口腔藥物學(xué)課件：第十六章 消毒防腐藥

1、全國(guó)高等學(xué)校教材 供口腔醫(yī)學(xué)類專業(yè)用第十六章 消毒防腐藥Chapter 16 Disinfectants & Antiseptics (D&A)口腔臨床藥物學(xué)Dental Clinical Pharmacy 第4版目的要求 Aims了解消毒防腐藥的概念、作用機(jī)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(xiàng)等 Be famil

2、iar with the clinical application and precautions of phenols, aldehydes, acids, alkaline medicine, halogen, oxidants and surfants消 毒 Disinfection環(huán)境Environment器械Instruments體表Body surface 第一節(jié) 消毒防腐藥概述Section 1 Overview of Disinfectants & Antiseptics能殺滅或抑制病原微生物生長(zhǎng)繁殖的藥物 The medicine that can kill or inhib

3、it the growth and reproduction of pathogenic microorganisms消毒藥防腐藥迅速殺滅病原微生物抑制病原微生物繁殖消毒防腐藥 D&A第一節(jié) 消毒防腐藥概述Quickly kill pathogenic microorganismsInhibition the proliferation of pathogenic microorganisms殺菌抑菌 使蛋白質(zhì)變性 與酶系統(tǒng)結(jié)合 增加膜通透性 作用機(jī)制 Mechanism第一節(jié) 消毒防腐藥概述Denature proteinsCombined with the enzyme systemInc

4、rease permeability of membrane SterilizationInhibition of bacteria藥物濃度和作用時(shí)間微生物敏感性 溶 媒 環(huán)境溫度有機(jī)物質(zhì)酸堿度 藥物配伍相互作用藥物性質(zhì) 影響因素第一節(jié) 消毒防腐藥概述Drug concentration and function timeMenstruumEnvironment temperaturePH valueOrganicsMicrobial sensitivityCombination and Interactions of drugsPharmacy Properties分 類 Classific

5、ation 藥效分類 By effectiveness殺滅一切病原微生物，包括芽孢殺滅細(xì)菌繁殖體和多數(shù)真菌、病毒，不能殺滅芽孢殺滅部分細(xì)菌繁殖體、真菌、病毒，不能殺滅芽胞、HBV等第一節(jié) 消毒防腐藥概述高 效中 效低 效EfficientIntermediate efficientLow efficientKill all pathogenic microorganisms, including sporesKill bacteria propagule and most fungi, viruses. Can not kill sporesKill part of bacteria prop

6、agule, fungi, viruses. Can not kill spores, HBV, etc.酚 類：苯酚、甲酚、麝香草酚、丁香酚第一節(jié) 消毒防腐藥概述醛 類：甲醛、多聚甲醛、戊二醛酸 類：硼酸、枸櫞酸堿 類：硼砂、碳酸氫鈉、氫氧化鈣鹵素類：次氯酸鈉、氯胺-T、碘仿、聚維酮碘氧化劑：過(guò)氧化氫、高錳酸鉀表面活性劑：氯己定、地喹氯銨、西吡氯銨染 料 類：依沙吖啶、甲紫化學(xué)分類 By Chemistry (Non-priority knowledge point)分 類 Classification 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、根尖周圍感染口 腔局

7、部使用消毒防腐藥 第一節(jié) 消毒防腐藥概述Non-priority knowledge point 第二節(jié) 酚 類 Section 2 Phenol 苯酚及其衍生物包 括 與微生物蛋白質(zhì)結(jié)合使之變性、沉淀和改變 細(xì)胞膜通透性屬于中效消毒劑第二節(jié) 酚 類作用機(jī)制 MechanismPhenol and its derivativesPhenol and its derivatives, which belongs to intermediate efficient disinfectants, can be combined with proteins of microbe. Then they

8、make the proteins of pathogenic microorganisms denature, precipitate, and even change the permeability of cell membrane. 苯酚及其衍生物包 括第二節(jié) 酚 類口腔常用藥物 Commonly used medicine in dentistry 苯酚甲酚麝香草酚丁香油（酚） 該類藥物遇光或長(zhǎng)期放置易氧化，色澤加深，應(yīng)置避光容器中 This type of medicine, when exposed to light or placed for a long time, may

9、be oxidized or change to deep color. It should be stored in light resistant container.Phenol and its derivatives Phenol Cresol Thymol Eugenol苯 酚（Phenol）第二節(jié) 酚 類藥理作用臨床應(yīng)用 Clinical application濃度不同作用不同 Different concentrations play different roles ：0.2% ：抑菌 Antibacterial 1 % ：殺菌，對(duì)G+、 G-菌有效 Sterilization,

10、 effective against G+/G- bacteria 1.3% ：殺滅真菌 Effective against fungi5 % ：殺滅結(jié)核桿菌 Effective against mycobacterium tuberculosis對(duì)芽孢和病毒無(wú)效 Ineffective against spores and viruses樟腦苯酚溶液碘酚液Camphor phenol solution is used in root canal sterilizationIodine phenol solution is used in periodontal diseasePharmaco

11、logical action 不良反應(yīng) Adverse reactions腐蝕性和刺激性 Corrosive and irritating對(duì)嬰兒有致命性 There are fatal to infants高濃度外用可致組織損傷 High concentrations can cause tissue damage 注意事項(xiàng) Cautions誤服本品可引起局部組織腐蝕、疼痛、惡心、 嘔吐、出汗和腹瀉，出現(xiàn)短暫的興奮，隨之知 覺(jué)喪失，中樞神經(jīng)系統(tǒng)抑制、循環(huán)和呼吸衰竭 Misuse the product can cause local tissue corrosion , pain, nause

12、a, 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 Avoid application on damaged skin and wounds第二節(jié) 酚 類苯 酚（Phenol） 第三節(jié) 醛 類Section 3 Aldehyde 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 com

13、bines with 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 醛 多聚甲醛 戊二醛第三節(jié) 醛 類作用機(jī)制 Mechanism 口腔常用藥物 Commonly used medicine in dentistry 對(duì)細(xì)菌、芽孢、真菌、病毒等均有效 Effective to bacteria, spores, fungi and viruses etc. Formal

14、dehyde Paraformaldehyde Glutaraldehyde 36%甲醛水溶液，具強(qiáng)烈刺激性，特臭，強(qiáng)烈刺激鼻、眼、喉黏膜，味灼烈 36% aqueous solution of formaldehyde, with strong irritant, special smell, strongly stimulate to nose, eyes, throat mucosa, has burly flavor第三節(jié) 醛 類甲醛溶液（Formaldehyde Solution）特 點(diǎn) Characters藥理作用 Pharmacological action揮發(fā)性廣譜殺菌劑 Vo

15、latile broad-spectrum bactericide能使蛋白質(zhì)變性 Make protein denaturation對(duì)細(xì)菌、真菌及病毒均有效，對(duì)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(duì)濕度75%時(shí)作用最強(qiáng)Effective to bacteria, 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

16、 effects on relative humidity 75% 臨床應(yīng)用 Clinical application用于對(duì)濕、熱敏感、易腐蝕的醫(yī)療用用品滅菌 Sterilization for wet, heat-sensitive and perishable medical supplies病理標(biāo)本的防腐保存 Save pathological specimens from corrosion 與其他藥物配伍用于根管消毒 Synergetic medical application in root canal disinfection 第三節(jié) 醛 類不良反應(yīng) Adverse reacti

17、on 接觸可引起過(guò)敏性皮炎 Can cause allergic contact dermatitis誤服可刺激口腔、咽喉和消化道黏膜 Misuse can irritate mouth, throat and digestive tract mucosa甲醛溶液（Formaldehyde Solution）Non-priority knowledge point不良反應(yīng)皮膚直接接觸可引起過(guò)敏性皮炎、色斑、壞死攝入會(huì)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(duì)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

18、 point戊二醛 (Glutaraldehyde)第三節(jié) 醛 類藥理作用 Pharmacological action 快速殺G+、G-菌 Quickly kill G+ and G- bacteria對(duì)某些真菌和病毒有效 Effective to some fungi and viruses對(duì)芽孢有緩慢殺菌作用 Slow effect on spores 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：2%堿性溶液（ pH= 7.58.5） Instrument disinf

19、ection: 2% alkaline solution (pH = 7.5 8.5) 根管消毒：2%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 After pulpotomy, used as dental pulp capping: compatibility with calcium hydroxide公認(rèn)較理想的消毒藥第三節(jié) 醛 類臨床應(yīng)用戊二醛 (Glutaraldehyde)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(duì)鋁制品有腐蝕空氣中最高限量為0.05ppm，應(yīng)

20、注意避光密閉儲(chǔ)存溫度不超過(guò)40第三節(jié) 醛 類注意事項(xiàng)戊二醛 (Glutaraldehyde)Non-priority knowledge point 第四節(jié) 酸 類Section 4 Acid離解的H+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；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 醋酸 苯甲酸 水楊酸 枸櫞酸 硼酸第四節(jié) 酸 類作用機(jī)制 Mechanism口腔常用藥物 Commonly used medicine in dentistry Non-priority knowledge pointNon-priority knowledge point枸櫞酸 Citri

21、c Acid第四節(jié) 酸 類藥理作用 Pharmacological action臨床應(yīng)用 Clinical application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)新生的膠原纖維發(fā)生新的連接降解根面內(nèi)毒素，利于牙周膜來(lái)源的成纖維細(xì)胞貼附根面生長(zhǎng)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Section 5 Alkali一般堿性藥物： General alkalis硼砂、碳酸氫鈉、氫氧化鈣等通過(guò)改變細(xì)菌正常生長(zhǎng)環(huán)境，呈現(xiàn)抑菌、防腐作用 Borax, sodium bicarbonate, calcium hydro

22、xide etc. change the growth environment of bacteria subsequently show antibacterial and antiseptic effects強(qiáng)堿性藥物：Strong alkalis如氫氧化鈉具溶解蛋白的強(qiáng)腐蝕性，呈現(xiàn)殺菌作用 For example, sodium hydroxide dissolved proteins with its strong corrosive, and show bactericidal effect第五節(jié) 堿性藥物作用機(jī)制 Mechanism氫氧化鈣（Calcium Hydroxide）第五

23、節(jié) 堿性藥物 藥理作用 Pharmacological action可促進(jìn)牙髓細(xì)胞表達(dá)和激活堿性磷酸酶，誘導(dǎo)牙髓細(xì)胞分化出成牙本質(zhì)細(xì)胞，并促進(jìn)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氫氧化鈣（Calcium Hydroxide）第五節(jié) 堿性藥物 藥理作用 Pharmacol

24、ogical action本品的強(qiáng)堿性有利于鈣化過(guò)程，對(duì)細(xì)菌有抑制生長(zhǎng)作用The strong alkaline character of this medicine is favorable to calcification by inhibiting the growth of bacteria直接或間接覆蓋牙髓；For 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 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)”；For those tooth without sealed apical foramen,

25、 use this medicine after root canal preparation and sterilization would helpful to continue the development of root apex. It is called “Apexification 可單獨(dú)或與其他成分（如碘仿等）配成合劑填充根管，促進(jìn)牙本質(zhì)和骨質(zhì)修復(fù)；Apply alone or be combined with other components (such as iodoform, etc.) is effective to promote dentin and bone r

26、epair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。Apply on the perforation near neck of tooth, the medicine can promote the formation of calcified barrier when placed the medicine on the perforation.第五節(jié) 堿性藥物臨床應(yīng)用 Clinical application氫氧化鈣（Calcium Hydroxide） 第六節(jié) 鹵 素 類Section 6 Halogen 通過(guò)鹵原子鹵化和氧化微生物原漿蛋白活性基團(tuán)，改變細(xì)

27、胞膜通透性，并與蛋白質(zhì)的氨基結(jié)合而使之變性第六節(jié) 鹵素類作用機(jī)制 Mechanism口腔常用藥物 Commonly used medicine in dentistry 次氯酸鈉 氯胺-T 碘 仿 聚維酮碘聚維酮碘（Povidone Iodine）第六節(jié) 鹵素類 藥理作用 Pharmacological action 臨床應(yīng)用 Clinical application廣譜強(qiáng)效殺菌劑；毒性低，對(duì)組織刺激性??；對(duì)細(xì)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Section 7 Oxidant

28、通過(guò)氧化反應(yīng)使細(xì)菌原漿蛋白的活性基團(tuán)被氧化， 使細(xì)胞壁和細(xì)胞膜通透性發(fā)生改變，破壞細(xì)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(xì)菌代謝，抑制生長(zhǎng)繁殖過(guò)氧化氫溶液 高錳酸鉀第七節(jié) 氧化劑作用機(jī)制口腔常用Non-priority knowledge point過(guò)氧化氫溶液 （Hydrogen Peroxide Solution）雙氧水第七節(jié) 氧化劑藥理作用 Pharmacological effects 氧化性消毒劑，殺菌力相對(duì)較弱； 具防腐、除臭作用；尤其對(duì)專性厭氧菌敏感。It belongs to oxidant, which has relatively weak bacteric

29、idal 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 ultraso

30、nic scaling第七節(jié) 氧化劑 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(wú)髓牙漂白 Bleaching for fading tooth

31、that is caused by tetracycline, dental fluorosis; and discolored teeth for pulpless tooth.第七節(jié) 氧化劑 臨床應(yīng)用 Clinical application1.勿使30%過(guò)氧化氫溶液碰觸正常牙齒表面及黏膜；2.長(zhǎng)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(shí)不可用力過(guò)猛；4.禁忌使用1%3%過(guò)氧化氫水溶液沖洗深部的膿腔， 以免引起感染擴(kuò)散；5.避光、密塞、陰涼處保存。第七節(jié) 氧化劑 注 意 cautions 第八節(jié) 表面活性劑Section 8 Surfactant氯己定（Chlorhexidine）藥理作用廣譜殺菌、抑菌作用 Broad-spectrum bactericidal, antibacterial effect抗菌譜包括G+、G-菌、真菌及某些病毒 Antibacterial spectrum, including G, G- bacteria, fungi and