老年心血管疾病患者拔牙不良事件危险因素预测研究  

Prediction of risk factors for adverse tooth extraction events in elderly patients with cardiovascular diseases

作　　者：翟宇润 马绍骏[1] 刘桐 盛净[1] Zhai Yurun;Ma Shaojun;Liu Tong;Sheng Jing(Department of Geriatrics,Shanghai Ninth People's Hospital,Medical College of Shanghai Jiaotong University,Shanghai,200011,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院老年病科,上海200011

出　　处：《老年医学与保健》2025年第1期120-124,共5页Geriatrics & Health Care

基　　金：上海市卫生健康委员会科研课题计划(202040076)。

摘　　要：目的探究老年心血管疾病拔牙患者围手术期不良事件发生的危险因素。方法2023年8月—2024年10月,招募上海交通大学医学院附属第九人民医院口腔拔牙评估门诊380例老年患者,根据患者有无发生围手术期不良事件分为不良事件组(n=101)和无不良事件组(n=279)。收集患者的年龄、性别、体质量指数、基础疾病史、药物使用情况和一般健康问卷(GHQ-28)评分等基本信息。拔牙前评估患者的血常规、凝血功能和左室射血分数等。拔牙时记录患者的拔牙数、拔牙类型、收缩压、舒张压及心率。术后1周电话随访患者围手术期不良事件的发生情况。采用二分类Logistic回归分析拔牙围手术期不良事件的影响因素。结果与无不良事件组相比,不良事件组收缩压、舒张压、纤维蛋白原(FIB)水平、GHQ-28总分、躯体症状、焦虑/失眠、社会功能障碍及严重抑郁得分较高,心率较快,凝血酶原时间(PT)较长,拔牙数较多,差异有统计学意义(P<0.05)。二分类Logistic回归分析显示,收缩压升高、PT延长、FIB升高、拔牙数增多和GHQ-28总分高是老年心血管疾病患者拔牙围手术期发生不良事件的影响因素(P<0.05)。结论老年心血管疾病患者拔牙手术发生不良事件可能与收缩压升高、PT延长、FIB升高、拔牙数多和高GHQ-28总分相关。Objective To investigate the risk factors for perioperative adverse tooth extraction events in elderly patients with cardiovascular diseases.Methods From August 2023 to October 2024,380 elderly patients were recruited from Oral Extraction Evaluation Outpatient Department of Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University.They were divided into adverse event group(n=101)and non-adverse event group(n=279)based on whether they experienced perioperative adverse events.Their clinical data such as age,gender,body mass index,history of underlying diseases,medication use,and General Health Questionnaire-28(GHQ-28)score were collected.The blood routine tests,coagulation function and left ventricular ejection fraction were assessed before tooth extraction.The number of teeth extracted,type of extraction,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the patients were recorded during extractions.The incidence of perioperative adverse events was followed up by telephone one week after surgery.Binary Logistic regression was used to identify the influencing factors.Results Compared with the non-adverse event group,the adverse event group exhibited significantly higher levels of SBP,DBP,fibrinogen(FIB),GHQ-28 total score and subscores(somatic symptoms,anxiety/insomnia,social dysfunction,severe depression),faster HR,longer prothrombin time(PT),and greater number of teeth extracted(P<0.05).Binary Logistic regression showed that elevated SBP,prolonged PT,increased FIB,greater number of teeth extracted,and higher GHQ-28 total scores were independent risk factors for perioperative adverse tooth extraction events in elderly patients with cardiovascular diseases(P<0.05).Conclusion The adverse events of tooth extraction in elderly patients with cardiovascular disease may be associated with elevated SBP,prolonged PT,elevated FIB,more tooth extraction and higher GHQ-28 total score.

关 键 词：老年 拔牙 风险因素 心理状态 一般健康问卷 

分 类 号：R78[医药卫生—口腔医学]