冠脉支架术后应用抗凝药群体牙周状态的临床调查

发布时间：2018-03-28 12:20

  本文选题：阿司匹林　切入点：牙龈出血　出处：《大连医科大学》2017年硕士论文

【摘要】：目的:本研究采用病例-对照方法,通过问卷调查、口腔专科检查及实验室检验,探究患者出现牙龈出血症状和长期应用抗凝类药物的互相联系,从而为牙龈出血症状的治疗和预防提供理论依据。方法:采取病例—对照研究方法。(1)病例组:选取32例行冠状动脉造影及介入治疗手术,术后联合应用阿司匹林和氯毗格雷(替格瑞洛)半年以上,同时主诉牙龈出血且牙龈探诊出血(BOP)率大于50%的患者(男性28例,女性4例);(2)对照组:选取同等数量行冠脉支架手术,术后联合应用阿司匹林和氯吡格雷(替格瑞洛)半年以上无牙龈出血症状患者,并且探诊出血率小于25%(男性23例,女性9例)。对两组患者进行问卷调查和口腔专科检查,调取凝血功能指标和血小板凝集功能结果,记录所有数据,然后运用SPSS17.0统计软件进行分析。结果:通过均衡性检验,所选取的两组患者调查数据具有良好的对比性。两组患者口腔专科检查结果比较,口腔卫生指数方面,牙龈指数有明显的差异(P0.01),菌斑指数和龈沟出血指数有一定差别(0.01P0.05),牙石指数和软垢指数两组虽有不同,无统计学意义;牙周健康状态包括牙龈退缩、牙齿松动、牙齿丧失、附着丧失以及牙周袋的探诊深度,两组比较均有统计学差异(P0.05)。牙周病危险因素比较分析,吸烟(OR=4.879,95%CI=1.406～1.657),高血压病史(OR=6.176,95%CI=1.183～1.142)和洁牙意识(OR=0.358,95%CI=1.405～1.656)有统计学差异(P0.05),刷牙频次和时长有差别,但无统计学意义。调取实验室检查数据,进行分析,术前凝血功能指标中部分活化凝血酶原时间(APTT)有统计学差异(P0.05);术后血小板凝集状态分析,以二磷酸腺苷(ADP)为诱聚剂测得的血小板平均聚集率(AAR)和血小板最大聚集率(MAR)有统计学差异(P0.05)。结论:患者本身牙周状态不佳或患有牙周组织疾病且未经过正规治疗,同时长期服用抗凝类药物,表现牙龈出血症状特别是刷牙出血,甚至是自发性出血;牙周状态健康的患者长期正规应用抗凝药物未出现明显的牙龈出血症状;具有良好的刷牙习惯和口腔保健意识,坚持每隔1～2年进行一次洁牙的患者,牙龈出血症状明显减少;针对牙龈出血症状的治疗方法究其本源是对牙周疾病的治疗,控制牙周组织炎症,同时患者做好自身的清洁维护,缓解牙龈出血症状,控制牙周组织疾病。调查研究发现,冠心病患者以男性居多且多伴有吸烟史,此类患者表现出牙槽骨明显吸收,牙齿松动,但牙龈出血症状不明显。
[Abstract]:Objective: to investigate the relationship between gingival bleeding symptoms and long-term use of anticoagulants in patients with gingival bleeding by using a case-control method. So as to provide theoretical basis for the treatment and prevention of gingival bleeding symptoms. Methods: a case-control study was carried out. Methods: 32 patients were treated with coronary angiography and interventional therapy. Patients who had been treated with aspirin and clopidogrel (tigrilol) for more than half a year and who complained of gingival bleeding and the rate of gingival bleeding were more than 50% (male 28 cases). Control group (4 female patients): patients with no gingival bleeding symptoms were treated with aspirin and clopidogrel (tigrilol) for more than half a year. The bleeding rate was less than 25% (male 23 cases). Nine female patients were investigated by questionnaire and stomatology examination, the results of coagulation function and platelet agglutination were collected, all the data were recorded and analyzed by SPSS17.0 software. The survey data of the two groups of patients selected have good contrast. The results of the special examinations of the two groups of patients are compared, the oral health index of the two groups are compared, There were significant differences in gingival index (P 0.01), plaque index (P 0.01) and gingival sulcus bleeding index (P 0.05). Although there were differences between the two groups, there was no significant difference between the two groups, and periodontal health status included gingival retreat, tooth loosening and tooth loss. There was statistical difference between the two groups in the depth of attachment loss and the probing depth of periodontal bag (P 0.05). The risk factors of periodontal disease were compared and analyzed. The risk factors of periodontal disease were compared. The risk factors of periodontal disease were compared. The risk factors of periodontal disease were compared. There were significant differences in the frequency of brushing teeth and the length of time, the history of hypertension was 6.176 ~ 95CII 1.183 ~ 1.142), and the periodontal consciousness was 0.35895CI1 / 1.4051.656), the frequency of brushing teeth was different from that of time. However, there was no statistical significance. The data of laboratory examination were collected and analyzed. There was a significant difference in activated prothrombin time (APTT) among the indexes of coagulation function before operation (P 0.05), and the state of platelet agglutination was analyzed after operation. The average platelet aggregation rate (AARR) and the maximum platelet aggregation rate (Mar) measured by ADP were significantly different (P 0.05). Conclusion: the patients have poor periodontal status or periodontal tissue disease without regular treatment. At the same time, long-term use of anticoagulant drugs to show gingival bleeding symptoms, especially brushing bleeding, even spontaneous bleeding, periodontal health patients with long-term regular use of anticoagulant drugs did not appear obvious gingival bleeding symptoms; The patients with good habit of brushing teeth and oral health care, who insist on cleaning their teeth every 1 ~ 2 years, have obviously reduced the symptoms of gingival bleeding, and the root cause of the treatment of gingival bleeding symptoms is the treatment of periodontal diseases. To control periodontal inflammation, at the same time patients do their own cleaning and maintenance, relieve the symptoms of gingival bleeding, and control periodontal tissue disease. These patients showed obvious alveolar bone absorption, tooth loosening, but no significant gingival bleeding symptoms.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R781.4;R541.4
，

本文编号：1676300