandibular third molar extraction effectively reduces pain during anesthetic injection and tooth extraction, shortens anesthesia onset time, decreases the need for supplemental anesthesia, lower lip and lingual numbness, and anesthesia-related local adverse reactions, demonstrating favorable safety and clinical value.