阿司匹林对牙周炎患牙拔牙创凝血的影响

Aspirin and Bleeding Risk in Exodontia in Severe Periodontitis Patients

目的：评估牙周炎患牙拔除前不停用阿司匹林的可行性，合理的停药时间及相应止血措施。方法：选取90例接受单颗上颌重度牙周炎患牙拔除且平日常规服阿司匹林患者（100mg／d），分为服药组（A组）、停药3d组（B组）、停药5d组（C组）：每组30例包含前牙、前磨牙、磨牙病例各10例。术后根据创面凝血情况选择相应止血措施；并依照拔牙创凝血分级表（I、Ⅱ级为凝血正常；Ⅲ～V级为出血量较多且依次增加）进行病例评价和比较。结果：①3组均未出现V级病例。②在A、B、C组中：前牙拔除后，Ⅲ级病例的比例分别为20％、10％、O％，IV级病例的比例分别为10％、0％、0％，3组间凝血差异无统计学意义（P=0．198）；前磨牙拔除后，Ⅲ级病例的比例分别为10％、10％、10％，IV级占比例分别为40％、10％、0％，组间差异有统计学意义（P=0．041）；磨牙拔除后，Ⅲ级病例的比例分别为10％、20％、10％，IV级病例的比例分别为50％、20％、0％，组间差异有统计学意义（P=0．016）。③对Ⅲ级病例延长纱布压迫时间。对Ⅳ级病例采用明胶海绵填塞并缝合创面后。取得理想止血效果。结论：对服用阿司匹林者（100mg／d）实施单颗上颌重度牙周炎患牙拔除，术前不停药虽可行．但术后出血较多，需采用明胶海绵填塞并缝合创面。前牙病例可停药3d，前磨牙、磨牙病例需停药5d，术后纱布压迫时间不少于60min。

Objective： To evaluate the effect of aspirin （ASA） on bleeding risk in exodontias as well as the relevant post- extraction hemostatic measures. Methods： 90 ASA users （100mg/d） requiring an extraction ofa maxillary tooth with serious periodontitis were enrolled and divided into 3 groups. Group A was ASA continuation group, group B was ASA 3 days withdrawal group, and group C was ASA 5 days withdrawal group. Each group was comprised 30 cases including 10 anterior teeth, 10 premolars and 10 molars. Postoperative hemostatic measures were applied according to the conditions of intra-socket clotting. Evaluation on coagulation was carried out according to the classification table （ I , Ⅱ ： normal intra- clotting, Ⅲ- V： abnormal clotting with successive rising bleeding amount）. Results： ① Class V cases did not appear in 3 groups. ② In group A, B and C, after extractions of an anterior tooth, the class Ⅲ case was 20%, 10% and 0%, while the class Ⅳ case was 10%, 0% and 0%, respectively, without any statistical significance （P=0.198）. After extractions of a premolar, the class Ⅲ case was all 10%, and the class IV case was 40%, 10% and 0% respectively, with statistically significant （P=0.041）. After extractions of an molar, the class Ⅲ case was 10% ,20% and 10%, while the class Ⅳ case was 50%, 20% and 0% respectively, the intergroup difference was statistically significant （P=0.016）. ③ For cases of class Ⅲ, the time of postoperative gauze pressure was prolonged, for cases of class IV, packing of absorbable sponge and suture were implemented. All the above measures achieved ideal hemostatic results. Conclusion： Before the extraction of a maxillary tooth with serious periodontitis as an ASA user, following should be paid attention： ① Preoperative ASA continuation is practicable, but may lead to rising bleeding amount of socket postoperatively, so packing of absorbable sponge and suture should be implemented. ② The feasible time of pre-extraction ASA suspension is 3 days for cases scheduled for an anterior tooth extraction as well as 5 days for cases scheduled for a premolar or a molar extraction. Additionally, gauze pressure on the surgical site should be no less than 60 minutes.