[出血性疾病患者的拔牙。基于所用麻醉类型的方案建议]
[Dental extraction in patients with bleeding disorders. Proposal of a protocol based on the type of anesthesia used].
作者信息
Piot B, Sigaud-Fiks M, Huet P, Fressinaud E, Trossaërt M, Mercier J
机构信息
Clinique de Stomatologie et Chirurgie Maxillo-faciale, Centre Hospitalier Régional et Universitaire de Nantes, 44093 Nantes Cedex 01.
出版信息
Rev Stomatol Chir Maxillofac. 2003 Apr;104(2):73-6.
INTRODUCTION
The authors propose a protocol to avoid bleeding complications in patients with bleeding disorders.
MATERIAL AND METHOD
When a general anesthesia or trunk nerve infiltration is indicated, clotting factor concentrates are to be used in patients with severe bleeding disorders. Desmopressin is to be used in patients with mild bleeding disorders but who are good responders and in patients with thrombopathy. An antifibrinolytic treatment and a fibrin glue are also used. Ninety-six patients underwent 107 extractions with this protocol.
RESULTS
Only two patients had bleeding complications requiring an additional treatment.
DISCUSSION
In case of bleeding disorders, the treatment depends on disease severity and type of anesthesia. A general treatment (clotting factor concentrates or desmopressin) is indicated with general anesthesia and with local anesthesia in severe bleeding disorders, but not absolutely necessary with local anesthesia in mild bleeding disorders. However, desmopressin can used in all good responders.
引言
作者提出了一种避免出血性疾病患者出血并发症的方案。
材料与方法
当需要全身麻醉或躯干神经浸润时，重度出血性疾病患者应使用凝血因子浓缩物。去氨加压素应用于轻度出血性疾病但反应良好的患者以及血小板病患者。同时也使用抗纤溶治疗和纤维蛋白胶。96例患者按照该方案接受了107次拔牙手术。
结果
仅有2例患者出现出血并发症，需要额外治疗。
讨论
对于出血性疾病，治疗取决于疾病严重程度和麻醉类型。全身麻醉以及重度出血性疾病患者进行局部麻醉时，需要进行常规治疗（凝血因子浓缩物或去氨加压素），但轻度出血性疾病患者进行局部麻醉时并非绝对必要。然而，去氨加压素可用于所有反应良好的患者。
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