目的 研究不同劑量地塞米松黏膜下注射對下頜第三磨牙拔除術(shù)后癥狀的臨床療效。方法 選取2016年8月-2016年11月復(fù)旦大學(xué)附屬中山醫(yī)院和上海市靜安區(qū)牙病防治所收治的拔除下頜第三磨牙患者156例，隨機分為對照組（53例）、地塞米松4 mg組（51例）和地塞米松8 mg組（52例）。對照組術(shù)前于下頜第三磨牙黏膜周圍1 cm范圍內(nèi)注射生理鹽水。地塞米松4 mg組術(shù)前于下頜第三磨牙黏膜周圍1 cm范圍內(nèi)注射地塞米松磷酸鈉注射液4 mg。地塞米松8 mg組術(shù)前于下頜第三磨牙黏膜周圍1 cm范圍內(nèi)注射地塞米松磷酸鈉注射液8 mg。觀察3組的第三磨牙拔除術(shù)后癥狀嚴(yán)重度（PoSSe）量表評分，比較3組的術(shù)后腫脹程度和最大張口程度。結(jié)果 治療后，地塞米松4 mg組和地塞米松8 mg組飲食、言語、腫脹、疼痛、日常生活評分和總評分明顯低于對照組，3組比較差異有統(tǒng)計學(xué)意義（P<0.05）；且地塞米松8 mg組這些觀察指標(biāo)下降程度明顯優(yōu)于地塞米松4 mg組，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，地塞米松8 mg組1級腫脹占比明顯高于對照組和地塞米松4 mg組，而3、4級腫脹明顯低于對照組和地塞米松4 mg組，3組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。術(shù)后1周，地塞米松4 mg組和地塞米松8 mg組最大張口程度明顯大于對照組，3組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 黏膜下注射地塞米松可改善下頜第三磨牙拔除術(shù)后癥狀，可減少術(shù)后腫脹程度，增加術(shù)后1周最大張口程度，且地塞米松8 mg優(yōu)于地塞米松4 mg，具有一定的臨床推廣應(yīng)用價值。

Objective To study the clinical effect of submucosal injection of dexamethasone to improve postoperative symptoms of mandibular third molar extraction. Methods Patients (156 cases) with mandibular third molar extraction in Zhongshan Hospital of Fudan University and Shanghai Jingan Dental Clinic from August 2016 to November 2016 were randomly divided into control group (53 cases), dexamethasone 4 mg group (51 cases) and dexamethasone 8 mg group (52 cases). Patients in the control group were submucosal injected with normal saline within 1 cm range of mandibular third molar. Patients in the dexamethasone 4 mg group were submucosal injected with 4 mg Dexamethasone Sodium Phosphate Injection within 1 cm range of mandibular third molar. Patients in the dexamethasone 8 mg group were submucosal injected with 8 mg Dexamethasone Sodium Phosphate Injection within 1 cm range of mandibular third molar. After treatment, the postoperative symptom score (PoSSe) was evaluated, and postoperative swelling and maximum mouth opening degree among three groups were compared. After treatment, the scores of diet, speech, swelling, pain, daily life and total scores in the dexamethasone 4 mg and dexamethasone 8 mg group were lower than those in the control group, and there were difference among three groups (P < 0.05). The observational indexes in the dexamethasone 8 m group were significantly better than those in the dexamethasone 4 mg group, with significant difference between two groups (P < 0.05). After treatment, the 1 grade swelling percentage in dexamethasone 8 mg group was significantly higher than those in the control and dexamethasone 4 mg groups, but the 3 and 4 grade swelling percentage in dexamethasone 8 mg group was significantly lower than those in the control and dexamethasone 4 mg groups, and there was difference among three groups (P < 0.05). After 1 week of surgery, the maximum mouth opening degree in the dexamethasone 4 mg and dexamethasone 8 mg group were significantly bigger than that in the control group, and there was difference among three groups (P < 0.05). Conclusion Submucosal injection with dexamethasone in mandibular third molar can improve postoperative symptoms, can decrease postoperative swelling, increase maximum mouth opening degree after 1 week of surgery, and dexamethasone with dose of 8 mg is better than dexamethasone with dose of 4 mg, which has a certain clinical application value.

上海市科委基礎(chǔ)研究重點項目（14JC1490600）；上海市科委政府間國際合作項目（16520710400）