老年心血管疾病患者拔牙术后出血的相关因素分析

Analysis of related factors of bleeding after tooth extraction in elderly patients with cardiovascular disease

目的探讨合并心血管疾病的老年拔牙患者术后出血的危险因素。方法2020年1月—2021年6月,于上海交通大学医学院附属第九人民医院募集414例合并心血管疾病的老年拔牙患者。通过倾向评分匹配患者,根据患者术后有无出血分为出血组(n=13)和未出血组(n=52)。收集受试者的围手术期资料,通过一般健康问卷(GHQ-28)在拔牙时对患者进行评估。记录患者拔牙时的舒张压、收缩压、心率、拔牙数和拔牙类型。分析受试者拔牙后出血的危险因素。结果3.14%(13/414)的合并心血管疾病的老年拔牙患者术后出血。与未出血组比较,出血组血小板计数降低,活化部分凝血活酶时间减少,GHQ-28总分、躯体症状、焦虑/失眠得分升高(P<0.05)。二分类logistic回归表明,血小板计数减少(OR=0.978,95%CI:0.960~0.996,P=0.017)和焦虑/失眠得分升高(OR=1.303,95%CI:1.024~1.659,P=0.032)是合并心血管疾病的老年拔牙患者术后出血的危险因素。结论血小板计数值低、焦虑/失眠得分高可能是老年心血管疾病拔牙患者术后出血的危险因素。

Objective To explore the risk factors of postoperative bleeding after tooth extraction in elderly patients with cardiovascular disease.Methods From January 2020 to June 2021,414 elderly tooth extraction patients with cardiovascular diseases were recruited from Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University.The patients were matched by propensity score,and were divided into bleeding group(n=13)and non-bleeding group(n=52)according to whether they had bleeding after operation.Their perioperative data were collected.The General Health Questionnaire(GHQ-28)was used to evaluate them during tooth extraction.Diastolic blood pressure,systolic blood pressure,heart rate,number of tooth extractions and type of tooth extractions were recorded.The risk factors of bleeding after tooth extraction were analyzed.Results 3.14%(13/414)of elderly tooth extraction patients with cardiovascular disease suffered from postoperative bleeding.Compared with the non-bleeding group,the platelet count and activated partial thromboplastin time of the bleeding group decreased,and the total score of GHQ-28,physical symptoms score and anxiety/insomnia score increased(P<0.05).The binary logistic regression showed that low platelet count(OR=0.978,95%CI:0.960-0.996,P=0.017)and high anxiety/insomnia scores(OR=1.303,95%CI:1.024-1.659,P=0.032)were the risk factors for postoperative bleeding in elderly patients with cardiovascular disease after tooth extraction.Conclusion Low platelet count and high score of anxiety/insomnia may be the risk factors for postoperative bleeding in elderly patients with cardiovascular disease after tooth extraction.