口腔急诊出血患者的临床特征与危险因素

doi:10.19723/j.issn.1671-167X.2025.01.021

摘要/Abstract

摘要：

目的: 分析口腔急诊出血患者的临床特征及危险因素。方法: 对北京大学口腔医院急诊科2019年1月至2022年12月期间收治的口腔出血患者进行回顾性研究，分析止血方法、就诊次数与患者性别、年龄、全身状况和出血原因等因素的关联性。结果: 共纳入口腔出血患者4 764人次，其中男性2 660人次(55.84%)，女性2 104人次(44.16%)，平均年龄40.7岁。口腔出血最常见的原因是拔牙术后出血(3 080例，64.65%)，其次为牙龈出血(1 386例，29.09%)、门诊手术术后出血(194例，4.07%)、颌面部肿物出血(33例，0.69%)、住院手术术后出血(24例，0.50%)、其他原因出血(47例，0.99%)。使用简单方法止血1 867例(39.19%)，使用复杂方法止血2 897例(60.81%)，其中碘条填塞及加压缝合是最常使用的止血方法。Logistic回归分析显示，男性患者较女性患者使用复杂止血方法的比例更高，牙龈出血通常使用简单方法止血，拔牙术后出血通常采用复杂方法止血。患有高血压、凝血功能障碍的人群更易因出血问题多次就诊，性别及年龄不影响患者的就诊次数。结论: 急诊就诊的口腔出血常见原因是拔牙术后出血及牙龈出血，临床上大多数患者通过压迫止血、加压缝合和填塞碘条可有效止血，部分严重出血的患者需进一步处理；少数的出血患者可诱发全身并发症，临床医生应充分重视。

关键词: 口腔急诊, 出血, 危险因素, 止血

Abstract:

Objective: To analyze the clinical characteristics and risk factors of patients with oral bleeding. Methods: A retrospective study was performed on patients with oral bleeding in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2019 to December 2022. The distribution of the patients ' gender, age, cause of bleeding, systemic condition, treatment methods and risk factors of hemostasis methods, and number of visits were analyzed. Results: A total of 4 764 patients with oral bleeding were enrolled, including 2 660 males (55.84%) and 2 104 females (44.16%), with an average age of 40.7 years. The most common causes of oral bleeding were bleeding after tooth extraction (3 080 cases, 64.65%), followed by gingival bleeding (1 386 cases, 29.09%), bleeding after outpatient surgery (194 cases, 4.07%), maxillofacial mass bleeding (33 cases, 0.69%), postoperative bleeding of inpatient (24 cases, 0.50%), and bleeding from other causes (47 cases, 0.99%). Simple hemostatic methods were applied in 1 867 cases (39.19%) while 2 897 cases (60.81%) used complex methods, among which iodine strip tamponade and suture were the most commonly used methods of hemostasis. Logistic regression analysis showed that the male patients had a higher proportion of complex methods than the female patients; gingival bleeding were often stopped by simple hemostatic methods while complex methods were more likely to be applied in the patients with bleeding after tooth extraction. The patients with hypertension and coagulation disorders were more likely to visit the hospital for repeated bleeding. Gender and age did not affect the number of visits. Conclusion: Oral bleeding was one of the common diseases in oral emergency. The common causes were bleeding after tooth extraction and gingival bleeding. Most patients could be treated by compression, local suture and packing of iodine strips while some cases with severe bleeding needed further treatment to stop bleeding. A minority of patients with oral bleeding could induce systemic complications, which should be paid full attention by clinicians.

Key words: Oral emergency, Bleeding, Risk factors, Hemostasis

中图分类号:

郭华秋, 王哲, 杨雪, 白洁. 口腔急诊出血患者的临床特征与危险因素[J]. 北京大学学报（医学版）, 2025, 57(1): 142-147.

Huaqiu GUO, Zhe WANG, Xue YANG, Jie BAI. Clinical features and risk factors of patients with oral bleeding in dental emergency[J]. Journal of Peking University (Health Sciences), 2025, 57(1): 142-147.

图/表 5

表1

表2

表3

表4

表5

口腔出血急救患者的概况"

Patient No.	Gender	Age/years	Physical condition	Cause of bleeding	Reason for rescue	Prognosis	Others
1	Female	65	Other disease	Maxillofacial mass	Airway obstruction, Hemorrhagic shock	Stable vital signs	History of radiotherapy
2	Male	67	Healthy	Maxillofacial mass	Airway obstruction	Stable vital signs	History of radiotherapy and chemotherapy
3	Male	26	Healthy	Tooth extraction	Hypoglycemia	Stable vital signs
4	Male	53	Healthy	Maxillofacial mass	Hemorrhagic shock	Stable vital signs
5	Male	55	Hypertension	Maxillofacial mass	Airway obstruction	Stable vital signs	History of radiotherapy
6	Male	45	Hypertension	Tooth extraction	Vasovagal syncope	Stable vital signs
7	Male	62	Healthy	Mandibular mass	Hemorrhagic shock	Stable vital signs
8	Male	64	Healthy	Maxillofacial mass	Hemorrhagic shock	Stable vital signs	History of radiotherapy
9	Male	76	Coagulation disorder	Maxillofacial mass	Hemorrhagic shock	Stable vital signs	History of radiotherapy
10	Male	51	Hypertension	Tooth extraction	Vasovagal syncope	Stable vital signs
11	Male	52	Healthy	Maxillofacial mass	Airway obstruction	Stable vital signs
12	Female	66	Diabetes	Maxillofacial mass	Hemorrhagic shock	Stable vital signs
13	Female	62	Hypertension	Maxillofacial mass	Respiratory and circulatory failure	Death
14	Male	61	Cachexia	Maxillofacial mass	Respiratory and circulatory failure	Death
15	Male	54	Other disease	Maxillofacial mass	Respiratory and circulatory failure	Death
16	Male	65	Cachexia	Maxillofacial mass	Hemorrhagic shock	Stable vital signs	History of radiotherapy and multiple surgeries
17	Male	50	Other disease	Maxillofacial mass	Airway obstruction	Stable vital signs
18	Male	65	Cachexia	Maxillofacial mass	Airway obstruction, Hemorrhagic shock	Stable vital signs
19	Male	54	Other disease	Maxillofacial mass	Airway obstruction	Stable vital signs
20	Male	67	Coagulation disorder	Gingival bleeding	Hemorrhagic shock	Stable vital signs	Cerebral infarction

表5

参考文献 19

1	吴幸晨, 周卓君, 江龙. 12 697例口腔夜间急诊常见疾病分析及对策[J]. 中国实用口腔科杂志, 2019, 12 (8): 492- 494.
2	徐晓, 廖骞, 王海宁, 等. 口腔夜间急诊病例10 000例回顾分析[J]. 临床口腔医学杂志, 2006, 22 (7): 437- 438.
3	曾嘉皓, 邢云娣, 陈蕾. 口腔夜间急诊患者10 811例就诊情况分析[J]. 广东医学, 2018, 39 (S2): 136- 139.
4	董依云, 郭一波, 陶岚. 2017—2020年上海第九人民医院口腔急诊上半年病例变化趋势分析[J]. 上海口腔医学, 2021, 30 (3): 323- 327.
5	沈烨青, 刘义, 江龙, 等. 2017—2018年2年间137 740例口腔急诊病例分析[J]. 上海口腔医学, 2021, 30 (2): 151- 155.
6	梁彤欣, 郝静, 邓润智. 口腔颌面部术后出血的临床特点分析[J]. 现代口腔医学杂志, 2018, 32 (2): 72- 74.
7	付元, 吴佳琪, 邵校, 等. 口腔急诊夜间患者流量及病种分析[J]. 现代口腔医学杂志, 2020, 34 (4): 235- 238.
8	翁烈利, 邓伟斌, 王丽晶. 拔牙术后出血原因临床分析[J]. 海南医学, 2013, 24 (7): 1052- 1053.
9	Moran IJ , Richardson L , Heliotis M , et al. A bleeding socket after tooth extraction[J]. BMJ, 2017, 357, j1217.
10	Sohn JB , Lee H , Han YS , et al. When do we need more than local compression to control intraoral haemorrhage?[J]. J Korean Assoc Oral Maxillofac Surg, 2019, 45 (6): 343- 350. doi: 10.5125/jkaoms.2019.45.6.343
11	Su Q , Li C , Long F , et al. Effects of a health promotion program on medication adherence to antiplatelet therapy among ischemic stroke patients in Hainan Province, China[J]. Vascular, 2017, 25 (3): 242- 248. doi: 10.1177/1708538116666159
12	López-Galindo M , Grau-Benítez M . Systematic review on the effects of the discontinuation of the anticoagulant therapy and the postoperative bleeding, in patients under new oral anticoagulants after dental extraction[J]. J Clin Exp Dent, 2023, 15 (4): e338- e345.
13	Caliskan M , Tukel H , Benlidayi E , et al. Is it necessary to alter anticoagulation therapy for tooth extraction in patients taking direct oral anticoagulants?[J]. Med Oral Patol Oral, 2017, 22 (6): e767- e773.
14	Bensi C , Belli S , Paradiso D , et al. Postoperative bleeding risk of direct oral anticoagulants after oral surgery procedures: A systema-tic review and meta-analysis[J]. Int J Oral Max Sur, 2018, 47 (7): 923- 932. doi: 10.1016/j.ijom.2018.03.016
15	Kämmerer PW , Frerich B , Liese J , et al. Oral surgery during therapy with anticoagulants: A systematic review[J]. Clin Oral Investig, 2015, 19 (2): 171- 180. doi: 10.1007/s00784-014-1366-3
16	刘丽骏, 孙凯, 蒋伟文. 口腔小手术前不停用阿司匹林对术后出血情况影响的Meta分析[C]// 中华口腔医学会老年口腔医学专业委员会. 第十次全国老年口腔医学学术年会论文汇编. 上海: [出版者不详], 2015.
17	Girotra C , Padhye M , Mandlik G , et al. Assessment of the risk of haemorrhage and its control following minor oral surgical procedures in patients on anti-platelet therapy: A prospective study[J]. Int J Oral Maxillofac Surg, 2014, 43 (1): 99- 106. doi: 10.1016/j.ijom.2013.08.014
18	徐训敏, 邵校, 姬爱平. 口腔急诊科死亡病例分析[J]. 北京大学学报(医学版), 2024, 56 (1): 185- 189.
19	Haghighi AG , Finder RG , Bennett JD . Systemic disease and bleeding disorders for the oral and maxillofacial surgeon[J]. Oral Maxillofac Surg Clin North Am, 2016, 28 (4): 461- 471.

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Variables	n	%
Gender
Male	2 660	55.84
Female	2 104	44.16
Age/years
0-9	27	0.57
10-19	131	2.75
20-29	1 581	33.19
30-39	1 235	25.92
40-49	398	8.35
50-59	427	8.96
60-69	471	9.89
70-79	284	5.96
≥80	210	4.41
Visiting time
0:00-6:00	1 242	26.07
6:00-12:00	609	12.78
12:00-18:00	601	12.62
18:00-24:00	2 312	48.53
Cause of bleeding
Tooth extraction	3 080	64.65
Gingival bleeding	1 386	29.09
Outpatient surgery	194	4.07
Tumor	33	0.69
Inpatient surgery	24	0.50
Others	47	0.99

Method	n	%
Simple
Compression	1 867	39.19
Complex
Lodine strip tanponade	1 036	21.75
Other material tanponade	252	5.29
Suture	611	12.83
Tanponade+suture	875	18.37
Local hemostatic medicine	79	1.66
Others^*	44	0.92

Items	Hemostatic methods, n (%)		Univariate analysis		Binary Logistic regression
Items	Simple	Complex	P	χ²	P	OR (95%CI)
Gender			0.003	8.733
Female	874 (41.54)	1 230 (58.46)
Male	993 (37.33)	1 667 (62.67)			0.002^*	1.228 (1.082-1.394)
Age/years			< 0.001	30.746
0-9	13 (48.15)	14 (51.85)			0.499
10-19	50 (38.17)	81 (61.83)			0.807	1.115 (0.464-2.682)
20-29	557 (35.23)	1 024 (64.77)			0.402	1.411 (0.631-3.155)
30-39	461 (37.33)	774 (62.67)			0.371	1.445 (0.645-3.237)
40-49	166 (41.71)	232 (58.29)			0.371	1.458 (0.638-3.334)
50-59	186 (43.56)	241 (56.44)			0.188	1.744 (0.762-3.993)
60-69	216 (45.86)	255 (54.14)			0.199	1.725 (0.751-3.959)
70-79	123 (43.31)	161 (56.69)			0.203	1.735 (0.743-4.054)
≥80	95 (45.24)	115 (54.76)			0.162	1.857 (0.78-4.419)
Cause of bleeding			< 0.001	601.957
Gingival bleeding	910 (65.66)	476 (34.34)			< 0.001^*	0.207 (0.107-0.398)
Tooth extraction	834 (27.08)	2 246 (72.92)			0.566	1.212 (0.628-2.338)
Outpatient surgery	85 (43.81)	109 (56.19)			0.081	0.533 (0.262-1.082)
Inpatient surgery	10 (41.67)	14 (58.33)			0.261	0.550 (0.194-1.561)
Tumor	15 (45.45)	18 (54.55)			0.084	0.434 (0.168-1.120)
Others^▲	13 (27.66)	34 (72.34)
Physical condition			< 0.001	32.721
Healthy	1 319 (36.93)	2 253 (63.07)			0.485
Hypertension	138 (45.10)	168 (54.90)			0.355	1.148 (0.857-1.537)
Coagulation disorder	380 (46.40)	429 (52.38)			0.339	1.117 (0.890-1.403)
Other diseases	30 (38.96)	47 (61.04)			0.206	1.390 (0.834-2.316)

Items	Number of visits, n (%)		Univariate analysis		Binary Logistic regression
Items	Single visit	Multiple visit	P	χ²	P	OR (95%CI)
Gender			0.053	3.737
Female	1 760 (83.65)	344 (16.35)
Male	2 190 (82.33)	470 (17.67)			0.293	1.091 (0.928-1.282)
Age/years			< 0.001	101.438
0-9	25 (92.59)	2 (7.41)
10-19	124 (94.66)	7 (5.34)			0.986	0.985 (0.185-5.257)
20-29	1 364 (86.27)	217 (13.73)			0.175	2.815 (0.632-12.542)
30-39	1 052 (85.18)	183 (14.82)			0.175	2.816 (0.632-12.558)
40-49	339 (85.18)	59 (14.82)			0.428	1.844 (0.406-8.385)
50-59	341 (79.86)	86 (20.14)			0.502	1.677 (0.370-7.589)
60-69	360 (76.43)	111 (23.57)			0.561	1.565 (0.346-7.078)
70-79	212 (74.65)	72 (25.35)			0.510	1.667 (0.363-7.614)
≥80	133 (63.33)	77 (36.67)			0.297	2.248 (0.49-10.322)
Cause of bleeding			< 0.001	204.906
Gingival bleeding	1 009(25.50)	377 (46.30)			0.720	1.132 (0.573-2.237)
Tooth extraction	2 718 (68.80)	362 (44.50)			0.068	0.528 (0.265-1.049)
Outpatient surgery	156 (3.90)	38 (4.70)			0.900	1.050 (0.489-2.257)
Inpatient surgery	19 (0.50)	5 (0.60)			0.995	1.004 (0.296-3.403)
Tumor	14 (0.40)	19 (2.30)			0.001^*	5.872 (2.166-15.919)
Others^▲	34 (0.90)	13 (1.60)
Physical condition			< 0.001	282.802
Healthy	3 129 (79.20)	443 (54.40)
Hypertension	242 (6.10)	64 (7.90)			0.001^*	1.852 (1.306-2.625)
Coagulation disorder	511 (12.90)	298 (36.60)			< 0.001^*	4.202 (3.232-5.463)
Other diseases	68 (1.70)	9 (1.10)			0.547	0.797 (0.382-1.66)