妊娠期口腔急症的临床考量

doi:10.7518/hxkq.2024.2023367

华西口腔医学杂志 ›› 2024, Vol. 42 ›› Issue (2): 142-153.doi: 10.7518/hxkq.2024.2023367

妊娠期口腔急症的临床考量

张雪峰, 刘显, 刘畅, 华成舸()

口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院，成都 610041

收稿日期:2023-11-02 修回日期:2024-02-06 出版日期:2024-04-01 发布日期:2024-03-26
通讯作者: 华成舸 E-mail:huacg@163.com
作者简介:张雪峰，主治医师，博士，E-mail：zhangxuefeng1990@scu.edu.cn|华成舸，口腔医学博士，现为四川大学华西口腔医学院硕士研究生导师，华西口腔医院主任医师、一级专家、口腔全科主任、循证口腔医学教研室主任。1993年毕业于华西医科大学，留校从事口腔医学临床、教学和科研工作，曾任四川省抗癌协会头颈肿瘤专业委员会委员、中华口腔医学会牙槽外科专业委员会常务委员、四川省口腔医学会口腔颌面外科专业委员会及牙槽外科专业委员会常务委员、老年口腔专业委员会副主任委员。现任中华口腔医学会口腔急诊专业委员会副主任委员、四川省口腔医学会理事兼口腔急诊专业委员会主任委员、口腔全科专业委员会副主任委员。多次获四川大学优秀带教教师一等奖，2017年获四川省临床技能名师称号，2018年获中国医师协会住院医师规范化培训优秀带教老师称号。主持多项省级科研和教改项目，发表专业论文70余篇，主编、参编专著15部。获省部级科技奖励4项。兼任循证口腔医学教研室主任并参与医疗质控管理工作，历任四川大学华西口腔医院医务部副部长、药物临床试验中心办公室主任、医院毕业后医学教育办公室主任等职。并曾兼任国家食品药品监管总局医疗器械分类专家委员会口腔器械组专家、中国医师协会口腔颌面外科专科医师培训专家委员会总干事、四川省口腔医疗质控中心业务主任、四川省卫生健康委员会毕业后医学教育委员会办公室副主任等职。E-mail: huacg@163.com
基金资助:
四川大学华西口腔医院临床研究项目(LCYJ2019-7)

Clinical considerations of emergent oral manifestations during pregnancy

Zhang Xuefeng, Liu Xian, Liu Chang, Hua Chengge()

State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2023-11-02 Revised:2024-02-06 Online:2024-04-01 Published:2024-03-26
Contact: Hua Chengge E-mail:huacg@163.com
Supported by:
Research and Develop Program, West China Hospital of Stomatology, Sichuan University(LCYJ2019-7)

摘要/Abstract

摘要：

妊娠期是口腔疾病患病和治疗的特殊时期，妊娠期发生的口腔急症需得到恰当的处置。一方面，孕妇生理环境、个人习惯的改变增加了部分口腔疾病的易患性；另一方面，为了保证孕妇和胎儿安全，临床治疗策略局限。孕妇应掌握口腔健康知识、增强口腔保健意识。口腔医生应在“孕前预防，孕期治标，孕后治本”的原则下，根据不同的妊娠时期制定合适的治疗方案，以最安全、简单、有效的手段控制急症、防止疾病进展，避免对孕妇和胎儿的不良影响。防治结合，让孕妇和口腔医生共同维护妊娠期口腔健康。本文围绕妊娠期治疗原则，对妊娠期口腔急症治疗的时机选择、临床管理和不同疾病的治疗策略等进行了总结。

关键词: 妊娠期, 口腔疾病, 急症, 治疗时机, 临床管理, 治疗策略

Abstract:

Pregnancy is a special period for developing and treating oral diseases. Oral emergencies during pregnancy need to be handled appropriately. Changes in the physiological environments and personal habits of pregnant women increase susceptibility to some oral diseases. However, clinical treatment strategies are limited due to the need to ensure the safety of pregnant women and fetuses. Pregnant women should obtain oral health knowledge and enhance their awareness. Dentists should adhere to the principle of “prevention before pregnancy, controlling symptoms during pregnancy, and treating diseases after pregnancy” for different pregnancy periods. They should also formulate appropriate treatment plans to control emergencies, prevent disease progression, and avoid harmful effects on pregnant women by using the safest, simplest, and most effective strategies that avoid adverse effects on fetuses. Pregnant women and dentists should combine prevention and treatment while collaborating in maintaining oral health during pregnancy. This article focuses on the principles of treatment during pregnancy, and the treatment timing, clinical management, and treatment strategies of different diseases causing oral emergencies during pregnancy are reviewed.

Key words: pregnancy, oral diseases, emergency, treatment timing, clinical management, treatment strategy

中图分类号:

张雪峰, 刘显, 刘畅, 华成舸. 妊娠期口腔急症的临床考量[J]. 华西口腔医学杂志, 2024, 42(2): 142-153.

Zhang Xuefeng, Liu Xian, Liu Chang, Hua Chengge. Clinical considerations of emergent oral manifestations during pregnancy[J]. West China Journal of Stomatology, 2024, 42(2): 142-153.

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药物名称		分级	药物名称		分级
抗菌药物			镇痛药
β-内酰胺类	阿莫西林（克拉维酸）	B	对乙酰氨基酚		B/C*
	氨苄西林	B	局部麻醉药
	哌拉西林（他唑巴坦）	B	局部注射	利多卡因	B
	头孢菌素类（各代）	B		丙胺卡因	B
大环内酯类	阿奇霉素	B		阿替卡因	C
硝基咪唑类	甲硝唑	B	表面麻醉	利多卡因	B
林可霉素类	克林霉素	B		丁卡因	C

用途	药物名称	安全性	参考文献
牙体牙髓局部常用药
牙髓失活剂	多聚甲醛/三聚甲醛	相对安全	61-63
盖髓剂	氢氧化钙	相对安全	64-65
盖髓剂	矿物三氧化物聚合物	不明确
根管冲洗剂	次氯酸钠	相对安全	59
	氯己定	相对安全	66
	过氧化氢	相对安全
根管消毒剂	氢氧化钙	相对安全	64-65
	碘仿氢氧化钙糊剂（Vitapex糊剂）	不明确	67-68
牙周局部常用药
含漱药	氯己定	相对安全	66
	过氧化氢	相对安全
牙周袋用药	聚维酮碘	不安全不安全	67-69
牙周袋用药	碘甘油	不安全不安全	67-69
	盐酸米诺环素	不安全	70

指标	非妊娠期数值或现象	妊娠期数值或现象	早期预警标准	单位	参考文献
心率	60~100	15%~25%↑	<50/>120	次/min	79-80
收缩压	12.00~18.67（90~140）	-	<12.00/>21.33（<90/>160）	kPa（mmHg）	79-81
舒张压	8.00~12.00（60~90）	↓/-	>13.33（>100）	kPa（mmHg）	79-80
经皮血氧饱和度	95~100	-	<95	%	82-83
呼吸频率	12~18	-	<10/>30	次/min	82,84
心电图	窦性心律	可能出现ST段压低、QRS轴左移、心律失常等，一般无临床意义		无	83,85-86

类别	重要指标	非妊娠期数值	妊娠期数值	单位	参考文献
血常规	红细胞计数	3.8~5.1	↓	×10¹²/L	36,87-95
	血红蛋白浓度	115~150	100~130↓	g/L
	白细胞计数	3.5~9.5	6~20↑	×10⁹/L
	中性粒细胞绝对值	1.8~6.3	↑	×10⁹/L
	淋巴细胞绝对值	1.1~3.2	↓	×10⁹/L
	嗜酸性粒细胞绝对值	0.02~0.52	↓/-	×10⁹/L
	嗜碱性粒细胞绝对值	0~0.06	-	×10⁹/L
	单核细胞绝对值	0.1~0.6	↑/-	×10⁹/L
	血小板计数	100~300	↓	×10⁹/L
凝血	血浆纤维蛋白原	2~4	↑	g/L	96
	活化部分凝血活酶时间	28~40	↓	s
	凝血酶原时间	11.5~14.3	↓	s
血糖	糖化血红蛋白	3.6~6	↓	%	90
	空腹血糖	3.9~6.1	3.6~5.1↓	mmol/L	97

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妊娠期口腔急症的临床考量

Clinical considerations of emergent oral manifestations during pregnancy

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