冠状动脉移植术和介入术后患者监护拔牙的临床观察

Clinical observation on the tooth extraction under ECG monitoring in the patients after the operation of coronary artery bypass grafting or percataneous coronary intervention

目的探讨对经冠脉血管重建(CABG)与冠脉介入术(PCI)患者安全实施拔牙手术的途径和方法。方法设定2病种在牙科手术和围手术期的安全基线,确定可施行手术观察组的入组条件。对每一拔牙手术需求患者进行术前评估,对其中较重病种给予药物治疗干预,根据评估的结果决定是否入组进行监护手术,依据各病种病情特点确定术后观察和随访原则。结果 CABG患者44例次,评估后符合入组条件41例次,安全施行拔牙手术39例次,占入组患者95.12%;PCI患者267例次,79例做安放支架前患心肌梗死,评估入组患者245例次,安全实施手术240例次,占入组患者97.95%。结论本研究制定的方法和路径对CABG和PCI患者实施拔牙手术安全可靠。

Objective To explore the way and safety of tooth extraction under ECG monitoring in the patients after the operation of coronary artery bypass grafting（CABG） or percataneous coronary intervention（PCI）. Methods The safe basdine in dental operation and at perioperative period for two kinds of diseases was set, and the condition of enrolling into operation observation group was determined. The preoperative evaluation for every patient who needed tooth extraction operation was carried out, furthermore, the medication intervention was given to the more severe cases, then, according to the evaluation results, the patients were decided whether they could be enrolled into the group to be performed for the monitoring operation, and according to the characteristics of pathogenetic condition in different diseases, the principles of postoperative observation and follow-up were decided. Results CABG was performed in 44 patients,in whom 41 patients met the condition of enrolling into the operation observation group after they were evaluated, among them 39 patients were performed for safe tooth extraction operation, which accounted for 95.12%. There were 267 patients who underwent PCI, of whom 79 patients suffered from myocardial infarction before placing stents. 245 patients were enrolled into the observation group after they wee evaluated, of whom 240 were operated safely, which accounted for 97.95 % of the patients in the observation group. Conclusion The method and pathway established by this investigation is safe and reliable for the patients who need to undergo tooth extraction after CABG or PCI.