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題 名 | 牙齦異常出血與第七凝血因子缺乏--病例報告=Gingival Bleeding Disorders and Coagulation Factor VII Deficiency: Case Report |
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作 者 | 張佑琪; 陳宛君; 林益弘; 盧俊泰; | 書刊名 | 臺灣牙周病醫學會雜誌 |
卷 期 | 15:3 2010.09[民99.09] |
頁 次 | 頁203-213 |
分類號 | 416.946 |
關鍵詞 | 第七凝血因子; 牙齦異常出血; Coagulation factor VII; Gingival bleeding disorders; |
語 文 | 中文(Chinese) |
中文摘要 | 第七凝血因子缺乏(Factor Ⅶ)會造成牙齦異常出血或流血不止。本病例為一位54歲女性,於2008年10月11日主訴因右下後方牙齦出血不止至本院急診部求診。詢問過去病史,患者無服用抗凝血劑或其它藥物的病史,近期也無接受任何牙科治療。口內檢查,牙齦多處紅腫發炎,並有流血不止的情形。安排患者抽血檢查,核查結果顯示凝血酶時間PT=20.0秒(正常值9.4~11.5秒),因而懷疑患者凝血功能異常而導致牙齦流血不止。會診血液腫瘤科醫師,進一步抽血檢查發現,Factor Ⅶ activity數值爲9.8%,較正常值(>65%)低很多,最後診斷爲第七凝血因子缺乏。安排患者接受口腔衛教,並且分次、分象限去除牙結石以控制牙齦發炎,也建議患者把嚴重的齲齒26、36、48拔除。在拔牙當天患者先至血液腫瘤科注射recombinant coagulation factor Ⅶa (rFⅦa)後,再將26、36、48拔除,拔除後並無出血不止情形。牙齦異常出血常跟凝血因子功能異常有闕,因此,如果患者有牙齦出血,在施行牙科治療前,務必詳問病史,必要時安排抽血檢查以幫助診斷,再會診血液腫瘤科醫師,以解決病人牙齦異常出血問題。 |
英文摘要 | A lack of coagulation factor VII leads to abnormal gingival bleeding. We report a 54-year-old lady who visited our Emergent Department because of continuous gingival bleeding in the right posterior quadrant on October 11, 2008. She did not have ally dental treatment or take any drug at that time. The dental check revealed gingivitis with bleeding. Tile prothrombin time (PT) was 20.0 seconds and exceeded the normal range of PT (9.4-11.5 seconds) in our hospital. We consulted the hematologist for detailed evaluation. The final diagnosis was deficiency of coagulation factor Ⅶ. The activity of her factor Ⅶ was 9.8% and fell far below the normal range (65%). The patient accepted oral hygiene instruction first. We then removed the dental plaque to control the gingivitis and extracted those extensively decayed teeth 26.36,48. She had an injection of factor Ⅶ in the Hematology Department before extraction. She did not have intractable bleeding after these dental procedures. Abnormal gingival bleeding is often related to various clotting disorders. In dealing with patients of bleeding gums, we have to carefully inquire the medical history and order the clotting tests whenever indicated. The hematologist can be of help in management of patients with abnormal gingival bleeding. |
本系統中英文摘要資訊取自各篇刊載內容。