不同配伍生物膜对鸡胚绒毛尿囊膜血管生成的影响:寻求最佳组合方式

背景:如何使生长因子安全的在体内稳定持久的表达,并获得长期的促血管生成效应是亟待解决的问题,这就需要一个良好的药物缓释系统,即可控释的生物模拟系统.目的:探讨不同配伍的生物膜对鸡胚绒毛尿囊膜血管生成的影响,寻找最佳的组合方式.设计、时间及地点:生物材料学体外观察,于2008-06/2009-05在江苏省中医院中心实验室完成.材料:通过交联剂将肝素、中药与Ⅰ型胶原发生共价结合,然后rhVEGF165、碱性成纤维细胞生长因子与肝素发生生理性结合,将血管生成素1制成微球均匀植入生物膜内,即为实验所需生物膜.方法:将制备的生物膜置于正对观察窗的鸡胚绒毛尿囊膜表面的血管最少处,然后贴在鸡胚绒毛尿囊膜表面上,封口膜封闭假气室,继续孵育.实验组在给予生物膜基础上,依次加入0,10,50,100 ng碱性成纤维细胞生长因子,从中筛选出最显著促进鸡胚绒毛尿囊膜血管新生的组合作为生物膜1;再依次加入100 μL丹参注射液、黄芪注射液、三七总甙注射液、川芎嗪注射液,同法筛选出生物膜2:再依次加入10,50 ng血管生成素Ⅰ,同法筛选出生物膜3作为实验最终结果.同时设立空白对照组,鸡胚绒毛尿囊膜表面未贴生物膜,仅加入PBS.加药7 d后取绒毛尿囊膜,拍摄给药部位,采用Image Pro Plus 5.0.2进行数据收集.主要观察指标:不同配伍的生物膜对血管新生面积的影响.结果:①与空白对照组比较,生物膜+0,10,50,100 ng碱性成纤维细胞生长因子各组新生血管面积均明显增加,其中生物膜+100 ng碱性成纤维细胞生长因子组增加幅度最高(P<0.01),为此将其选为生物膜1.②与生物膜1组比较,生物膜1+三七总甙注射液组、生物膜1+川芎嗪注射液组无明显变化,生物膜1+丹参注射液组、生物膜1+黄芪注射液组新生血管面积分别增加25.48%,63.21%(P均<0.01),因此将生物膜1+黄芪注射液组作为生物膜2的最佳组成.③与生物膜2组比较,生物膜2+10 ng血管生成素Ⅰ组新生血管面积无明显差异;生物膜2+50 ng血管生成素Ⅰ组新生血管面积增加21.49%(P<0.05),因此将其作为生物膜3.结论:在实验制备的生物膜基础上,加入100 ng碱性成纤维细胞生长因子、100μL黄芪注射液组、50 ng血管生成素Ⅰ的组合,具有明显促进鸡胚绒毛尿囊膜血管生成的作用.     

Continuous brachial plexus block as treatment for the Pancoast syndrome

BACKGROUND: Six patients with severe neuropathic pain caused by a Pancoast tumor were treated with the continuous administration of local anesthetics. These patients had not responded to any other treatment, including nonsteroidal anti-inflammatory drugs, opioids, dexamethasone, tricyclic antidepressants, anticonvulsants, ketamine, and transcutaneous electric nerve stimulation. INTERVENTIONS: An axillary catheter was placed in the brachial plexus using a posterior approach that has not been described previously. A continuous infusion system of local anesthetics was delivered via a catheter. In two patients, the main purpose was to evaluate the technical possibilities and implications of this new approach. In all patients, the visual analogue scale score was evaluated until the patient died. In four additional patients, the quality of life and performance skills were recorded. RESULTS: In all patients, there was a significant reduction in the visual analog scale score, and there was an increase in performance skills and quality of life in four patients. No side effects occurred from this technique or from the continuous administration of local anesthetics. CONCLUSIONS: We conclude that neuropathic pain may be treated by local anesthetics administered through an axillary catheter placed in the brachial plexus. This technique is reversible and is preferable to destructive procedures such as cordotomy.     

一种皮肤黏膜消毒剂的毒理学评价

为研究醋酸氯已定复方皮肤黏膜消毒剂的毒性,采用动物试验法进行了毒理学评价。结果,以醋酸氯己定为评价剂量,该消毒剂对小鼠急性经口LD50>20 g/kg体重,属实际无毒;该药原液对家兔皮肤和眼睛黏膜均无刺激性;阴道黏膜刺激试验中,三只家兔阴道黏膜经病理组织学检查发现,均有不同程度的充血、水肿、白细胞浸润和组织变形,刺激反应平均积分为1.9,有极轻度刺激性。亚急性毒性试验3个剂量组大鼠给药28 d后,10项血液生化指标和6项血液指标测定结果与正常对照组比较均无显著性改变,病理组织学检查10个脏器末见明显异常。3个剂量诱导PCE微核细胞率与阴性对照组比较无显著性差异(P>0.05),对小鼠骨髓PCE无诱变作用。结论,该消毒剂属实际无毒,亚急性毒性评价无异常改变,对家兔阴道黏膜有轻度刺激性。     

Caudal anesthesia and its determinant factors

In 130 surgical patients with diseases and injuries in the area of the perineum and lower extremities the clinical effects of three modern local anesthetics: 2% solution of lidocaine, 0.5% solution of bupivacaine, 0.75% solution of ropivacaine and their combinations (2% lidocaine and 0.25% bupivacaine solution 2% lidocaine and ropivacaine 0.375% solution) were followed with regard to the influence of increasing volumes of local anesthetics and different rates of drug administration. It is established that an effective caudal anesthesia is provided with all modern local anesthetics, with increasing use of local anesthetic solution to 40 ml provides duration and the prevalence of sensory and motor blocks, the use of mixture of local anesthetics optimizes the development and maintenance of the caudal blockade.     

双氧胍复合消毒湿巾抑菌效果的实验研究

为了解双氧胍复合消毒湿巾的抑菌效果和刺激性,采用抑菌环试验和动物试验对其进行了观察。结果,以含20g/L双氧胍复合消毒液浸湿无纺布制成的湿巾对金黄色葡萄球菌和大肠杆菌的抑菌环平均直径分别为11.91mm和10.18mm。40g/L双氧胍复合消毒液对家兔皮肤和眼刺激试验的平均刺激积分指数均为0,属无刺激性。结论,20g/L双氧胍复合消毒湿巾对金黄色葡萄球菌及大肠杆菌均有较强抑菌作用,40g/L双氧胍复合消毒液对皮肤黏膜无刺激性。     

The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study

PurposeTo assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces.MethodsAll 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system – real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores.ResultsThe area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system – real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576).InterpretationBased on the results of this study, the landing error score system – real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.     

Benzyl alcohol with epinephrine as an alternative to lidocaine with epinephrine

A randomized, prospective, double-blind study comparing benzyl alcohol with epinephrine, 1:100,000 (BA), and lidocaine with epinephrine, 1:100,000 (LID), as local anesthetics was carried out on adult patients with simple lacerations. The two study groups were compared for pain of infiltration (100 mm visual analog scale) and need for additional anesthesia. Pain scores were compared by a Mann Whitney Independent Rank Sum test and need for additional anesthesia by a Fishers Exact test. A total of 52 subjects (26 per group) were analyzed. The groups were similar in demographics and wound characteristics. The median pain score for BA, 7.5 mm, was less than for LID, 19.5 mm (p = 0.049). Although more patients receiving BA required additional anesthesia as compared to LID (8/26 versus 2/26), this difference did not reach statistical significance. BA is a reasonable alternative local anesthetic to LID for patients who are allergic to LID.     

Evaluation of the mucosal irritation potency of co-spray dried Amioca/poly(acrylic acid) and Amioca/Carbopol 974P mixtures.

The purpose of this study was to evaluate the biocompatibility of different Amioca/poly(acrylic acid) and Amioca/Carbopol 974P co-spray dried mixtures with an alternative mucosal irritation test using slugs. The irritation potential of the mixtures was measured by the amount of mucus produced during a repeated 30-min contact period. Additionally, membrane damage was assessed by measuring the protein and enzyme release from the body wall of slugs after treatment. All the Amioca/poly(acrylic acid) co-spray dried mixtures (50:50 and 25:75 ratios) induced slight irritation of the mucosal tissue as was demonstrated by the significantly increased mucus production however no increased protein and enzyme release was detected. Co-spray dried Amioca/Carbopol 974P mixtures containing 40% and more Carbopol 974P demonstrated a significantly higher mucus production and release of cytosolic LDH, indicating membrane damage. The total mucus production of the slugs treated with the co-spray dried mixtures containing up to 20% Carbopol 974P was significantly higher compared to the blank slugs. However, these mixtures induced no membrane damage since no additional effect on the protein release and no enzyme release was detected. By co-spray drying up to 20% Carbopol 974P could be incorporated without showing a distinct sign of irritation. These mixtures can be considered as potentially safe bioadhesive carriers.     

Allergic reactions to local anesthetics

The majority of adverse reactions to local anesthetics are due to high plasma levels from excessive quantities of a drug. These are often blamed on idiosyncrasy, sensitivity, or allergy. The incidence of reactions due to allergy to local anesthetics is low compared to that with other drugs. Allergic reactions may be systemic or local. More than 80% of reactions are cell mediated, resulting in contact dermatitis. The remainder are caused by circulating antibodies that give rise to systemic anaphylaxis. Acute anaphylactic reactions are rare but invariably fatal unless promptly treated. Localized systemic anaphylactic reactions manifested by urticaria, laryngeal edema, and extrinsic asthma are less serious and amenable to treatment. There is no foolproof test for screening of susceptible persons. The intradermal test is of no value for detecting possible systemic sensitivity. The patch test is useful for detecting contact allergy. Systemic reactions are treated with epinephrine, antihistamines, and steroids. Contact dermatitis responds to topical steroids.     

STUDIES ON GONOCOCCUS INFECTION : III. CORRELATION OF GONOCOCCAL COLONY MORPHOLOGY WITH INFECTIVITY FOR THE CHICK EMBRYO

Comparable numbers of types 1, 2, 3, and 4 gonococci were placed on the intact chorioallantoic membrane of 236, 10-day old chick embryos. Types 1 and 2 organisms produced infection and could be cultured from chorioallantoic fluid 2 days later significantly more often (69%) than types 3 and 4 organisms (12%, P < 0.001). This confirms in an animal model the same correlation between colony types and infectivity observed in human volunteers and suggests that types 1 and 2 gonococci possess a fundamental virulence characteristic which is absent from types 3 and 4 organisms. Gonococcal infection of the chick embryo chorioallantoic cavity remains a useful model somewhat analogous to localized gonococcal infection in man.     

Lessons learned in the management of thirteen celiac axis injuries

OBJECTIVES: Celiac axis injuries are rare. The purposes of this study were to (1) review institutional experience, (2) determine additive effect on death of associated vessel injuries, and (3) correlate mortality rates with the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) for abdominal vascular injury. METHODS: This was a retrospective, 132-month study (January 1992 to December 2002) of patients with celiac axis injuries. RESULTS: Thirteen patients were included in the study. Mean revised trauma score was 5.35+/-2.63; mean injury severity score was 25+/-12. The mechanism was penetrating in 12 (92%) and blunt in 1 (8%); 3 of 13 had Emergency Department thoracotomy (100% mortality rate). Treatment included ligation in 11 and primary repair in 1; 1 exsanguinated. Overall survival was 5 of 13 (38%). Adjusted survival excluding patients who had Emergency Department thoracotomy was 5 of 10 patients (50%). Those surviving with isolated injuries included 57% of patients. Mortality rate versus AAST-OIS was grade III, 43% (3 of 7 patients); grade IV, 50% (1 of 2 patients); and grade V, 100% (4 of 4 patients). CONCLUSIONS: Celiac axis injuries are rare. Patients with isolated injuries have better survival rates. Mortality rate correlates well with AAST-OIS for abdominal vascular injury.     

How pharmacokinetic can help to choose the right local anesthetics during epidural infusion

Local anesthetics (LA) are used for the prevention and relief of both acute and chronic pain. The local anesthetic molecule consists of three components; each of these contributes distinct properties to the molecule. The onset of action is determined by tissue pH, the pKa of the particular agent used, and the amount of nonionized drug available in the tissue. The duration of action depends on the length of time that the drug binds to the membrane. Most local anesthetics were produced as enantiomeric mixtures known as racemates, although it is recognized that each enantiomer possesses quite different pharmacological properties. All amide-type local anesthetics, except for lidocaine, contain a chiral center, meaning that two enantiomers exist. Enantiomers have the same physicochemical properties and differ only in the way that they rotate plane-polarized light. However, their biological behavior, in terms of pharmacokinetic and pharmacodynamic characteristics, can be very different. The clinical response to a particular local anesthetic or its toxicity may vary substantially from patient to patient; dosing often requires careful titration. Interindividual variability is caused by several factors including the pharmacokinetics features of the drug, pharmacodynamic properties or patient’s characteristics.     

Physicochemical interaction of local anesthetics with lipid model systems--correlation with in vitro permeation and in vivo efficacy.

In dermal/transdermal drug administration stratum corneum (SC) is often the rate-limiting step. Furthermore, the intercellular lipid domain of SC is nowadays widely accepted as the major contributor to the skin barrier. The current work investigates whether the difference in the level of topical efficacy of local anesthetic compounds correlates with the type of interaction between the drug and the intercellular lipids of SC. Therefore, local anesthetics of varying topical efficacy were evaluated with respect to their effect on the morphology of various model lipid systems using small and wide angle X-ray diffraction (SWAXD) and differential scanning calorimetry (DSC). The model lipids used were glyceryl monooleate, sphingomyelin and lipids isolated from human SC. Furthermore, partitioning into isolated human SC as well as permeation through isolated human SC and human tape-stripped skin were investigated in vitro.The results indicate that local anesthetics may act as their own permeation enhancers by increasing the degree of hydrocarbon chain fluidity of the intercellular lipids. Eventually these interactions may induce non-lamellar reversed types of liquid crystalline structures locally in SC, which further facilitate the drug mobility. The large difference in topical efficacy of the investigated local anesthetics could not be explained simply by looking at their effect on the phase behavior of lipid model systems. Despite the similarities in physicochemical properties of these substances, the in vitro skin permeability differed markedly (AD>EMLA>lidocaine>prilocaine>sameridine). Thus, it was concluded that sufficient drug permeability over SC is essential to obtain local anesthesia by blocking the superficial nociceptors.     

The neurotoxicity of intrathecal lidocaine is enhanced in postpartum compared to virgin rats

During the perinatal period, the pharmacokinetics and pharmacodynamics of drugs may be altered. Data about the neurotoxicity of intrathecal local anesthetics in the peripartum period are lacking. So we hypothesized that the neurotoxicity of intrathecal lidocaine during perinatal period may be changed. Therefore, we designed the present study to determine whether the neurotoxicity of intrathecal lidocaine in postpartum rats would be different from that in nonpregnant, virgin rats. Postpartum and nonpregnant rats randomly received an intrathecal infusion of lidocaine 50 mg/mL in saline, lidocaine 20 mg/mL in saline, or saline for 1 h at a rate of 1 μL/min. Four days after drug infusion, the rats were assessed for persistent impairment of sensory and motor function (MF) using the tail‐flick (TF) test, paw pressure test, and MF score. Spinal cords and nerve roots were obtained for light and electron microscopic examinations, and the injury scores were compared between groups. The TF latencies and the mean nerve injury scores of the postpartum group were significantly higher than those of nonpregnant group. Lidocaine induced a dose‐dependent impairment in TF latencies and nerve injury scores. There was no significant interaction between postpartum and the drug. Our results suggest that the neurotoxicity of intrathecal lidocaine is enhanced in rats during the early postpartum period compared with nonpregnant, virgin rats.     

脑源性神经营养因子(BDNF)在多发性骨髓瘤患者血浆中表达增高及其意义的初步研究

为了研究多发性骨髓瘤 (MM)患者血浆中脑源性神经营养因子 (BDNF)、血管内皮细胞生长因子 (VEGF)的表达情况和BDNF与血管新生的关系 ,初步探讨BDNF在MM的发生与发展中的潜在作用 ,用酶联免疫吸附试验 (ELISA)测定MM患者与健康体检者血浆BDNF和VEGF的浓度 ;采用MTT法观察BDNF对脐静脉内皮细胞(HUVEC)增殖的作用 ;用改良的Boyden小室法和体外小管形成实验等体外血管新生模型观察BDNF对HUVEC迁移和形成血管通道的影响 ;采用鸡胚尿囊膜血管生成实验和小鼠matrigelplug方法观察BDNF对体内血管新生的影响。结果表明 :患者血浆BDNF浓度为 (4.2 2± 0 .6 4 )ng ml,与健康体检者 (2 .0 3± 0 .38)ng ml相比 ,差异有显著性意义 (P =0 .0 10 ) ;患者血浆VEGF浓度为 (79.35± 13.2 5 ) pg ml,与健康体检者 (34.4 1± 1.78)pg ml相比 ,差异有显著性意义 (P =0 .0 0 6 )。BDNF与VEGF水平间存在着相关性 (r =0 .4 30 ,P =0 .0 2 5 )。BDNF对HUVEC的增殖没有显著作用 ,但可明显促进HUVEC的迁移和管状结构形成 ;同时可促进鸡胚尿囊膜血管生成和matrigelplug中血管新生。结论 :MM患者血浆BDNF和VEGF显著增高 ,BDNF在体内外均具有明显的促血管新生效应 ,在MM的血管新生中可能起着重要作用。     

骨髓液促进鸡胚绒毛尿囊膜血管的生成

背景:生长因子能促进侧支血管的发育,且多种因子协同效果更为明显,骨髓液中富含多种生长因子.目的:观察血管内膜损伤后的骨髓液对鸡胚绒毛尿囊膜血管生成的作用.方法:受精蛋70枚在(37.5±0.5) ℃条件下孵育,第7天开窗,第8天将存活鸡胚随机分为生理盐水组、正常血清组、正常骨髓液组、损伤血清组、损伤骨髓液组以及血管内皮生成因子组,每组10枚,分别滴加5 μL兔正常血清、5 μL兔骨髓液、5 μL兔血管内膜损害血清、5 μL兔血管内膜损害骨髓液、5 μL生理盐水及0.3 μg 血管内皮生长因子进鸡胚绒毛尿囊膜中,连续3 d.数码相机拍照后平铺于载玻片上,计数鸡胚绒毛尿囊膜新生的血管数目.结果与结论:与正常血清组相比,正常骨髓液组、血管内膜损害血清组鸡胚绒毛尿囊膜新生的血管总数明显增多,大中血管明显增生;且血管内膜损害血清组大、中血管数更为明显增加.提示正常骨髓液具有明显的促进鸡胚绒毛尿囊膜模型血管生成的作用,其强度优于血管内皮生长因子;血管内膜损伤第7天的血清和骨髓液能够明显的促进鸡胚绒毛尿囊膜上的血管生成,其强度优于血管内皮生长因子组.     

Tetrodotoxin-resistant action potentials in dorsal root ganglion neurons are blocked by local anesthetics

Evidence from animal models and studies of human sensory nerves demonstrate that tetrodotoxin (TTX)-resistant Na(+) channels are present in sensory neurons and might play an important role in pain conduction and chronic pain. Recent investigations suggest that TTX-resistant Na(+) channels in the peripheral nervous system are less sensitive to local anesthetics than TTX-sensitive Na(+) channels. To test the effects of the clinically used local anesthetics lidocaine and bupivacaine on TTX-resistant action potentials (APs) in sensory neurons, we performed electrophysiological experiments on small dorsal root ganglion (DRG) neurons from young rats. Amplitudes, time to peak and duration of TTX-resistant APs were measured in Adelta- and C-type neurons using the patch-clamp technique in a thin slice preparation (150 microm), thus avoiding enzymatic treatment. With increasing concentrations of the local anesthetics, the AP amplitude was gradually reduced but the AP did not disappear abruptly. The concentrations needed to reduce the amplitudes of TTX-resistant APs by half were 760 microM for lidocaine and 110 microM for bupivacaine. Time to peak and duration of TTX-resistant APs were prolonged by local anesthetics. Trains of APs could be elicited in some neurons by long-lasting current injections, and the half-maximal concentrations needed to suppress these trains were 30 microM lidocaine or 10 microM bupivacaine. We suggest that the reduction in firing frequency at low concentrations of local anesthetic may explain the phenomenon of paresthesia when sensory information is gradually suppressed during spinal anesthesia.     

Long-term pain control in trigeminal neuralgia with local anesthetics using an indwelling catheter in the mandibular nerve

OBJECTIVE: The authors sought to determine the usefulness of long-term continuous trigeminal nerve block with local anesthetics using an indwelling catheter in a patient with trigeminal neuralgia. DESIGN: The study design included pain control in a patient with trigeminal neuralgia until the time of neurosurgical operation. SETTING: The study was conducted in the Dental Hospital of Tokyo Medical and Dental University. PATIENT: The patient was a 78-year-old woman with trigeminal neuralgia in the right maxillary region. Her pain could not be controlled by carbamazepine and was unbearable. INTERVENTION: The authors estimated the patient's pain intensity, quality, and locality using a visual analog scale to determine the effectiveness of continuous nerve block. OUTCOME MEASURES: Visual analog scores were measured during treatment. The treatment term was divided into three periods according to the difference of the catheter location and injection protocol (premandibular nerve block, infuser injection, and patient-controlled analgesia [PCA] pump injection). The authors also examined the patient's general condition and blood concentration of drugs. RESULTS: The visual analog values were 44.8 +/- 3.6, 26.7 +/- 3.5, and 11.9 +/- 3.1 mm in each period, respectively. The value in the PCA pump infusion period was significantly lower than that in the other periods. No side effects of the local anesthetics were observed on the patient's systemic condition. CONCLUSIONS: The authors controlled trigeminal neuralgia pain by blocking the mandibular nerve with local anesthetics administered through an indwelling catheter. Because the continuous nerve block with local anesthetics is reversible and only mildly toxic, this method is beneficial for pain control in patients with trigeminal neuralgia scheduled to undergo microvascular decompression.     

W/O microemulsions for ocular delivery: evaluation of ocular irritation and precorneal retention.

Water-in-oil microemulsions (w/o ME) capable of undergoing a phase-transition to lamellar liquid crystals (LC) or bicontinuous ME upon aqueous dilution were formulated using Crodamol EO, Crill 1 and Crillet 4, an alkanol or alkanediol as cosurfactant and water. The hypothesis that phase-transition of ME to LC may be induced by tears and serve to prolong precorneal retention was tested. The ocular irritation potential of components and formulations was assessed using a modified hen's egg chorioallantoic membrane test (HET-CAM) and the preocular retention of selected formulations was investigated in rabbit eye using gamma scintigraphy. Results showed that Crill 1, Crillet 4 and Crodamol EO were non-irritant. However, all other cosurfactants investigated were irritant and their irritation was dependent on their carbon chain length. A w/o ME formulated without cosurfactant showed a protective effect when a strong irritant (0.1 M NaOH) was used as the aqueous phase. Precorneal clearance studies revealed that the retention of colloidal and coarse dispersed systems was significantly greater than an aqueous solution with no significant difference between ME systems (containing 5% and 10% water) as well as o/w emulsion containing 85% water. Conversely, a LC system formulated without cosurfactant displayed a significantly greater retention compared to other formulations.     

油/水乳化胶用于牙体摩削时的镇痛效果

背景:牙体病治疗时高速涡轮机常直接刺激牙髓和根尖周组织引起疼痛,已有应用油/水乳化胶涂抹对其镇痛的报道.目的:观察应用油/水乳化胶用于牙体病牙齿制备治疗过程中的镇痛以及对牙齿电活力的影响.设计:自身配对随机对照观察.对象:选择2000-01/2001-01在第四军医大学口腔医学院牙体病科就诊的50例牙病患者,男28例,女22例,年龄18～55岁,平均36岁.纳入标准:①患牙均为浅洞需进行补牙治疗者,同时有两颗牙齿需要治疗,并且两颗患牙位置需要相隔4个牙位以上者或上下患牙.②无局麻药过敏史者.③无心血管疾病及口腔溃疡者.实验经过医院伦理委员会批准许可,患者对实验及治疗项目知情同意.方法:①分组及干预: 采用自身牙齿配对随机对照实验, 即随机抛硬币法将每位患者两颗牙齿分为实验牙和对照牙,实验牙齿冲洗干净,吹干,用棉签将2 g 油/水乳化胶(瑞典,Astra AB)涂于牙齿表面及两侧牙周黏膜,牙齿两侧用棉球阻塞防止唾液浸入.涂抹油/水乳化胶后5 min开始给予补牙治疗,对照牙不进行油/水乳化胶涂抹,直接治疗.②疼痛视觉模拟评分值和电活力测定:采用疼痛视觉模拟评分法评价实验牙及对照牙磨切时疼痛情况,在油/水乳化胶处理牙齿前及处理5 min后分别应用美国产SYBLONENDO电活力仪检测实验牙电活力.主要观察指标:疼痛视觉模拟评分评分及电活力检测结果.结果:患者50例均进入结果分析.①疼痛视觉模拟评分评分结果:对照牙治疗时平均疼痛视觉模拟评分分值明高于实验牙,差异有统计学意义[(7.42±0.51)分,(2.54 ±0.84)分,P < 0.01].②牙电活力:油/水乳化胶处理前实验牙电活力平均值低于处理后,差异有统计学意义[(45.76±1.56)分,(64.34±2.28)分,P < 0.01].结论:油/水乳化胶涂抹可提高牙齿电活力,对牙体病牙齿制备时有镇痛作用.