CAJ | 학술논문

目的观察老年冠心病患者拔牙围术期持续应用阿司匹林对手术的影响. 方法选择需拔牙手术的冠心病患者中的心绞痛和经冠状动脉血运重建患者926例,其中拔牙手术前停用阿司匹林者241例,术前仍持续服用阿司匹林者685例,设立评估入组安全准线后,分析比较心绞痛和冠状动脉重建两组患者阿司匹林的服用情况对检查评估实施手术入组率的影响;再从评估入组后的冠心病患者中随机选择停用和持续服用阿司匹林患者各100例(服药组、停药组),检测、记录拔牙手术前后收缩压、舒张压和心率的变化差值,与健康老年拔牙对照组患者100例比较;对影响老年冠心病患者拔牙手术的危险因素进行多因素回归分析. 结果心绞痛患者手术前停药组193例经检查评估入组率67.9％(131例),与术前服药组380例的评估入组率82.1％(312例)比较,差异有统计学意义(x2 =14.77,P＜0.01);冠状动脉重建患者手术前停药组48例检查评估实施手术入组率41.7％(20例),与术前服药组305例的评估入组率80.7％(246例)比较,差异有统计学意义(x2=33.95,P＜0.01);拔牙术前停药组手术中和术前的收缩压变化差值(15.9±5.5)mmHg(1 mmHg=0.133kPa)与对照组差值(12.2±4.7)mmHg比较,差异有统计学意义(P＜0.05),服药组差值(13.6±4.5)与对照组差值比较,差异无统计学意义(P＞0.05);停药组与服药组手术期间舒张压、心率的变化差值与对照组差值比较差异无统计学意义(均P＞0.05);服药组拔牙创出血复诊率与对照组差异无统计学意义(P＞0.05);老年冠心病患者拔牙危险因素中术前停用阿司匹林为第2位. 结论对老年冠心病患者实施拔牙手术,不应停用阿司匹林.
목적 관찰노년관심병환자발아위술기지속응용아사필림대수술적영향. 방법 선택수발아수술적관심병환자중적심교통화경관상동맥혈운중건환자926례,기중발아수술전정용아사필림자241례,술전잉지속복용아사필림자685례,설립평고입조안전준선후,분석비교심교통화관상동맥중건량조환자아사필림적복용정황대검사평고실시수술입조솔적영향;재종평고입조후적관심병환자중수궤선택정용화지속복용아사필림환자각100례(복약조、정약조),검측、기록발아수술전후수축압、서장압화심솔적변화차치,여건강노년발아대조조환자100례비교;대영향노년관심병환자발아수술적위험인소진행다인소회귀분석. 결과 심교통환자수술전정약조193례경검사평고입조솔67.9％(131례),여술전복약조380례적평고입조솔82.1％(312례)비교,차이유통계학의의(x2 =14.77,P＜0.01);관상동맥중건환자수술전정약조48례검사평고실시수술입조솔41.7％(20례),여술전복약조305례적평고입조솔80.7％(246례)비교,차이유통계학의의(x2=33.95,P＜0.01);발아술전정약조수술중화술전적수축압변화차치(15.9±5.5)mmHg(1 mmHg=0.133kPa)여대조조차치(12.2±4.7)mmHg비교,차이유통계학의의(P＜0.05),복약조차치(13.6±4.5)여대조조차치비교,차이무통계학의의(P＞0.05);정약조여복약조수술기간서장압、심솔적변화차치여대조조차치비교차이무통계학의의(균P＞0.05);복약조발아창출혈복진솔여대조조차이무통계학의의(P＞0.05);노년관심병환자발아위험인소중술전정용아사필림위제2위. 결론 대노년관심병환자실시발아수술,불응정용아사필림.
Objective To investigate the influence of perioperative continuing aspirin therapy on tooth extraction surgery in elderly patients with coronary heart disease.Methods A total of 926 patients with coronary heart disease who required tooth extraction were enrolled in this study.Among them,241 patients discontinued aspirin therapy before tooth extraction,685 patients continued aspirin therapy before tooth extraction.The entering rate of operation was evaluated.100 patients continuing aspirin and 100 patients discontinuing aspirin were randomly selected.Systemic pressure,diastolic pressure and heart rate before and after tooth extraction were detected.100 matched healthy elderly patients were selected as normal control group.Multivariate logistic regression analysis was used to estimate the risk for tooth extraction.Results The entering rate of operation was 67.9％ (131 cases) in 193 patients with angina pectoris discontinuing aspirin therapy and 82.1 ％ (312 cases) in 380 patients with angina pectoris continuing aspirin therapy (x2 =14.77,P＜0.01).The entering rate of operation was 41.7％ (20 cases) in 48 patients undergoing coronary revascularization and discontinuing aspirin therapy,and 80.7％ (312 cases) in 305 patients undergoing coronary revascularization and continuing aspirin therapy (x2=33.95,P＜0.01).The changes in systolic blood pressure before versus after dental extraction had a significant difference between the discontinuing aspirin group and control group [(15.9±5.5) mmHg vs.(12.2±4.7)mmHg,P＜0.05,1 mmHg=0.133 kPa],while had no significant difference between the continuing aspirin group and control group [(13.6±4.5) mmHg vs.(12.2±4.7) mmHg,P＞0.05].There were no significant differences in changes in diastolic blood pressure and heart rate in the intraoperative period between the patients and controls (P＞0.05).The bleeding rate in patients continuing aspirin therapy was not significantly different as compared with control group (P＞ 0.05).Multivariate logistic regression analysis revealed that perioperative discontinuing aspirin therapy remained the second significant risk factor for tooth extraction.Conclusions Preoperative administration of aspirin should be continued in dental extraction surgery in elderly patients with coronary heart disease.