口服阿司匹林患者不停药牙种植手术出血情况的临床观察  

Clinical observation of the hemorrhagic risk in patients with low-dose aspirin therapy following dental implantation

作　　者：项天庆[1] 吕亚林[1] 余兰[1] 段向青[1] 丁芳[1] 蔡钎[1] 

机构地区：[1]首都医科大学附属北京安贞医院口腔医疗中心,北京100029

出　　处：《首都医科大学学报》2016年第3期270-274,共5页Journal of Capital Medical University

基　　金：首都特色临床应用研究项目(Z121107001012026);中华口腔医学会专项基金~~

摘　　要：目的探讨口服小剂量阿司匹林患者不停药情况下行简单牙种植手术的安全性。方法选择长期口服小剂量阿司匹林的心血管患者45例纳入试验组,每位患者不停药情况下植入1～3枚种植体,采用牙龈拉拢缝合、盐水纱布压迫等局部处理措施控制术后出血;同时选择未接受抗血小板治疗或抗凝治疗的患者45例纳入对照组,每位患者植入1～3枚种植体,术后未采取特殊止血措施。两组患者术中均无需大面积翻瓣植骨。观察两组患者术后即刻出血、延迟出血和严重出血发生率。结果试验组术后即刻出血患者共2例（4%）,对照组1例（2%）,两组间比较差异无统计学意义（P=0.50）,强化局部处理措施后出血停止;试验组和对照组均无延迟出血和严重出血情况发生。结论口服小剂量阿司匹林患者行简单牙种植手术出血风险很低,可在不停药情况下实施手术。Objective To evaluate the feasibility of dental implantation therapy without altering antiplatelet therapy in patients taking low dose aspirin. Methods Patients taking antiplatelet drug of low dose of aspirin and receiving dental implantation without altering aspirin dosage from June 2012 to March 2015 were enrolled into the trial group,the same number of 45 patients who had not taken oral anti-platelet drugs or anti-coagulant agents served as the control group after propensity-score matching. All implantation surgeries were performed without extensive gingival flapping or bone grafting. Hemorrhage condition of the implantation sites was checked 30 minutes after the surgery and additional hemostatic measures were supplemented if necessary. Patients were discharged until no blood oozing was observed. Telephone interviews were conducted at 24 hours,72 hours after the procedure and a follow up visit was made 1 week later. The rates of post-operation hemorrhage were determined and analyzed using Fisher＇s exact test with SPSS 19. 0（ SPSS,Inc.,Chicago,IL,USA） software,and statistical significance was set at 0. 05 level. Results There were 2 immediate postoperative bleeding cases in the aspirin group and 1 case in the control group. No significant difference was detected between the two groups（ P = 0. 50）. None was observed for late postoperative bleeding and severe postoperative bleeding in either group. Conclusion Our study support the recommendation that there is no indication to alter single low dose aspirin before simple dental implantation surgery,and the local hemostatic measures are sufficient to control bleeding.

关 键 词：出血 抗血小板治疗 阿司匹林 牙种植 

分 类 号：R782.12[医药卫生—口腔医学]