本文選題：阿司匹林　切入點：牙齦出血　出處：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:本研究采用病例-對照方法,通過問卷調(diào)查、口腔�？茩z查及實驗室檢驗,探究患者出現(xiàn)牙齦出血癥狀和長期應(yīng)用抗凝類藥物的互相聯(lián)系,從而為牙齦出血癥狀的治療和預(yù)防提供理論依據(jù)。方法:采取病例—對照研究方法。(1)病例組:選取32例行冠狀動脈造影及介入治療手術(shù),術(shù)后聯(lián)合應(yīng)用阿司匹林和氯毗格雷(替格瑞洛)半年以上,同時主訴牙齦出血且牙齦探診出血(BOP)率大于50%的患者(男性28例,女性4例);(2)對照組:選取同等數(shù)量行冠脈支架手術(shù),術(shù)后聯(lián)合應(yīng)用阿司匹林和氯吡格雷(替格瑞洛)半年以上無牙齦出血癥狀患者,并且探診出血率小于25%(男性23例,女性9例)。對兩組患者進行問卷調(diào)查和口腔�？茩z查,調(diào)取凝血功能指標和血小板凝集功能結(jié)果,記錄所有數(shù)據(jù),然后運用SPSS17.0統(tǒng)計軟件進行分析。結(jié)果:通過均衡性檢驗,所選取的兩組患者調(diào)查數(shù)據(jù)具有良好的對比性。兩組患者口腔�？茩z查結(jié)果比較,口腔衛(wèi)生指數(shù)方面,牙齦指數(shù)有明顯的差異(P0.01),菌斑指數(shù)和齦溝出血指數(shù)有一定差別(0.01P0.05),牙石指數(shù)和軟垢指數(shù)兩組雖有不同,無統(tǒng)計學(xué)意義;牙周健康狀態(tài)包括牙齦退縮、牙齒松動、牙齒喪失、附著喪失以及牙周袋的探診深度,兩組比較均有統(tǒng)計學(xué)差異(P0.05)。牙周病危險因素比較分析,吸煙(OR=4.879,95%CI=1.406～1.657),高血壓病史(OR=6.176,95%CI=1.183～1.142)和潔牙意識(OR=0.358,95%CI=1.405～1.656)有統(tǒng)計學(xué)差異(P0.05),刷牙頻次和時長有差別,但無統(tǒng)計學(xué)意義。調(diào)取實驗室檢查數(shù)據(jù),進行分析,術(shù)前凝血功能指標中部分活化凝血酶原時間(APTT)有統(tǒng)計學(xué)差異(P0.05);術(shù)后血小板凝集狀態(tài)分析,以二磷酸腺苷(ADP)為誘聚劑測得的血小板平均聚集率(AAR)和血小板最大聚集率(MAR)有統(tǒng)計學(xué)差異(P0.05)。結(jié)論:患者本身牙周狀態(tài)不佳或患有牙周組織疾病且未經(jīng)過正規(guī)治療,同時長期服用抗凝類藥物,表現(xiàn)牙齦出血癥狀特別是刷牙出血,甚至是自發(fā)性出血;牙周狀態(tài)健康的患者長期正規(guī)應(yīng)用抗凝藥物未出現(xiàn)明顯的牙齦出血癥狀;具有良好的刷牙習(xí)慣和口腔保健意識,堅持每隔1～2年進行一次潔牙的患者,牙齦出血癥狀明顯減少;針對牙齦出血癥狀的治療方法究其本源是對牙周疾病的治療,控制牙周組織炎癥,同時患者做好自身的清潔維護,緩解牙齦出血癥狀,控制牙周組織疾病。調(diào)查研究發(fā)現(xiàn),冠心病患者以男性居多且多伴有吸煙史,此類患者表現(xiàn)出牙槽骨明顯吸收,牙齒松動,但牙齦出血癥狀不明顯。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R781.4;R541.4
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本文編號：1676300