咽反射敏感患者的口腔诊疗策略

doi:10.7518/gjkq.2022078

摘要/Abstract

摘要：

咽反射是一种防止吞咽异物的生理反应，主要表现为异物刺激咽后壁和舌根部引起的恶心、呕吐。咽反射是一种正常的保护性反射，然而过于敏感的咽反射将会限制患者接受口腔治疗的能力，对患者的口腔健康非常不利，同时也为口腔医生的诊疗过程带来了很大不便。本文将从咽反射敏感的临床表现及其刺激因素、危害、咽反射严重程度及控制程度分级、咽反射敏感患者的控制措施等多个方面进行综述，为临床医生制定对咽反射敏感患者的口腔诊疗策略提供帮助。

关键词: 咽反射, 刺激因素, 脱敏疗法, 静脉镇静

Abstract:

The gag reflex is a normal defense mechanism that protects the pharynx and throat from foreign objects. Its main manifestations are nausea and vomiting after a foreign body stimulates the posterior pharyngeal wall and the root of the tongue. Despite being a normal protective reflex, the gag reflex, when pronounced, can complicate dental care and adversely affect oral health. Moreover, it causes inconvenience to diagnosis and treatment processes. Here, the sensitivity and etiology of the gag reflex, related hazards, gagging severity, gagging prevention index, and management measures were analyzed in patients with sensitive gag reflex. This paper will help dentists develop assessment issues and a variety of management strategies for these patients.

Key words: gag reflex, stimulating factor, desensitization therapy, intravenous sedation

中图分类号:

R 78

李洲驰,叶玲,汪成林. 咽反射敏感患者的口腔诊疗策略[J]. 国际口腔医学杂志, 2022, 49(6): 690-698.

Li Zhouchi,Ye Ling,Wang Chenglin.. Oral diagnosis and treatment strategies for patients with gag reflex sensitivity[J]. Int J Stomatol, 2022, 49(6): 690-698.

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分级	描述
一级：正常咽反射	偶尔发生在高风险的口腔操作中。这基本上是一种在治疗困难情况下的“正常”咽反射。一般由患者自己控制。
二级：轻度咽反射敏感	发生在普通口腔操作中，如充填、取模。通常可以由患者自己控制，但可能需要口腔医生的帮助和安慰，可以继续口腔治疗操作。一般不需要采取特别措施，但可能使治疗过程更加困难。
三级：中度咽反射敏感	在正常的口腔操作中经常发生。这可能包括对高风险区域的简单检查，如下颌磨牙的舌侧面。一旦发生，如果不停止操作，就很难自行缓解。重新开始治疗可能很困难。通常需要采取控制措施。可能会影响治疗计划，并可能限制治疗选择。
四级：严重的咽反射敏感	发生在所有形式的口腔治疗中，包括简单的目视检查。如果没有某种形式的特殊措施来试图控制咽反射，不可能进行常规治疗。治疗方案可能受到限制，咽反射问题将是制定治疗计划的一个主要考虑因素。
五级：非常严重的咽反射敏感	很容易发生，而且可能不一定需要物理刺激来触发反射。能否控制咽反射，决定了患者能否进行口腔诊疗，是制定治疗计划时应考虑的首要因素。治疗方案可能会受到严重的限制。如果没有对控制咽反射问题的具体、特殊的治疗，就不可能进行口腔治疗。

分级	描述
一级：完全控制	使用的治疗和管理方法，完全控制了咽反射。拟定的治疗方案完全成功。
二级：大部分控制	咽反射被大部分控制，建议的口腔治疗操作是可能的，但偶尔还会发生咽反射。
三级：部分控制	咽反射被部分控制。建议的口腔治疗操作已部分完成或进行了替代治疗。咽反射较为经常发生。
四级：控制不足	咽反射控制不足。所提议的口腔治疗操作不可能进行。仅一些“治疗”可以进行，但只进行了非常简单的步骤。咽反射经常发生。
五级：无控制	咽反射非常严重，即使是简单的治疗也不可能进行。

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