牛黄解毒片联合超声龈下洁治...火炽盛证老年牙周炎临床研究_张金凤.pdf

新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4收稿日期 2022-01-25修回日期 2022-11-18作者简介张金凤（1990-），女，主治医师，E-mail：。牛黄解毒片联合超声龈下洁治术治疗胃火炽盛证老年牙周炎临床研究张金凤1，华依梦21.浙江省荣军医院口腔科，浙江 嘉兴 314000；2.浙江省荣军医院中医科，浙江 嘉兴 314000摘要目的：观察牛黄解毒片联合超声龈下洁治术治疗胃火炽盛证老年牙周炎的临床疗效。方法：选择胃火炽盛证老年牙周炎患者 88 例作为研究对象，按随机数字表法分为观察组和对照组各 44 例。对照组给予超声龈下洁治术治疗，观察组在对照组的基础上加用牛黄解毒片口服。2 组疗程均为 2 周。比较 2 组牙周组织指标、中医证候评分、临床症状改善时间及临床疗效。结果：观察组总有效率为 93.18%，明显高于对照组75.00%，组间比较，差异有统计学意义（P0.05）。治疗前，2 组菌斑指数、探针深度、龈沟出血指数、牙龈指数评分比较，差异无统计学意义（P0.05）；治疗后，2 组菌斑指数、探针深度、龈沟出血指数、牙龈指数评分均较治疗前明显下降（P0.05），且观察组上述各项评分均明显低于对照组（P0.05）。治疗前，2 组牙龈肿痛、渴喜冷饮、口臭、大便干结等胃火炽盛证证候评分比较，差异无统计学意义（P0.05）；治疗后，2 组上述各项中医证候评分均较治疗前显著降低（P0.05），且观察组各项证候评分均明显低于对照组（P0.05）。观察组牙齿松动、口臭、牙龈肿痛等症状改善时间均明显短于对照组，差异有统计学意义（P0.05）。结论：牛黄解毒片辅助超声龈下洁治术治疗胃火炽盛证老年牙周炎疗效显著，能更好地改善患者的症状体征及中医证候，加速疾病康复。关键词牙周炎；超声龈下洁治术；胃火炽盛证；牛黄解毒片；牙周组织评分中图分类号R781.4+2文献标志码A文章编号0256-7415（2023）04-0121-04DOI：10.13457/ki.jncm.2023.04.027Clinical Study on Niuhuang Jiedu Pills Combined with Ultrasonic Subgingival Scalingfor Senile Periodontitis with Intense Stomach Fire SyndromeZHANG Jinfeng，HUA YimengAbstract：Objective：To observe the clinical effect of Niuhuang Jiedu Pills combined with ultrasonicsubgingival scaling for senile periodontitis with intense stomach fire syndrome.Methods：A total of88 cases of senile patients with periodontitis of intense stomach fire syndrome were selected as the studyobjects and divided into the observation group and the control group according to the random number tablemethod，with 44 cases in each group.The control group was treated with ultrasonic subgingival scaling，and the observation group was additionally treated with the oral administration with Niuhuang Jiedu Pillsbased on the treatment of the control group.Both groups were treated for 2 weeks.The indexes ofperiodontal tissue，traditional Chinese medicine(TCM)syndrome scores，the improvement time of clinicalsymptoms，and clinical effects were compared between the two groups.Results：The total effective ratewas 93.18%in the observation group，significantly higher than that of 75.00%in the control group，thedifference being significant(P0.05).Before treatment，there was no significant difference being found inthe comparison of the scores of plaque indexes，probe depth，gingival sulcus bleeding indexes，and 121新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4牙周炎是口腔科临床常见病，由于局部因素影响使牙周支持组织发生慢性炎症发应所致。本病好发于老年人，治疗不当易迁延不愈。中医学认为该病的发生多与胃火炽盛关系密切，多以清胃降火为主要治则1。牛黄解毒片具有清热解毒之功效，临床常用于治疗火热内盛所致咽喉、牙龈肿痛，或由于胃肠积热、上焦火旺等导致的里实热证2。基于此，本研究应用牛黄解毒片联合超声龈下洁治术治疗胃火炽盛证牙周炎，结果报道如下。1临床资料1.1诊断标准符合临床牙周病学3中牙周炎诊断标准。成年人病程缓慢；牙齿移位及松动，咀嚼无力；牙槽骨见程度不一的吸收，以水平吸收为主；牙周袋出现，甚至溢脓；牙龈见程度不一的红肿、充血、糜烂，探诊出血；明显的菌斑、牙石及局部刺激因素，且与牙周炎症和破坏程度较为一致；伴口臭、逆行牙髓炎等。1.2辨证标准符合中医病证诊断疗效标准4中胃火炽盛证诊断标准。症见牙龈红肿疼痛，出血，甚则溢出脓血，渴喜冷饮，口气热臭，大便干结，舌红、苔黄，脉数。1.3纳入标准符合以上诊断及辨证标准，病情属中、重度3；年龄60 周岁；全口牙20 颗；入组前1 个月内未予牙周相关治疗；签署知情同意书。1.4排除标准伴牙周炎之外其他口腔疾病；长期吸烟史；伴心、肺、肾等功能障碍；伴其他感染性疾病；有口腔手术史；对牛黄解毒片过敏。1.5一般资料选取 2017 年 10 月2020 年 10 月浙江省荣军医院就诊的胃火炽盛证老年牙周炎患者88 例作为研究对象，按随机数字表法分为观察组和对照组各 44 例。观察组男 27 例，女 17 例；年龄6073 岁，平均（68.047.44）岁；牙周炎发作 15 d，平均（3.370.41）d；病情分级3：中度 23 例，重度 21 例。对照组男 29 例，女 15 例；年龄 6074 岁，平均（68.097.46）岁；牙周炎发作 16 d，平均（3.300.40）d；病情分级：中度 25 例，重度 19 例。2 组一般资料比较，差异无统计学意义（P0.05），具有可比性。2治疗方法2.1对照组给予超声龈下洁治术治疗。操作方法：采用 EMS 超声治疗仪在超声低挡输出能量下去除较大龈下牙石，用 P 型工作尖刮出剩余牙石，再gingival indexes between the two groups(P0.05).After treatment，the scores of plaque indexes，probedepth，gingival sulcus bleeding indexes，and gingival indexes in the two groups were significantlydecreased when compared with those before treatment(P0.05)，and the scores of the above indexes inthe observation group were significantly lower than those in the control group(P0.05).Before treatment，there was no significant difference being found in the comparison of the syndrome scores of intensestomach fire syndrome including swelling and pain of the gingiva，thirst with a predilection for cold drink，bad breath，and dry hard stool between the two groups(P0.05).After treatment，each TCM syndromescore in the two groups was significantly decreased when compared with that before treatment(P0.05)，and each syndrome score in the observation group was significantly lower than that in the control group(P0.05).The improvement time of loose teeth，bad breath，swelling and pain of the gingiva and othersymptoms in the observation group was significantly shorter than that in the control group，the differencebeing significant(P0.05).Conclusion：Niuhuang Jiedu Pills combined with ultrasonic subgingival scalinghas a significant curative effect in the treatment of senile periodontitis with intense stomach fire syndrome，and can better improve the symptoms，signs，and TCM syndrome，and accelerate the recovery from thedisease.Keywords：Periodontitis；Ultrasonic subgingival scaling；Intense stomach fire syndrome；NiuhuangJiedu Pills；Scores of periodontal tissue 122新中医2023年2月第55卷第4期NEW CHINESE MEDICINEFebruary 2023 Vol.55 No.4用热固性树脂浸渍纸高压层积板对根面行平整和抛光，3过氧化氢水溶液冲洗龈下，于 14 d 内分 2 次治疗。2.2观察组在对照组的基础上予牛黄解毒片（北京同仁堂科技发展股份有限公司制药厂，国药准字Z11020452）口服，每次 3 片，每天 3 次。2 组疗程均为 2 周。3观察指标与统计学方