服用阿司匹林患者血小板聚集率与上颌牙周炎患牙拔牙创凝血的关系

上海口腔医学 ›› 2014, Vol. 23 ›› Issue (3): 328-332.

服用阿司匹林患者血小板聚集率与上颌牙周炎患牙拔牙创凝血的关系

陆萌萌¹, 庄晓华², 高益鸣³

1.上海市口腔病防治院口腔外科,上海 200001;2.上海市浦东新区公利医院口腔科,上海 200135;3.上海交通大学附属瑞金医院口腔科,上海 200025

收稿日期:2013-07-26 出版日期:2014-06-20 发布日期:2014-09-09
通讯作者: 陆萌萌,E-mail:lumengmeng428@126.com
作者简介:陆萌萌, (1981-), 男, 硕士, 主治医师
基金资助:
上海市卫生局青年科研基金(20124Y059)

Correlation between platelet aggregation rates of aspirin users and intra-socket clotting after extraction of a maxillary tooth with periodontitis

LU Meng-meng¹, ZHUANG Xiao-hua², GAO Yi-ming³

1.Department of Oral Surgery, Shanghai Stomatology Disease Centre. Shanghai 200001;
2. Department of Stomatology, Gongli Hospital of Pudong New District. Shanghai 200135;
3. Department of Stomatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University. Shanghai 200025, China

Received:2013-07-26 Online:2014-06-20 Published:2014-09-09
Supported by:
Supported by Youth Science and Technology Fund of Bureau of Health of Shanghai Municipality(20124Y059).

摘要/Abstract

摘要： 目的:探讨服用阿司匹林者在上颌牙周炎患牙拔除后正常凝血所需的血小板聚集率(PAgT)水平和术前合理的停药天数。方法:选取90例接受单颗上颌重度牙周炎患牙拔除的服药者(100 mg/d),分为前牙组(A组)、前磨牙组(B组)和磨牙组(C组),每组30例,包括术前不停药、停药3d 和5d者各10例。对其行以花生四烯酸(AA)为诱导剂的光学法血小板聚集率检测(LTA)后实施拔牙,根据拔牙创凝血分级表(Ⅰ级为正常,Ⅱ、Ⅲ级出血量依次增加)评估病例,分析术前不停药、不同停药时间对创面凝血的影响,采用受试者工作特征曲线(ROC curve,SPSS11.6)探讨使用PAgT(AA诱导值)预判术后正常凝血的最佳诊断界值。结果:①Ⅱ级病例在A组中为3例不停药和1例停药3d者,在B组中为5例不停药、2例停药3d和1例停药5d者,在C组中为6例不停药、4例停药3d和1例停药5 d者;3组其余病例为Ⅰ级。②A、B、C组AA诱导值最佳诊断界值分别为10.15%、13.25%和16.5%。结论:服用阿司匹林的患者(100 mg/d)在拔除单颗上颌前牙、前磨牙、磨牙重度牙周炎患牙前经LTA-AA检测,如PAgT≥10.15%、13.25%和16.5%,可预计拔牙创凝血正常,术前可不停药;反之出血量增加,前牙病例可停药3 d,前磨牙、磨牙病例可停药5 d,并完善创面止血措施。

关键词: 阿司匹林, 血小板聚集率, 拔牙, 凝血, 光学法血小板聚集率检测

Abstract: PURPOSE: To explore the optimal platelet aggregation rates (PAgTs) of aspirin users, which can ensure normal intra-socket clotting after extraction of a maxillary tooth with serious periodontitis, and to determine the reasonable time of pre-extraction aspirin suspension. METHODS: Ninety aspirin users (100mg/d) requiring extraction of a maxillary tooth with serious periodontitis were enrolled and divided into anterior tooth group (group A), premolar group (group B) and molar group (group C). Each group contained 10 cases with aspirin continuation, 10 cases with aspirin withdrawal 3 days pre-extraction and 10 cases with 5-day of aspirin withdrawal. After preoperative light transmission aggregometry (LTA) using arachidonic acid (AA) as the inducer to each case, the extractions were preformed. According to the intra-socket clotting classification table (classⅠ indicated normal clotting, classⅡ—Ⅲ indicated successively increasing bleeding amount), the evaluation for each case was implemented and the analysis of the impacts caused by pre-extraction aspirin continuation and suspension on intra-socket clotting was conducted. The research on the best cut-off value of AA-induced PAgT to predict normal post-extraction clotting was also carried out by using receiver operating characteristic curve (ROC curve, SPSS11.6). RESULTS: ① There were 4 cases of ClassⅡin group A (3 without aspirin cessation and 1 with 3-day suspension), 8 in group B (5 without aspirin cessation, 2 with 3-day suspension and 1 with 5-day suspension) and 11 in group C (6 without aspirin cessation, 4 with 3-day suspension and 1 with 5-day suspension). The other cases in 3 groups were ClassⅠ. ② The best cut-off value of AA induced PAgT was 10.15%, 13.25%, 16.5% for group A, B, C, respectively. CONCLUSIONS: For aspirin users (100mg/d) who will accept extraction of a maxillary tooth with serious periodontitis, a detection of pre-extraction LTA-AA is profitable, AA induced PAgT≥10.15% for an anterior tooth extraction, PAgT≥13.25% for a premolar extraction and PAgT≥16.5% for a molar extraction indicate normal postoperative intra-socket clotting, so aspirin continuation is feasible under such conditions. Otherwise, post-extraction bleeding amount can increase and preoperative aspirin cessation should be considered. The reasonable time of aspirin suspension is 3 days for an anterior tooth extraction and 5 days for a premolar or molar extraction. Additionally, hemostatic measures on the surgical site should be strengthened.

Key words: Aspirin, Platelet aggregation rate, Extraction, Clotting, Light transmission aggregometry

中图分类号:

R782.05

陆萌萌, 庄晓华, 高益鸣. 服用阿司匹林患者血小板聚集率与上颌牙周炎患牙拔牙创凝血的关系[J]. 上海口腔医学, 2014, 23(3): 328-332.

LU Meng-meng, ZHUANG Xiao-hua, GAO Yi-ming. Correlation between platelet aggregation rates of aspirin users and intra-socket clotting after extraction of a maxillary tooth with periodontitis[J]. Shanghai Journal of Stomatology, 2014, 23(3): 328-332.

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