第十六章消毒防腐藥

1、目的要求目的要求 Aims Aims了解消毒防腐藥的概念、作用機制、影響因素及分類 Understand the concept, mechanism, influencing factors and classification of Disinfectants & Antiseptics 熟悉酚類、醛類、酸類、堿性藥物、鹵素類、氧化劑、表面活性劑的代表藥物及其臨床應(yīng)用、注意事項等 Be familiar with the clinical application and precautions of phenols, aldehydes, acids, alkaline medic

2、ine, halogen, oxidants and surfants消消 毒毒 Disinfection Disinfection環(huán)境環(huán)境EnvironEnvironm e n tm e n t器械器械InstrumInstrume n t se n t s體表體表B o d y B o d y surfacesurface 第一節(jié) 消毒防腐藥概述能殺滅或抑制病原微生物生長繁殖的藥物能殺滅或抑制病原微生物生長繁殖的藥物 The medicine that can kill or inhibit The medicine that can kill or inhibit the growth

3、and reproduction of the growth and reproduction of pathogenic microorganismspathogenic microorganisms消毒藥消毒藥防腐藥防腐藥迅速殺滅病原微生物迅速殺滅病原微生物抑制病原微生物繁殖抑制病原微生物繁殖消毒防腐藥消毒防腐藥 D&A D&AQuickly kill pathogenic microorganismsQuickly kill pathogenic microorganismsInhibition the proliferation of pathogenic microo

4、rganismsInhibition the proliferation of pathogenic microorganisms殺菌抑菌殺菌抑菌 使蛋白質(zhì)變性使蛋白質(zhì)變性 與酶系統(tǒng)結(jié)合與酶系統(tǒng)結(jié)合 增加膜通透性增加膜通透性 作用機制作用機制 Mechanism MechanismDenature proteinsCombined with the enzyme systemIncrease permeability of membrane SterilizationInhibition of bacteria藥物濃度和作用時間藥物濃度和作用時間微生物敏感性微生物敏感性 溶溶 媒媒 環(huán)境溫度環(huán)

5、境溫度有機物質(zhì)有機物質(zhì)酸堿度酸堿度 藥物配伍藥物配伍相互作用相互作用藥物性質(zhì)藥物性質(zhì) Drug concentration and function timeMenstruumEnvironment temperaturePH valueOrganicsMicrobial sensitivityCombination and Interactions of drugsPharmacy Properties藥效分類藥效分類 By effectiveness殺滅一切病原微生物，包括芽孢殺滅細菌繁殖體和多數(shù)真菌、病毒，不能殺滅芽孢殺滅部分細菌繁殖體、真菌、病毒，不能殺滅芽胞、HBV等高高 效效中中

6、效效低低 效效EfficientIntermediate efficientLow efficientKill all pathogenic microorganisms, including sporesKill bacteria propagule and most fungi, viruses. Can not kill sporesKill part of bacteria propagule, fungi, viruses. Can not kill spores, HBV, etc.酚酚 類：苯酚、甲酚、麝香草酚、丁香酚類：苯酚、甲酚、麝香草酚、丁香酚醛醛 類：甲醛、多聚甲醛、戊二

7、醛類：甲醛、多聚甲醛、戊二醛酸酸 類：硼酸、枸櫞酸類：硼酸、枸櫞酸堿堿 類：硼砂、碳酸氫鈉、氫氧化鈣類：硼砂、碳酸氫鈉、氫氧化鈣鹵素類：次氯酸鈉、氯胺鹵素類：次氯酸鈉、氯胺-T-T、碘仿、聚維酮碘、碘仿、聚維酮碘氧化劑：過氧化氫、高錳酸鉀氧化劑：過氧化氫、高錳酸鉀表面活性劑：氯己定、地喹氯銨、西吡氯銨表面活性劑：氯己定、地喹氯銨、西吡氯銨染染 料料 類：依沙吖啶、甲紫類：依沙吖啶、甲紫化學(xué)分類化學(xué)分類 By Chemistry (Non-priority knowledge point)由致病和非致病微生物構(gòu)成的微生態(tài)環(huán)境由致病和非致病微生物構(gòu)成的微生態(tài)環(huán)境感染疾?。貉乐懿　x齒、牙髓炎、根尖

8、周圍感染感染疾病：牙周病、齲齒、牙髓炎、根尖周圍感染局部使用消毒防腐藥局部使用消毒防腐藥 Non-priority knowledge point 第二節(jié) 酚 類 包包 括括 與微生物蛋白質(zhì)結(jié)合使之變性、沉淀和改變 細胞膜通透性屬于中效消毒劑作用機制作用機制 Mechanism Mechanism包包 括括口腔常用藥物口腔常用藥物 Commonly used Commonly used medicine in dentistry medicine in dentistry 苯酚苯酚甲酚甲酚麝香草酚麝香草酚丁香油（酚）丁香油（酚） 該類藥物遇光或長期放置易氧化，色澤加深，該類藥物遇光或長期放置易

9、氧化，色澤加深，應(yīng)置避光容器中應(yīng)置避光容器中 This type of medicine, when This type of medicine, when exposed to light or placed for a long time, may exposed to light or placed for a long time, may be oxidized or change to deep color. It should be oxidized or change to deep color. It should be stored in light resistant co

10、ntainer.be stored in light resistant container.藥理作用藥理作用臨床應(yīng)用臨床應(yīng)用 Clinical application濃度不同作用不同濃度不同作用不同 Different concentrations play different roles ：0.2% ：抑菌：抑菌 Antibacterial 1 % ：殺菌，對：殺菌，對G+、 G-菌有效菌有效 Sterilization, effective against G+/G- bacteria 1.3% ：殺滅真菌：殺滅真菌 Effective against fungi5 % ：殺滅結(jié)核桿菌：

11、殺滅結(jié)核桿菌 Effective against mycobacterium tuberculosis對芽孢和病毒無效對芽孢和病毒無效 Ineffective against spores and viruses樟腦苯酚溶液樟腦苯酚溶液碘酚液碘酚液Camphor phenol solution is used in root canal sterilizationIodine phenol solution is used in periodontal disease 不良反應(yīng)不良反應(yīng) Adverse reactions腐蝕性和刺激性腐蝕性和刺激性 Corrosive and irritati

12、ng對嬰兒有致命性對嬰兒有致命性 There are fatal to infants高濃度外用可致組織損傷高濃度外用可致組織損傷 High concentrations can cause tissue damage 注意事項注意事項 Cautions誤服本品可引起局部組織腐蝕、疼痛、惡誤服本品可引起局部組織腐蝕、疼痛、惡心、心、 嘔吐、出汗和腹瀉，出現(xiàn)短暫的興奮，嘔吐、出汗和腹瀉，出現(xiàn)短暫的興奮，隨之知隨之知 覺喪失，中樞神經(jīng)系統(tǒng)抑制、循環(huán)和呼覺喪失，中樞神經(jīng)系統(tǒng)抑制、循環(huán)和呼吸衰竭吸衰竭 Misuse the product can cause local tissue corrosio

13、n , pain, nausea, vomiting, sweating and diarrhea brief excitement, followed by loss of consciousness, central nervous system depression, circulatory and respiratory failure避免應(yīng)用在破損皮膚和傷口避免應(yīng)用在破損皮膚和傷口 Avoid application on damaged skin and wounds 第三節(jié) 醛 類 醛基與微生物核酸和蛋白質(zhì)的氨基相結(jié)合， 使其變性、沉淀 Aldehyde combines wit

14、h the amino group of microbial nucleic acids and proteins, makes them denatured and precipitated 屬于高效消毒劑 Belong to efficient disinfectant甲甲 醛醛 多聚甲醛多聚甲醛 戊二醛戊二醛作用機制作用機制 Mechanism Mechanism 口腔常用藥物口腔常用藥物 Commonly used medicine Commonly used medicine in dentistry in dentistry 對細菌、芽孢、真菌、病毒等均有效對細菌、芽孢、真菌、病毒

15、等均有效 Effective to bacteria, spores, fungi Effective to bacteria, spores, fungi and viruses etc.and viruses etc. 36%甲醛水溶液，具強烈刺激性，特臭，強烈刺激鼻、甲醛水溶液，具強烈刺激性，特臭，強烈刺激鼻、眼、喉黏膜，味灼烈眼、喉黏膜，味灼烈 36% aqueous solution of formaldehyde, with strong irritant, special smell, strongly stimulate to nose, eyes, throat mucosa

16、, has burly flavor特特 點點 Characters藥理作用藥理作用 Pharmacological action Pharmacological action揮發(fā)性廣譜殺菌劑揮發(fā)性廣譜殺菌劑 Volatile broad-spectrum bactericide能使蛋白質(zhì)變性能使蛋白質(zhì)變性 Make protein denaturation對細菌、真菌及病毒均有效，對芽孢和抗酸桿菌作用緩慢對細菌、真菌及病毒均有效，對芽孢和抗酸桿菌作用緩慢升高溫度可加速其殺滅芽孢，相對濕度升高溫度可加速其殺滅芽孢，相對濕度75%時作用最強時作用最強Effective to bacteria,

17、fungi and viruses. The effect s on spores and acid-fast bacilli is slow. Raising the temperature could accelerate the effect of killing spores with the strongest effects on relative humidity 75% 臨床應(yīng)用臨床應(yīng)用 Clinical application用于對濕、熱敏感、易腐蝕的醫(yī)療用用品滅用于對濕、熱敏感、易腐蝕的醫(yī)療用用品滅菌菌 Sterilization for wet, heat-sensiti

18、ve and perishable medical supplies病理標本的防腐保存病理標本的防腐保存 Save pathological specimens from corrosion 與其他藥物配伍用于根管消毒與其他藥物配伍用于根管消毒 Synergetic medical application in root canal disinfection 不良反應(yīng)不良反應(yīng) Adverse reaction 接觸可引起過敏性皮炎接觸可引起過敏性皮炎 Can cause allergic contact dermatitis誤服可刺激口腔、咽喉和消化道誤服可刺激口腔、咽喉和消化道黏膜黏膜 Mi

19、suse can irritate mouth, throat and digestive tract mucosaNon-priority knowledge point不良反應(yīng)不良反應(yīng)皮膚直接接觸可引起過敏性皮炎、色斑、壞死攝入會引起口、咽喉、胸部和胃劇烈燒灼痛以及黏膜炎癥、潰瘍和壞死甲醛氣體對眼、鼻、上呼吸道有刺激性用于根管消毒易滲透至根尖周組織引起化學(xué)性根尖炎Non-priority knowledge point藥理作用藥理作用 Pharmacological action Pharmacological action 快速殺快速殺G+G+、G-G-菌菌 Quickly kill G

20、+ and G- Quickly kill G+ and G- bacteriabacteria對某些真菌和病毒有效對某些真菌和病毒有效 Effective to some Effective to some fungi and virusesfungi and viruses對芽孢有緩慢殺菌作用對芽孢有緩慢殺菌作用 Slow effect on Slow effect on sporesspores 可與異丙醇配伍呈協(xié)同殺菌作用可與異丙醇配伍呈協(xié)同殺菌作用 Synergistic bactericidal effect when combines with isopropanol器械消毒：器

21、械消毒：2%堿性溶液（堿性溶液（ pH= 7.58.5） Instrument disinfection: 2% alkaline solution (pH = 7.5 8.5) 根管消毒：根管消毒：2%戊二醛溶液戊二醛溶液 Root canal disinfection: 2% glutaraldehyde solution 牙髓切斷后覆蓋劑：與氫氧化鈣配伍使用牙髓切斷后覆蓋劑：與氫氧化鈣配伍使用 After pulpotomy, used as dental pulp capping: compatibility with calcium hydroxide公認較理想的消毒藥公認較理想的消

22、毒藥臨床應(yīng)用臨床應(yīng)用用于金屬器械消毒，先加堿性藥物，再加亞硝酸鈉用于金屬器械消毒，先加堿性藥物，再加亞硝酸鈉堿性溶液對鋁制品有腐蝕堿性溶液對鋁制品有腐蝕空氣中最高限量為空氣中最高限量為0.05ppm，應(yīng)注意避光密閉，應(yīng)注意避光密閉儲存溫度不超過儲存溫度不超過40注意事項注意事項Non-priority knowledge point 第四節(jié) 酸 類離解的離解的H+能與菌體蛋白中氨基結(jié)合，使蛋白質(zhì)能與菌體蛋白中氨基結(jié)合，使蛋白質(zhì)變性而呈現(xiàn)殺菌作用；變性而呈現(xiàn)殺菌作用；酸性亦可改變微生物生存環(huán)境，影響代謝呈抑菌作用。酸性亦可改變微生物生存環(huán)境，影響代謝呈抑菌作用。乳酸乳酸 醋酸醋酸 苯甲酸苯甲酸

23、水楊酸水楊酸 枸櫞酸枸櫞酸 硼酸硼酸作用機制作用機制 Mechanism Mechanism口腔常用藥物口腔常用藥物 Commonly used medicine in Commonly used medicine in dentistry dentistry Non-priority knowledge pointNon-priority knowledge point藥理作用藥理作用 Pharmacological action臨床應(yīng)用臨床應(yīng)用 Clinical application具有一定抗菌作用具有一定抗菌作用牙周手術(shù)中，可使牙面輕度脫鈣，有助于與齦瓣內(nèi)新生的膠原牙周手術(shù)中，可使牙面

24、輕度脫鈣，有助于與齦瓣內(nèi)新生的膠原纖維發(fā)生新的連接纖維發(fā)生新的連接降解根面內(nèi)毒素，利于牙周膜來源的成纖維細胞貼附根面生長降解根面內(nèi)毒素，利于牙周膜來源的成纖維細胞貼附根面生長處理牙周手術(shù)中暴露的牙根面處理牙周手術(shù)中暴露的牙根面Non-priority knowledge point 第五節(jié) 堿性藥物一般堿性藥物：一般堿性藥物： General alkalis General alkalis硼砂、碳酸氫鈉、氫氧化鈣等通過改變細菌正常生長環(huán)境，硼砂、碳酸氫鈉、氫氧化鈣等通過改變細菌正常生長環(huán)境，呈現(xiàn)抑菌、防腐作用呈現(xiàn)抑菌、防腐作用 Borax, sodium bicarbonate, Borax,

25、 sodium bicarbonate, calcium hydroxide etc. change the growth calcium hydroxide etc. change the growth environment of bacteria subsequently show environment of bacteria subsequently show antibacterial and antiseptic effectsantibacterial and antiseptic effects強堿性藥物：強堿性藥物：Strong alkalisStrong alkalis如

26、氫氧化鈉具溶解蛋白的強腐蝕性，呈現(xiàn)殺菌作用如氫氧化鈉具溶解蛋白的強腐蝕性，呈現(xiàn)殺菌作用 For For example, sodium hydroxide dissolved proteins with example, sodium hydroxide dissolved proteins with its strong corrosive, and show bactericidal effectits strong corrosive, and show bactericidal effect作用機制作用機制 Mechanism Mechanism 藥理作用藥理作用 Pharmacolo

27、gical action可促進牙髓細胞表達和激活堿性磷酸酶，誘導(dǎo)牙髓細胞分化出成牙本質(zhì)細胞，并促進牙本質(zhì)基質(zhì)的形成Promote the expression and activation of alkaline (ALP) of dental pulp, Induce dental pulp cells to differentiate into odontoblasts, and promote the formation of dentin matrix 藥理作用藥理作用 Pharmacological action本品的強堿性有利于鈣化過程，對細菌有抑制生長作用The strong a

28、lkaline character of this medicine is favorable to calcification by inhibiting the growth of bacteria直接或間接覆蓋牙髓；直接或間接覆蓋牙髓；For direct or indirect pulp cappingFor direct or indirect pulp capping根尖孔未完全形成死髓牙，在根管預(yù)備消毒后，以氫氧化鈣糊劑根尖孔未完全形成死髓牙，在根管預(yù)備消毒后，以氫氧化鈣糊劑 充填根管，有些牙根尖部可繼續(xù)發(fā)育完成，即充填根管，有些牙根尖部可繼續(xù)發(fā)育完成，即“根尖誘導(dǎo)形成術(shù)根尖誘導(dǎo)

29、形成術(shù)”；For those tooth without sealed apical foramen, use this For those tooth without sealed apical foramen, use this medicine after root canal preparation and sterilization would medicine after root canal preparation and sterilization would helpful to continue the development of root apex. It is hel

30、pful to continue the development of root apex. It is called “Apexificationcalled “Apexification 可單獨或與其他成分（如碘仿等）配成合劑填充根管，促進牙本質(zhì)和可單獨或與其他成分（如碘仿等）配成合劑填充根管，促進牙本質(zhì)和骨質(zhì)修復(fù)；骨質(zhì)修復(fù)；Apply alone or be combined with other components Apply alone or be combined with other components (such as iodoform, etc.) is effectiv

31、e to promote dentin and (such as iodoform, etc.) is effective to promote dentin and bone repairbone repair近牙頸部根管側(cè)穿，可將氫氧化鈣放于側(cè)穿處，促使形成鈣化屏近牙頸部根管側(cè)穿，可將氫氧化鈣放于側(cè)穿處，促使形成鈣化屏 障，封閉側(cè)穿處。障，封閉側(cè)穿處。Apply on the perforation near neck of tooth, Apply on the perforation near neck of tooth, the medicine can promote the fo

32、rmation of calcified barrier the medicine can promote the formation of calcified barrier when placed the medicine on the perforation.when placed the medicine on the perforation.臨床應(yīng)用臨床應(yīng)用 Clinical application 第六節(jié) 鹵 素 類 通過鹵原子鹵化和氧化微生物原漿蛋白活性基團，改變細胞膜通透性，并與蛋白質(zhì)的氨基結(jié)合而使之變性作用機制作用機制 Mechanism Mechanism口腔常用藥物口腔常

33、用藥物 Commonly used Commonly used medicine in dentistry medicine in dentistry 次氯酸鈉次氯酸鈉 氯胺氯胺-T -T 碘碘 仿仿 聚維酮碘聚維酮碘 藥理作用藥理作用 Pharmacological action Pharmacological action 臨床應(yīng)用臨床應(yīng)用 Clinical application廣譜強效殺菌劑；毒性低，對組織刺激性??；對細菌、病毒、真菌芽孢均有效；不易產(chǎn)生耐藥性。 手術(shù)前皮膚和手消毒 口腔潰瘍、冠周炎、口腔真菌感染等外用或含漱 牙周袋內(nèi)沖洗 義齒消毒 第七節(jié) 氧 化 劑 通過氧化反應(yīng)使細

34、菌原漿蛋白的活性基團被氧化， 使細胞壁和細胞膜通透性發(fā)生改變，破壞細胞內(nèi) 外物質(zhì)平衡使微生物死亡 直接作用于酶系統(tǒng)，干擾細菌代謝，抑制生長繁殖過氧化氫溶液過氧化氫溶液 高錳酸鉀高錳酸鉀作用機制作用機制口腔常用口腔常用Non-priority knowledge point雙氧水雙氧水藥理作用藥理作用 Pharmacological effects 氧化性消毒劑，殺菌力相對較弱；氧化性消毒劑，殺菌力相對較弱； 具防腐、除臭作用；具防腐、除臭作用；尤其對專性厭氧菌敏感。尤其對專性厭氧菌敏感。It belongs to oxidant, which has relatively weak bacte

35、ricidal effect;However, it has antiseptic and deodorant effects, specially sensitive to obligate anaerobes.1.口腔抗感染 Oral anti-infection 壞死性齦口炎、牙周炎、冠周炎、干槽癥 Necrotizing gingival stomatitis, periodontitis, pericoronitis, alveolitis 2.根管沖洗 Root canal irrigation3.超聲波潔牙前含漱 Application for rinse before ultr

36、asonic scaling 臨床應(yīng)用臨床應(yīng)用 Clinical application4.齦上潔治和齦下刮治術(shù)后沖洗 Irrigation in super/sub-gingival scaling5.用于頑固性齦緣充血、反復(fù)牙周基礎(chǔ)治療后效果不佳者Apply for patients who have refractory gingival congestion, or poor healing after repeated periodontal therapy6.牙齒漂白 Bleaching 四環(huán)素牙、氟牙癥的脫色；變色無髓牙漂白 Bleaching for fading tooth that is caused by tetracycline, dental fluorosis; and discolored teeth for pulpless tooth. 臨床應(yīng)用臨床應(yīng)用 Clinical application1.勿使30%過氧化氫溶液碰觸正常牙齒表面及黏膜；2.長期使用本品含漱，應(yīng)與碳酸氫鈉溶液交替， 可中和其酸性；3.根管沖洗時不可用力過猛；4.禁忌使用1%3%過氧化氫