人工心脏瓣膜置换术患者牙拔除术的临床研究

Clinical study of teeth extraction in patients with anticoagulation therapy following mechanical heart valve replacement

目的观察116例(170颗牙齿)心脏瓣膜置换术后长期口服华法令的患者,在暂停抗凝药物与不停抗凝药物两种情况下,拔牙术中、术后的出血情况,探讨对该类患者安全的拔牙方法。方法对116例瓣膜置换术后口服华法令抗凝治疗的患者进行拔牙手术,根据患者有无华法令的停药史,分为停药组49例(68颗),非停药组67例(102颗)。停药组术前停药3天,术后次日恢复用药,共拔除牙齿68颗;非停药组在不中止、不减量抗凝剂的情况下进行牙齿拔除术,术后常规拔牙创牙龈缝合,共拔除牙齿102颗。结果停药组44例患者共计61颗牙齿,非停药组61例患者共计93颗牙齿,术后均无明显出血,效果良好。停药组5例7颗牙齿、非停药组6例9颗牙齿,术后出血经局部再处理后,均达到良好止血效果。停药组与非停药组术后出血率无显著性差异。结论大多数长期口服华法令的患者拔牙时可不停药、不减量,均可获得良好效果。

Objective To investigate the safety of tooth extraction in patients following heart valve replacement with long-term administration of anticoagulant warfarin.Methods A total of 116 heart valve replacement patients were divided in two groups： warfarin discontinuation group （49 cases,68 teeth） and warfarin group（ 67 cases,102 teeth）.In warfarin discontinuation group,patients stopped anticoagulation therapy 3 days before operation and resumed the therapy the next day after teeth extraction.In warfarin group,patients continued anticoagulation medication without dose adjustment.Results Seven extraction wounds in discontinued warfarin group and 9 in warfarin group showed postoperative hemorrhage and were treated by secondary local hemostasis.The other extraction wounds showed no problems in blood coagulation.There was no significant difference in hemorrhage rates between the two groups.Conclusion Tooth extraction in warfarin-taking patients is safe.