右下第一與第二大臼齒間牙齦異常出血之急症處理：病例報告

異常出血是牙科門診最常見的急症之一，本篇將討論患者的術前評估、出血風險因子、抗凝血藥物治療注意事項、面對異常出血時之處理原則、及常用的止血措施。本文報告一位74歲女性，經牙齦切除術後，因不明原因導致血流如注，由診所轉診至仁愛醫院急診。經口內檢查，出血點位於右下第一與第二大臼齒間的頰側牙齦，在移除肉芽組織後發現小動脈斷口，初步診斷為小動脈破裂出血。使用常規止血措施無法順利止血，並因傷口解剖位置無法做縫合關閉，最後合併使用Surgicel®與Tranexamic acid，牙齦外上側使用骨蠟填滿並穩固加壓。術後一天無繼發性出血。一週後回診，傷口癒合狀況良好，遂轉至牙周科作後續治療與追蹤。

關鍵字

牙齦異常出血；動脈出血；急症處理

並列摘要

Oral bleeding is one of the most common causes of dental emergencies. This article will discuss preoperative assessment of patients, bleeding risk factors, precautions for patients under anticoagulation therapy, management of bleeding disorders, and common hemostasis interventions. The study reported a 74-year-old female who was referred from a local clinic to the Emergency Department of Renai Hospital due to the unknown reasons of abnormal bleeding from lower right site after gingivectomy procedure. An active bleeding point was noted over the buccal gingival area between the lower right first and second molars. It showed a small artery rupture after removal of granulation tissue. The small artery hemorrhage was difficult to be controlled by regular hemostasis interventions. Moreover, primary closure by suture cannot be performed because of the limitation of anatomical structure and location. Finally, it was successfully managed with placement of Surgicel® combined with tranexamic acid paste, then compression with bone wax on the upper side of the gingiva. Post-operation day 1, no secondary bleeding was noted. One week for wound recall, the wound healing was well and the patient was referred to a periodontal specialist for further treatment and follow-up.

並列關鍵字

gingival bleeding disorders ； vascular hemorrhage ； emergency treatment

國際替代計量

右下第一與第二大臼齒間牙齦異常出血之急症處理：病例報告

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