Naylor G D, Fredericks M R
Oral Diagnosis Department, Naval Dental Center, San Diego, California, USA.
Dent Clin North Am. 1996 Jul;40(3):665-83.
As reviewed in this article, the patient with ESRD presents a number of unique management challenges. A rapidly increasing number of patients are receiving renal transplants and undergoing dialysis, making it necessary for the dental practitioner to have a thorough understanding of the special treatment considerations that arise. Conservative medical management is designed to slow the progression of the disease and ameliorate the clinical consequences. Dialysis and transplantation provide renal replacement to sustain life and allow for the medical and social rehabilitation of the patient. When considering transplantation, oral examination is an essential part of the preoperative evaluation. Elimination of pathologic entities and restoring patient function are essential before the transplant and the immunosuppressive drug regimen. Any oral symptom or sign of infection must be examined immediately and treated aggressively in an immunosuppressed transplant recipient. Patients receiving hemodialysis and those with transplants should be considered for antimicrobial prophylaxis before dental treatment that induces bleeding to protect the function and patency of the vascular access site and the transplant. Drug therapy may need to be adjusted, depending on the degree of chronic renal failure, the patient's dialysis schedule, or the presence of a transplant. Therefore, the dentist must be familiar with the complexity of this interesting patient population and pay particular attention when prescribing and using various medications.
如本文所述，终末期肾病患者面临一些独特的管理挑战。越来越多的患者正在接受肾移植和透析治疗，这使得牙科医生有必要全面了解由此产生的特殊治疗注意事项。保守治疗旨在减缓疾病进展并改善临床后果。透析和移植提供肾脏替代以维持生命，并使患者能够进行医疗和社会康复。考虑进行移植时，口腔检查是术前评估的重要组成部分。在移植和免疫抑制药物治疗方案之前，消除病理实体并恢复患者功能至关重要。对于免疫抑制的移植受者，任何口腔症状或感染迹象都必须立即检查并积极治疗。接受血液透析的患者和移植患者在进行导致出血的牙科治疗前应考虑进行抗菌预防，以保护血管通路部位和移植的功能及通畅性。药物治疗可能需要根据慢性肾衰竭的程度、患者的透析时间表或是否存在移植进行调整。因此，牙医必须熟悉这一特殊患者群体的复杂性，并在开处方和使用各种药物时格外注意。
