再生氧化纤维素止血纱布降低长期口服华法林患者拔牙后出血的临床研究  

Clinical analysis on the effects of oxidized regenerated cellulosein on reducing risks of postoperative hemorrhage after tooth extraction in patients taking long-term oral Warfarin

作　　者：许广杰 侯锐 杨霞 王肖楠 钟良燕 胡曼 张新庆 田磊 XU Guangjie HOU Rui YANG Xia WANG Xiaonan ZHONG Liangyan HU Man ZHANG Xinqing TIAN Lei(State Key Laboratory of Military Stomatology ＆ National Clinical Research Center for Oral Diseases ＆ Shannxi Clinical Research Center for Oral Diseases,Department of Oral Surgery,School of Stomatology,the Fourth Military Medical Universit)

机构地区：[1]军事口腔医学国家重点实验室、国家口腔疾病临床医学研究中心、陕西省口腔疾病临床医学研究中心、第四军医大学口腔医院口腔外科,陕西西安710032 [2]中国人民解放军第413医院口腔科,浙江舟山316000

出　　处：《口腔医学》2017年第9期805-809,共5页Stomatology

基　　金：陕西省自然科学基金(2016JM8141);国家自然科学基金(81670964)

摘　　要：目的探讨并分析长期口服华法林的患者在不停药的情况下,采用再生氧化纤维素止血纱布(速即纱)填塞拔牙创降低其拔牙后出血的风险。方法选取长期口服华法林的拔牙患者100例随机分为试验组和对照组,试验组在拔牙创填塞再生氧化纤维素止血纱布而对照组填塞可吸收明胶海绵。分别从性别、年龄、INR、患牙牙位和拔牙难易程度等方面分析两组拔牙后出血的情况。结果 (1)试验组拔牙后出血率2%,明显低于对照组16%(P<0.05);(2)试验组仅有1例男性患者拔牙后出血,对照组出血率男性高于女性,但差异无统计学意义(P>0.05),对照组拔牙后出血率随着年龄的增大及INR的升高而上升(P<0.05);(3)试验组1例出血发生在上颌磨牙,对照组出血率磨牙组>前磨牙组>前牙组、复杂牙组>简单牙组,且差异均有统计学意义(P<0.05)。结论长期口服华法林且INR<3.5的患者拔除1颗简单或复杂牙(非埋藏阻生牙)不停药是相对安全的,再生氧化纤维素止血纱布可有效降低该类患者拔牙后出血率。Objective To discuss and analyze the effects of oxidized regenerated cellulose （Surgicel） which was packed in tooth extraction sockets on reducing the risks of postoperative hemorrhage after tooth extraction,without interrupting the therapy of patients taking long-term oral Warfarin.Methods 100 patients taking long-term oral Warfarin were selected and randomly divided into the experimental group and the control group.Surgicel was packed inside the extraction socket in the experimental group,while absorbable gelatin sponge was packed in the control group.The differences of hemorrhage rate after tooth extraction between two groups were analyzed from the perspectives of gender,age,INR,tooth position and the complexity of surgery.Results （1） The hemorrhage rate of the experimental group （2%） was significantly lower than that of the control group （16%） （P 〈0.05）;（2） There was only 1 case occurring hemorrhage after tooth extraction in the experimental group.The hemorrhage rate of male group after tooth extraction was higher than the female in the control group,but there was no statistically significant difference （P〉0.05）.The hemorrhage rate of control group after tooth extraction increased with the age and INR （P〈0.05）;（3） There was only 1 case of hemorrhage after tooth extraction in the maxillary molar in the experimental group.In the control group,the hemorrhage rates after tooth extraction were that the molar group was higher than the premolar group which was higher than the front teeth and complicated dental group was higher than simple teeth,and the differences were statistically significant （P 〈0.05）.Conclusions It is relatively safe to have a simple or complicated tooth extraction for the patients who take long-term oral Warfarin without interruption and whose INR is no more than 3.5.Surgicel can effectively reduce the rate of hemorrhage after tooth extraction in these patients.

关 键 词：华法林 拔牙后出血 再生氧化纤维素止血纱布 

分 类 号：R782.11[医药卫生—口腔医学]