摘要： 目的: 评估服用阿司匹林患者的残根拔除前不停用阿司匹林的可行性和合理的停药时间。方法：选取90例年龄在50~80岁的心脑血管疾病患者（服用阿司匹林时间>2周，剂量100 mg/d）, 分为服药组（A组）、停药3 d组（B组）和停药5 d组（C组），实施单颗上颌牙残根拔除术（每组前牙、前磨牙、磨牙各10例），将拔牙创凝血情况从正常至较差分为Ⅰ~Ⅵ级，对病例进行评价和比较。结果：①各组未出现凝血Ⅴ、Ⅵ级病例。②前牙残根拔除后，各组病例均为凝血Ⅰ、Ⅱ级。③前磨牙残根拔除后，A组中凝血Ⅲ、Ⅳ级病例比例分别为20%和10%；B组和C组未出现凝血Ⅲ、Ⅳ级病例。④磨牙残根拔除后，A组中凝血Ⅲ、Ⅳ级病例比例分别为30%和10%；B组分别为10%和0；C组未出现凝血Ⅲ、Ⅳ级病例。结论：对服用阿司匹林患者（100 mg/d）实施单颗上颌牙残根拔除时，①前牙术前可不停药；②前磨牙﹑磨牙术前可停药3 d；如考虑患者停药后并发血管栓塞风险较高，术前可不停药，但必须完善拔牙创止血措施。
关键词:
阿司匹林,
残根拔除术,
出血,
停药
Abstract: Objective: To evaluate the feasibility of residual root extraction without preoperative ASA withdrawal and the reasonable preoperative ASA suspension time. Methods: 90 cardiovascular and cerebrovascular disease cases who take ASA for disease prevention (time more than 2 weeks; dosage: 100 mg/d) were enrolled in this study. All cases were divided into 3 groups: Group A, ASA continuation group, Group B, ASA 3 day suspension group, and Group C, ASA 5 day suspension group. After upper single tooth (residual root) extraction was performed （10 anterior teeth， 10 premolars, and 10 molars in each group）, condition of the socket coagulation was evaluated (class Ⅰ-Ⅵ, from ideal to undesirable） and comparison was implemented. Results: ① Class Ⅴ and Ⅵ of socket coagulation cases did not appear in all 3 groups. ② For anterior tooth extraction, all cases appeared in class Ⅰ and Ⅱ coagulation. ③ For premolar extraction, the percentages of class Ⅲ coagulation was 20% and class Ⅳ was 10% in Group A. No class Ⅲ and class Ⅳ coagulatin cases were appeared in Group B and Group C . ④ For molar roots extraction, the percentages of class Ⅲ and Ⅳ cases in Group A (30% and 10% respectively) were higher than those in Group B (10% and 0 respectively) and Group C ( 0 and 0 respectively). Conclusion: ① For anterior tooth, preoperative ASA continuation is feasible. ② For premolar and molar, preoperative 3 day ASA suspension is necessary to minimize postoperative bleeding risk unless it can lead to very high incidence of vascular thrombosis; for cases with very high ASA withdrawal risk, preoperative ASA continuation is feasible with strengthened socket haemostatic measures.
Key words:
Aspirin,
residual root extraction,
bleeding,
withdrawal
中图分类号:
陆萌萌， 高益鸣. 对服用阿司匹林患者拔牙创凝血的临床观察[J]. 《口腔颌面外科杂志》, 2013, 23(1): 42-45.
LU Meng-meng， GAO Yi-ming. Clinical Effects of Small Doses of Aspirin on Socket Bleeding in Residual Root Extraction[J]. 《Journal of Oral and Maxillofacial Surgery》, 2013, 23(1): 42-45.