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孤独症(autism)是一种儿童广泛性发育障碍,其核心症状包括社会交往障碍、交流障碍、兴趣狭窄和刻板重复的行为方式,多在3岁前起病。病因学研究发现,主要是遗传易感性和特定环境因素综合作用的结果。进10年来,其发病率在国内呈持续上升趋势,现有患儿100多万,患病率约为1/100,男女比例为7.5∶1。国内在此方面的研究起步较晚。在口腔医疗方面,患儿因不能正常交流沟通,不能配合治疗等,使口腔保健措施和医疗过程难于实施。国外的辅助措施主要是对轻症采用行为管理,对重症者采用全身麻醉下治疗。我中心从2005年起,尝试采用口服咪达唑仑镇静技术,辅助孤独症儿童口腔治疗。至2013年,共完成病例38例(63人次),年龄3-14岁,男女比例约10∶1,口服药物剂量为0.75-1mg/kg。治疗内容包括乳恒牙龋齿充填、牙髓治疗、窝沟封闭、涂氟防龋、拔牙术等。治疗效果采用Houpt评分,记录治疗中的生命体征并在治疗结束后随访不良反应及家长的满意度。所有病例镇静治疗效果均达到Houpt评分3分及以上,治疗中生命体征无明显波动。未及严重不良反应,偶有反常兴奋和小便失禁,个别接受局麻注射的患儿出现治疗后唇部自伤。与健康儿童相比,同一药物剂量下,孤独症儿童的镇静效果稍好(P<0.05)。笔者认为,对于全身无严重系统疾患,口腔治疗内容相对简单,行为管理效果欠佳的孤独症儿童,采用口服镇静药物辅助口腔治疗,是安全有效的。此外,孤独症儿童的口腔保健,应首先立足于预防,应采用长期、个体化的措施,不断主动干预,并对家长进行细致专业的宣教和指导。
Autism is a generalized developmental disorder in children whose core symptoms include social interaction disorders, communication problems, narrow interests and stereotyped and repetitive behaviors that predate the age of 3 years. Etiology study found that the main genetic susceptibility and the specific environmental factors combined results. In the past 10 years, its incidence has been on the rise in China. The number of existing children is over 1 million with a prevalence of about 1/100 and a male / female ratio of 7.5: 1. Domestic research in this area started late. In the area of dental care, children can not implement oral health care and medical procedures because they can not communicate properly and can not cooperate with treatment. Foreign aid is mainly used for the management of mild disease, the use of general anesthesia for severe treatment. My center from 2005 onwards, try oral midazolam sedation technology to assist children with autism oral treatment. By 2013, a total of 38 cases (63) were completed, aged 3-14 years, with a ratio of about 10: 1 for males and females and an oral dose of 0.75-1 mg / kg. Treatment includes primary permanent dental caries filling, endodontic treatment, pit and fissure sealant, fluoridation dental caries, tooth extraction and so on. The Houpt score was used to document the treatment’s vital signs and follow-up adverse events and parental satisfaction at the end of treatment. All cases of sedation treatment reached Houpt score of 3 points and above, no significant fluctuations in the treatment of vital signs. Not serious adverse reactions, occasional abnormal excitement and urinary incontinence, some patients admitted to local anesthesia with lip injury after treatment. Compared with healthy children, children with autism had slightly better sedation (P <0.05) at the same dose of medication. The author believes that the system for the absence of serious systemic disorders, oral treatment is relatively simple, poor behavior management of autistic children with oral sedation medication-assisted oral treatment is safe and effective. In addition, oral health care for children with autism should be based on prevention first. Long-term, individualized measures should be adopted to continuously and actively involve parents in conducting mission education and guidance.