口腔医学
口腔醫學
구강의학
STOMATOLOGY
2015年
9期
734-738,754
,共6页
陆萌萌%庄晓华%於丽明%高益鸣
陸萌萌%莊曉華%於麗明%高益鳴
륙맹맹%장효화%어려명%고익명
阿司匹林%拔牙%牙周炎%血小板聚集率%凝血
阿司匹林%拔牙%牙週炎%血小闆聚集率%凝血
아사필림%발아%아주염%혈소판취집솔%응혈
aspirin%dental extraction%periodontitis%platelet aggregation rate%clotting
目的：探讨阿司匹林对不同部位重度牙周炎患牙拔牙创凝血影响的差异及原因。方法选取需拔除单颗重度牙周炎患牙的服药者160例（年龄50～80岁，剂量100 mg ／ d，服药时间＞2周）；包括上下颌前牙各30例，前磨牙各20例，磨牙各30例。对病例进行光学法血小板聚集率检测（LTA）后，在不停药情况下拔牙。根据拔牙创凝血分级表（Ⅰ、Ⅱ级凝血正常，Ⅲ～Ⅴ级出血依次增加）评估创面，对病例的凝血情况和正常凝血者的血小板聚集率（PAgT）进行比较，分析阿司匹林对不同部位拔牙创抗凝作用的差异及可影响该药作用的因素。结果①在上颌前牙、前磨牙、磨牙病例中，凝血正常者比例分别为43％、15％、10％，下颌该比例分别为93％、30％、20％；其中下颌中切牙、侧切牙病例凝血均正常，其余牙位病例中出现Ⅲ、Ⅳ级，Ⅴ级未见。②上颌前牙、前磨牙、磨牙凝血正常者的PAgT 分别为（14．01±1．05）％，（15．27±0．62）％，（16．83±0．57）％，三者差异有统计学意义（P ＝0．037）；下颌分别为（12．83±1．64）％，（13．92±0．87）％，（15．44±0．92）％，三者差异有统计学意义（P ＝0．041）；并且，上颌前牙、前磨牙、磨牙凝血正常者的PAgT 均高于下颌同名牙病例，差异均有统计学意义（P 分别为0．028，0．047，0．044）。③Ⅲ、Ⅳ级病例拔牙创周围颌骨及牙槽突骨质较疏松，血供丰富，牙周膜面积较大。结论①阿司匹林可对重度牙周炎患牙（除下颌中切牙、侧切牙）拔牙创产生抗凝作用。②对于上、下颌牙列，前牙、前磨牙、磨牙创面正常凝血所需的PAgT 逐渐升高，依次更易受到该药抗凝作用的影响；同时，上颌拔牙创正常凝血所需的PAgT 高于下颌同名牙，故该药对上颌创面的影响较下颌明显。③患牙周围颌骨及牙槽突的血供、牙周膜面积等因素可影响拔牙创出血量；创面出血越多，其正常凝血的PAgT 越高，阿司匹林对其抗凝作用越明显。
目的：探討阿司匹林對不同部位重度牙週炎患牙拔牙創凝血影響的差異及原因。方法選取需拔除單顆重度牙週炎患牙的服藥者160例（年齡50～80歲，劑量100 mg ／ d，服藥時間＞2週）；包括上下頜前牙各30例，前磨牙各20例，磨牙各30例。對病例進行光學法血小闆聚集率檢測（LTA）後，在不停藥情況下拔牙。根據拔牙創凝血分級錶（Ⅰ、Ⅱ級凝血正常，Ⅲ～Ⅴ級齣血依次增加）評估創麵，對病例的凝血情況和正常凝血者的血小闆聚集率（PAgT）進行比較，分析阿司匹林對不同部位拔牙創抗凝作用的差異及可影響該藥作用的因素。結果①在上頜前牙、前磨牙、磨牙病例中，凝血正常者比例分彆為43％、15％、10％，下頜該比例分彆為93％、30％、20％；其中下頜中切牙、側切牙病例凝血均正常，其餘牙位病例中齣現Ⅲ、Ⅳ級，Ⅴ級未見。②上頜前牙、前磨牙、磨牙凝血正常者的PAgT 分彆為（14．01±1．05）％，（15．27±0．62）％，（16．83±0．57）％，三者差異有統計學意義（P ＝0．037）；下頜分彆為（12．83±1．64）％，（13．92±0．87）％，（15．44±0．92）％，三者差異有統計學意義（P ＝0．041）；併且，上頜前牙、前磨牙、磨牙凝血正常者的PAgT 均高于下頜同名牙病例，差異均有統計學意義（P 分彆為0．028，0．047，0．044）。③Ⅲ、Ⅳ級病例拔牙創週圍頜骨及牙槽突骨質較疏鬆，血供豐富，牙週膜麵積較大。結論①阿司匹林可對重度牙週炎患牙（除下頜中切牙、側切牙）拔牙創產生抗凝作用。②對于上、下頜牙列，前牙、前磨牙、磨牙創麵正常凝血所需的PAgT 逐漸升高，依次更易受到該藥抗凝作用的影響；同時，上頜拔牙創正常凝血所需的PAgT 高于下頜同名牙，故該藥對上頜創麵的影響較下頜明顯。③患牙週圍頜骨及牙槽突的血供、牙週膜麵積等因素可影響拔牙創齣血量；創麵齣血越多，其正常凝血的PAgT 越高，阿司匹林對其抗凝作用越明顯。
목적：탐토아사필림대불동부위중도아주염환아발아창응혈영향적차이급원인。방법선취수발제단과중도아주염환아적복약자160례（년령50～80세，제량100 mg ／ d，복약시간＞2주）；포괄상하합전아각30례，전마아각20례，마아각30례。대병례진행광학법혈소판취집솔검측（LTA）후，재불정약정황하발아。근거발아창응혈분급표（Ⅰ、Ⅱ급응혈정상，Ⅲ～Ⅴ급출혈의차증가）평고창면，대병례적응혈정황화정상응혈자적혈소판취집솔（PAgT）진행비교，분석아사필림대불동부위발아창항응작용적차이급가영향해약작용적인소。결과①재상합전아、전마아、마아병례중，응혈정상자비례분별위43％、15％、10％，하합해비례분별위93％、30％、20％；기중하합중절아、측절아병례응혈균정상，기여아위병례중출현Ⅲ、Ⅳ급，Ⅴ급미견。②상합전아、전마아、마아응혈정상자적PAgT 분별위（14．01±1．05）％，（15．27±0．62）％，（16．83±0．57）％，삼자차이유통계학의의（P ＝0．037）；하합분별위（12．83±1．64）％，（13．92±0．87）％，（15．44±0．92）％，삼자차이유통계학의의（P ＝0．041）；병차，상합전아、전마아、마아응혈정상자적PAgT 균고우하합동명아병례，차이균유통계학의의（P 분별위0．028，0．047，0．044）。③Ⅲ、Ⅳ급병례발아창주위합골급아조돌골질교소송，혈공봉부，아주막면적교대。결론①아사필림가대중도아주염환아（제하합중절아、측절아）발아창산생항응작용。②대우상、하합아렬，전아、전마아、마아창면정상응혈소수적PAgT 축점승고，의차경역수도해약항응작용적영향；동시，상합발아창정상응혈소수적PAgT 고우하합동명아，고해약대상합창면적영향교하합명현。③환아주위합골급아조돌적혈공、아주막면적등인소가영향발아창출혈량；창면출혈월다，기정상응혈적PAgT 월고，아사필림대기항응작용월명현。
Objective To investigate the influences of aspirin on intra-socket clotting after extractions of tooth with periodontitis at different positions and to analyze the influencing factors. Methods 160 aspirin users (age:50-80 years old,course > 2 week,dosage:100 mg / d)requiring an extraction of one tooth with severe periodontitis were enrolled. The selected teeth included 60 anterior teeth,40 premolars,60 molars and each kind contained 50% maxillary and 50% madibular cases. After pre-extraction Light Transmission Aggre-gometry (LTA)by Arachidonic Acid (AA)as the inducer,extractions were carried out in all cases without preoperative aspirin suspen-sion and evaluations on clotting of all cases were performed postoperatively according to the Coagulation Classification Table (Class Ⅰand Ⅱ indicated normal clotting,Class Ⅲ ~ Ⅴ indicated successively increasing bleeding). Comparisons on post-extraction clotting of all cases and on Platelet Aggregation Rates (PAgT)of cases with normal coagulation were implemented. Furthermore,analyses to anti-platelet effects of aspirin on extraction wounds of different tooth positions and search for potential factors influencing the effect of aspirin were conducted. Results (1)In anterior tooth area,premolar area and molar area,the percentage of cases showing normal clotting af-ter an extraction of one maxillary tooth was 43%,15% and 10% respectively,and that of cases after an extraction of one mandibular tooth was 93%,30% and 20% accordingly. All cases of madibular central and lateral incisors (1,2)were under Class Ⅰ and Ⅱ,ca-ses under Class Ⅲ and Ⅳ appeared after extractions of a tooth of other positions. In addition,cases under Class Ⅴ were not observed. (2)In anterior tooth area,premolar area and molar area,the PAgT of cases with normal coagulation after an extraction of one maxillary tooth was (14. 01 ± 1. 05)%,(15. 27 ± 0. 62)%,(16. 83 ± 0. 57)% with statistical difference (P = 0. 037)and that of cases after an extraction of one madibular tooth was (12. 83 ± 1. 64)%,(13. 92 ± 0. 87)%,(15. 44 ± 0. 92)% with statistical difference (P =0. 041 ). Additionally,the PAgTs of normal clotting cases after extractions of an anterior tooth,a premolar and a molar at maxillary dentition were higher than those for normal coagulation after extrac-tions of a mandibular tooth at corresponding position (P = 0. 028, 0. 047,0. 044 respectively). (3)In cases under Class Ⅲ and Ⅳ, the sclerotin of jaw bones and processus alveolaries adjacent to the sockets was loose with rich blood supply,and the areas of periodon-tal ligaments around the removed teeth were relatively large. Conclusions (1)Aspirin can exert an anti-coagulation effect on an ex-traction wound after removal of one tooth with severe periodontitis (except 1,2). (2)For both maxillary and mandibular dentitions,the PAgT required for normal clotting after extraction of an anterior tooth,a premolar and a molar rises successively,so the susceptibility to aspirin effect of extraction site of an anterior tooth,a premolar and a molar increases accordingly. The PAgTs for normal clotting after ex-tractions of a maxillary tooth are higher than those for extractions of a mandibular tooth at corresponding position,so aspirin can lead to more influence on normal coagulation after removal of a maxillary tooth than that after extraction of a mandibular tooth. (3)The blood supply to jaw bones and processus alveolaries around the sockets,the areas of periodontal ligaments around extracted teeth can affect the post-extraction bleeding amount. Since extraction wounds with more bleeding require higher PAgT to achieve normal coagulation,the an-ti-platelet effects of aspirin on the surgical sites become more obvious.
