阿司匹林对不同部位牙周炎患牙拔牙创凝血影响的比较分析

Comparison and analysis on the effects of aspirin on intra-socket clotting after extractions of tooth with periodontitis at different positions

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。

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,＆amp;nbsp;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.