口服阿司匹林患者牙周机械治疗的出血控制

目的：通过对长期口服小剂量阿司匹林的慢性牙周炎伴冠心病患者不停药进行牙周机械治疗时给予相应的止血措施，探讨不停药进行牙周机械治疗的可行性。方法： 选取长期口服小剂量阿司匹林的慢性牙周炎伴冠心病患者69例作为服药组（A组）， 20例自行停用阿司匹林1周的慢性牙周炎伴冠心病患者作为停药组（B组）， 单纯慢性牙周炎患者50例为对照组（C组），对3组患者进行牙周机械治疗，术后观察牙周局部出血情况。牙周机械治疗术后30 min局部仍有活动性渗血需采取局部止血措施（牙周袋内放置氧化纤维素、纱布压迫、缝合）, 采取止血措施30 min(即术后60 min) 仍出血者使用Nd:YAG激光止血。结果： 基线时A组和B、C组的菌斑指数（plaque index，PLI）、探诊深度（probing depth，PD）、附着丧失（attachment loss，AL）比较差异均无统计学意义，而A组的出血指数（bleeding index，BI）显著高于C组（P=0.024）,也高于B组（P=0.088)。部分研究对象使用花生四烯酸（arachidonic acid，AA）法检测了血小板最大聚集率，A组血小板最大聚集率平均为15.2%，大于B组（60.7%）和C组（62.5%）。3组病例均顺利进行了牙周机械治疗，术后30 min A组有5例，B组和C组各有1例活动性渗血，采取局部止血措施，术后60 min后A组仍有1例活动性渗血，使用Nd:YAG激光彻底止血。结论： 对长期口服小剂量阿司匹林的慢性牙周炎伴冠心病患者可以进行牙周机械治疗，在不停药的前提下，局部止血效果肯定，没有出现术后出血不止等并发症。

Bleeding control of periodontal mechanical therapy for patients taking aspirin

Objective:To investigate the feasibility of periodontal mechanical therapy for chronic periodontitis and coronary heart disease patients with low dose of aspirin.Methods:Sixty nine chronic periodontitis patients with coronary heart disease were randomly selected as the experimental group (medication group,group A),the control group (withdrawal group,group B) including 20 chronic periodontitis patients with coronary artery disease,stopping the drug for one week and another control group with 50 chronic periodontitis patients (group C).The three groups were examined with pocket probing,and received supragingival scaling,subgingival scaling,and root planning.Local bleeding after operation was observed.In 30 minutes after periodontal mechanical treatment,there was still a need to take some hemostatic measures (containing the oxidized cellulose putting in the periodontal pocket,gauze oppressing,and suturing).Nd:YAG laser was used to stop bleeding 60 minutes after operation.Results:At baseline,there was no significant difference in the three groups,as to the plaque index (PLI),the probing depth (PD),and the attachment loss (AL).The bleeding index (BI)in group A was significantly higher than that in group C (P =0.024),higher than that in group B (P =0.088).The platelet maximum aggregation rate (Aggmax) was detected in some subjects.The average Aggmax value group A was 15.2％,which was much greater than that in group B (60.7％) and group C (62.5 ％).The three groups were all safe in the treatment of periodontal therapy.There were five cases of active bleeding in group A,one case in group B and one case in group C in 30 minutes after operation.In 60 minutes after operation,there was one case of bleeding actively in group A.Nd:YAG laser was used to stop bleeding successfully.Conclusion:The chronic periodontitis and coronary heart disease patients with long-term oral administration of low dose of aspirin can be safely treated with periodontal mechanical treatment,and the effect of local hemostasis is positive without stopping the drug.