心臟外科手術前後牙科照護的考量－文獻回顧

Perioperative Dental Considerations for Cardiac Surgery

陳怡伶(I-Ling Chen) ； 雷文天(Man-Tin Lui) ； 高壽延(Shou-Yen Kao) ； 陳雅薇(Ya-Wei Chen)

《臺灣口腔顎面外科學會雜誌》 25卷4期 (2014/12) Pp. 240-249

摘要

臨床上牙科醫師常常會遇到心臟外科的會診，和那些曾接受心臟手術之病患求診。本文將以牙醫師觀點，探討這類患者牙科照護的考量，包括心臟手術前牙科會診的必要性及治療重點，我們將提出兩個論點並加以討論：（一）假使病患術前沒有進行牙科治療，會引起嚴重的手術後併發症嗎（如心內膜炎）？假使需要治療，應該要治療到多徹底？（二）術前的牙科治療需要提早多久完成？如果牙科治療與心臟外科手術之間隔不夠久，是否反而增加菌血症的發生。另外，我們也回顧這些曾接受心臟手術之病患，術後至牙科求診時所應該考慮的三個面向：（一）心臟功能；（二）心內膜炎的風險；（三）可能服用抗血栓藥物。

關鍵字

心臟手術 ； 心臟瓣膜手術 ； 牙科治療 ； 抗血栓藥物 ； 心內膜炎

並列摘要

As dentists in hospital, we are often consulted by cardiovascular surgeons for preoperative dental survey. Patients who have received cardiac surgery also present to us for dental treatment. This article is a review regarding peri operative dental considerations for cardiac surgery from dentists' perspective, which include the necessity to do dental treatment before cardiac surgery and the weight-bearing points of dental treatment. We propose two points of questions in order to elaborate: (1) If the patients don't receive preoperative dental survey and treatment, will they be subject to serious postoperative complications (such as endocarditis)? (2) If preoperative dental treatment is indispensable, how extensiveness of dental treatment should be done? Besides, we also give a review for three considerations in patients who have received cardiac surgery seek for dental treatment: (1) Assessment of cardiac function, (2) evaluate the risk of infective endocarditis, (3)adjust or hold antithrombotic agents.

並列關鍵字

cardiac surgery ； cardiac valve surgery ； dental treatment ； antithrombotic agents ； infective endocarditis