下颌第三磨牙拔除时下牙槽动脉出血的风险评估及急救处理

Risk assessment and first aid treatment for bleeding of inferior alveolar artery during extraction of mandibular third molar

目的通过术前曲面体层片检查，评估下颌第三磨牙拔除术中发生下牙槽动脉出血的几率，概述出血发生时的急救处理。方法收集330例术前行曲面体层片检查的下颌阻生第三磨牙拔除患者，通过曲面体层片分析牙根与下颌管的位置关系，以下颌管为参照，将阻生牙分为4类，统计各类术中发生下牙槽动脉出血的例数，应用SPSS20．0软件包对数据进行X2检验，分析易导致下牙槽动脉出血的阻生类型。结果共有20例发生下牙槽动脉出血，发生率为6．1％，第1类5例发生下牙槽动脉出血（5／167，3．0％），第Ⅱ类6例发生下牙槽动脉出血（6／105，5．7％），第Ⅲ类9例发生下牙槽动脉出血（9／54，16．7％），第Ⅰ类和第Ⅱ类下牙槽动脉出血的发生率显著低于第Ⅲ类。第Ⅳ类未发生下牙槽动脉出血（0／4）。经统计学分析，第1类和第Ⅲ类，第Ⅱ类和第Ⅲ类智齿拔除术中下牙槽动脉出血的发生率差异有统计学意义（P〈O．05），而第Ⅰ类和第Ⅱ类智齿拔除术中下牙槽动脉出血的发生率差异无统计学意义（P〉0．05）。结论下颌阻生第三磨牙拔除术前曲面体层片显示根尖距下颌管距离越近，拔除术中发生下牙槽动脉出血的机率越大。术前应仔细分析曲面体层片，术中做好应对准备，发生出血时应采取有效措施立即止血。

Obsjective To assess the risk of and first aid treatment for bleeding of inferior alveolar artery during extraction ofmandibular third molar surgery through panoramic radiographic findings,and summarize bleeding. Methods Three hundred and thirty cases with impacted mandibular third molars underwent pantomography to analyze the relationship between tooth root and the inferior alveolar canal （IAC）. The cases were divided into4 types using the IAC as a reference and the bleeding cases were recorded during the third molar surgry. Results Out of the 330 cases 20 suffered from bleeding of inferior alveolar artery during surgery （20/330, 6.1% ）. The bleeding rate of the type 1 group was 3.0% （5/167） and the bleedinbg rate of the type 2 group was 5.7% （6/105）, both significantly lower than that of the type 3 group ,and 9 cases in the group of type 3 （9/54）.No bleeding cases was found in the group of type 4.Statiscal analysis showed there was significant differenc between type 1 and type 3 and type 2 and type 3（X2 test, （P 〈0.05）;and there was no significant difference between the first group and the second group（X2 test, （P〉0.05）.Conclusion At panoramic radiograph,the nearer the tooth root of mandibular third molars is to the IAC,the more easily inferior alveolar artery bleed during mandibular third molar surgery.It is important to analyse the adiographic signs of patients with impacted mandibular third molars before extraction and take preparation for bleeding of of inferior alveolar artery during mandibular third molar surgery.