第十六章消毒防腐药

1、目的要求目的要求 Aims Aims了解消毒防腐药的概念、作用机制、影响因素及分类 Understand the concept, mechanism, influencing factors and classification of Disinfectants & Antiseptics 熟悉酚类、醛类、酸类、碱性药物、卤素类、氧化剂、表面活性剂的代表药物及其临床应用、注意事项等 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环境环境EnvironEnvironm e n tm e n t器械器械InstrumInstrume n t se n t s体表体表B o d y B o d y surfacesurface 第一节 消毒防腐药概述能杀灭或抑制病原微生物生长繁殖的药物能杀灭或抑制病原微生物生长繁殖的药物 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消毒药消毒药防腐药防腐药迅速杀灭病原微生物迅速杀灭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药消毒防腐药 D&A D&AQuickly kill pathogenic microorganismsQuickly kill pathogenic microorganismsInhibition the proliferation of pathogenic microo

4、rganismsInhibition the proliferation of pathogenic microorganisms杀菌抑菌杀菌抑菌 使蛋白质变性使蛋白质变性 与酶系统结合与酶系统结合 增加膜通透性增加膜通透性 作用机制作用机制 Mechanism MechanismDenature proteinsCombined with the enzyme systemIncrease permeability of membrane SterilizationInhibition of bacteria药物浓度和作用时间药物浓度和作用时间微生物敏感性微生物敏感性 溶溶 媒媒 环境温度环

5、境温度有机物质有机物质酸碱度酸碱度 药物配伍药物配伍相互作用相互作用药物性质药物性质 Drug concentration and function timeMenstruumEnvironment temperaturePH valueOrganicsMicrobial sensitivityCombination and Interactions of drugsPharmacy Properties药效分类药效分类 By effectiveness杀灭一切病原微生物，包括芽孢杀灭细菌繁殖体和多数真菌、病毒，不能杀灭芽孢杀灭部分细菌繁殖体、真菌、病毒，不能杀灭芽胞、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 类：苯酚、甲酚、麝香草酚、丁香酚类：苯酚、甲酚、麝香草酚、丁香酚醛醛 类：甲醛、多聚甲醛、戊二

7、醛类：甲醛、多聚甲醛、戊二醛酸酸 类：硼酸、枸橼酸类：硼酸、枸橼酸碱碱 类：硼砂、碳酸氢钠、氢氧化钙类：硼砂、碳酸氢钠、氢氧化钙卤素类：次氯酸钠、氯胺卤素类：次氯酸钠、氯胺-T-T、碘仿、聚维酮碘、碘仿、聚维酮碘氧化剂：过氧化氢、高锰酸钾氧化剂：过氧化氢、高锰酸钾表面活性剂：氯己定、地喹氯铵、西吡氯铵表面活性剂：氯己定、地喹氯铵、西吡氯铵染染 料料 类：依沙吖啶、甲紫类：依沙吖啶、甲紫化学分类化学分类 By Chemistry (Non-priority knowledge point)由致病和非致病微生物构成的微生态环境由致病和非致病微生物构成的微生态环境感染疾病：牙周病、龋齿、牙髓炎、根尖

8、周围感染感染疾病：牙周病、龋齿、牙髓炎、根尖周围感染局部使用消毒防腐药局部使用消毒防腐药 Non-priority knowledge point 第二节 酚 类 包包 括括 与微生物蛋白质结合使之变性、沉淀和改变 细胞膜通透性属于中效消毒剂作用机制作用机制 Mechanism Mechanism包包 括括口腔常用药物口腔常用药物 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） 该类药物遇光或长期放置易氧化，色泽加深，该类药物遇光或长期放置易

9、氧化，色泽加深，应置避光容器中应置避光容器中 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.药理作用药理作用临床应用临床应用 Clinical application浓度不同作用不同浓度不同作用不同 Different concentrations play different roles ：0.2% ：抑菌：抑菌 Antibacterial 1 % ：杀菌，对：杀菌，对G+、 G-菌有效菌有效 Sterilization, effective against G+/G- bacteria 1.3% ：杀灭真菌：杀灭真菌 Effective against fungi5 % ：杀灭结核杆菌：

11、杀灭结核杆菌 Effective against mycobacterium tuberculosis对芽孢和病毒无效对芽孢和病毒无效 Ineffective against spores and viruses樟脑苯酚溶液樟脑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 不良反应不良反应 Adverse reactions腐蚀性和刺激性腐蚀性和刺激性 Corrosive and irritati

12、ng对婴儿有致命性对婴儿有致命性 There are fatal to infants高浓度外用可致组织损伤高浓度外用可致组织损伤 High concentrations can cause tissue damage 注意事项注意事项 Cautions误服本品可引起局部组织腐蚀、疼痛、恶误服本品可引起局部组织腐蚀、疼痛、恶心、心、 呕吐、出汗和腹泻，出现短暂的兴奋，呕吐、出汗和腹泻，出现短暂的兴奋，随之知随之知 觉丧失，中枢神经系统抑制、循环和呼觉丧失，中枢神经系统抑制、循环和呼吸衰竭吸衰竭 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避免应用在破损皮肤和伤口避免应用在破损皮肤和伤口 Avoid application on damaged skin and wounds 第三节 醛 类 醛基与微生物核酸和蛋白质的氨基相结合， 使其变性、沉淀 Aldehyde combines wit

14、h the amino group of microbial nucleic acids and proteins, makes them denatured and precipitated 属于高效消毒剂 Belong to efficient disinfectant甲甲 醛醛 多聚甲醛多聚甲醛 戊二醛戊二醛作用机制作用机制 Mechanism Mechanism 口腔常用药物口腔常用药物 Commonly used medicine Commonly used medicine in dentistry in dentistry 对细菌、芽孢、真菌、病毒等均有效对细菌、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，具强烈刺激性，特臭，强烈刺激鼻、甲醛水溶液，具强烈刺激性，特臭，强烈刺激鼻、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 点点 Characters药理作用药理作用 Pharmacological action Pharmacological action挥发性广谱杀菌剂挥发性广谱杀菌剂 Volatile broad-spectrum bactericide能使蛋白质变性能使蛋白质变性 Make protein denaturation对细菌、真菌及病毒均有效，对芽孢和抗酸杆菌作用缓慢对细菌、真菌及病毒均有效，对芽孢和抗酸杆菌作用缓慢升高温度可加速其杀灭芽孢，相对湿度升高温度可加速其杀灭芽孢，相对湿度75%时作用最强时作用最强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% 临床应用临床应用 Clinical application用于对湿、热敏感、易腐蚀的医疗用用品灭用于对湿、热敏感、易腐蚀的医疗用用品灭菌菌 Sterilization for wet, heat-sensiti

18、ve and perishable medical supplies病理标本的防腐保存病理标本的防腐保存 Save pathological specimens from corrosion 与其他药物配伍用于根管消毒与其他药物配伍用于根管消毒 Synergetic medical application in root canal disinfection 不良反应不良反应 Adverse reaction 接触可引起过敏性皮炎接触可引起过敏性皮炎 Can cause allergic contact dermatitis误服可刺激口腔、咽喉和消化道误服可刺激口腔、咽喉和消化道黏膜黏膜 Mi

19、suse can irritate mouth, throat and digestive tract mucosaNon-priority knowledge point不良反应不良反应皮肤直接接触可引起过敏性皮炎、色斑、坏死摄入会引起口、咽喉、胸部和胃剧烈烧灼痛以及黏膜炎症、溃疡和坏死甲醛气体对眼、鼻、上呼吸道有刺激性用于根管消毒易渗透至根尖周组织引起化学性根尖炎Non-priority knowledge point药理作用药理作用 Pharmacological action Pharmacological action 快速杀快速杀G+G+、G-G-菌菌 Quickly kill G

20、+ and G- Quickly kill G+ and G- bacteriabacteria对某些真菌和病毒有效对某些真菌和病毒有效 Effective to some Effective to some fungi and virusesfungi and viruses对芽孢有缓慢杀菌作用对芽孢有缓慢杀菌作用 Slow effect on Slow effect on sporesspores 可与异丙醇配伍呈协同杀菌作用可与异丙醇配伍呈协同杀菌作用 Synergistic bactericidal effect when combines with isopropanol器械消毒：器

21、械消毒：2%碱性溶液（碱性溶液（ 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 牙髓切断后覆盖剂：与氢氧化钙配伍使用牙髓切断后覆盖剂：与氢氧化钙配伍使用 After pulpotomy, used as dental pulp capping: compatibility with calcium hydroxide公认较理想的消毒药公认较理想的消

22、毒药临床应用临床应用用于金属器械消毒，先加碱性药物，再加亚硝酸钠用于金属器械消毒，先加碱性药物，再加亚硝酸钠碱性溶液对铝制品有腐蚀碱性溶液对铝制品有腐蚀空气中最高限量为空气中最高限量为0.05ppm，应注意避光密闭，应注意避光密闭储存温度不超过储存温度不超过40注意事项注意事项Non-priority knowledge point 第四节 酸 类离解的离解的H+能与菌体蛋白中氨基结合，使蛋白质能与菌体蛋白中氨基结合，使蛋白质变性而呈现杀菌作用；变性而呈现杀菌作用；酸性亦可改变微生物生存环境，影响代谢呈抑菌作用。酸性亦可改变微生物生存环境，影响代谢呈抑菌作用。乳酸乳酸 醋酸醋酸 苯甲酸苯甲酸

23、水杨酸水杨酸 枸橼酸枸橼酸 硼酸硼酸作用机制作用机制 Mechanism Mechanism口腔常用药物口腔常用药物 Commonly used medicine in Commonly used medicine in dentistry dentistry Non-priority knowledge pointNon-priority knowledge point药理作用药理作用 Pharmacological action临床应用临床应用 Clinical application具有一定抗菌作用具有一定抗菌作用牙周手术中，可使牙面轻度脱钙，有助于与龈瓣内新生的胶原牙周手术中，可使牙面

24、轻度脱钙，有助于与龈瓣内新生的胶原纤维发生新的连接纤维发生新的连接降解根面内毒素，利于牙周膜来源的成纤维细胞贴附根面生长降解根面内毒素，利于牙周膜来源的成纤维细胞贴附根面生长处理牙周手术中暴露的牙根面处理牙周手术中暴露的牙根面Non-priority knowledge point 第五节 碱性药物一般碱性药物：一般碱性药物： General alkalis General alkalis硼砂、碳酸氢钠、氢氧化钙等通过改变细菌正常生长环境，硼砂、碳酸氢钠、氢氧化钙等通过改变细菌正常生长环境，呈现抑菌、防腐作用呈现抑菌、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强碱性药物：强碱性药物：Strong alkalisStrong alkalis如

26、氢氧化钠具溶解蛋白的强腐蚀性，呈现杀菌作用如氢氧化钠具溶解蛋白的强腐蚀性，呈现杀菌作用 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作用机制作用机制 Mechanism Mechanism 药理作用药理作用 Pharmacolo

27、gical action可促进牙髓细胞表达和激活碱性磷酸酶，诱导牙髓细胞分化出成牙本质细胞，并促进牙本质基质的形成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 药理作用药理作用 Pharmacological action本品的强碱性有利于钙化过程，对细菌有抑制生长作用The strong a

28、lkaline character of this medicine is favorable to calcification by inhibiting the growth of bacteria直接或间接覆盖牙髓；直接或间接覆盖牙髓；For direct or indirect pulp cappingFor direct or indirect pulp capping根尖孔未完全形成死髓牙，在根管预备消毒后，以氢氧化钙糊剂根尖孔未完全形成死髓牙，在根管预备消毒后，以氢氧化钙糊剂 充填根管，有些牙根尖部可继续发育完成，即充填根管，有些牙根尖部可继续发育完成，即“根尖诱导形成术根尖诱导

29、形成术”；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 可单独或与其他成分（如碘仿等）配成合剂填充根管，促进牙本质和可单独或与其他成分（如碘仿等）配成合剂填充根管，促进牙本质和骨质修复；骨质修复；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近牙颈部根管侧穿，可将氢氧化钙放于侧穿处，促使形成钙化屏近牙颈部根管侧穿，可将氢氧化钙放于侧穿处，促使形成钙化屏 障，封闭侧穿处。障，封闭侧穿处。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.临床应用临床应用 Clinical application 第六节 卤 素 类 通过卤原子卤化和氧化微生物原浆蛋白活性基团，改变细胞膜通透性，并与蛋白质的氨基结合而使之变性作用机制作用机制 Mechanism Mechanism口腔常用药物口腔常

33、用药物 Commonly used Commonly used medicine in dentistry medicine in dentistry 次氯酸钠次氯酸钠 氯胺氯胺-T -T 碘碘 仿仿 聚维酮碘聚维酮碘 药理作用药理作用 Pharmacological action Pharmacological action 临床应用临床应用 Clinical application广谱强效杀菌剂；毒性低，对组织刺激性小；对细菌、病毒、真菌芽孢均有效；不易产生耐药性。 手术前皮肤和手消毒 口腔溃疡、冠周炎、口腔真菌感染等外用或含漱 牙周袋内冲洗 义齿消毒 第七节 氧 化 剂 通过氧化反应使细

34、菌原浆蛋白的活性基团被氧化， 使细胞壁和细胞膜通透性发生改变，破坏细胞内 外物质平衡使微生物死亡 直接作用于酶系统，干扰细菌代谢，抑制生长繁殖过氧化氢溶液过氧化氢溶液 高锰酸钾高锰酸钾作用机制作用机制口腔常用口腔常用Non-priority knowledge point双氧水双氧水药理作用药理作用 Pharmacological effects 氧化性消毒剂，杀菌力相对较弱；氧化性消毒剂，杀菌力相对较弱； 具防腐、除臭作用；具防腐、除臭作用；尤其对专性厌氧菌敏感。尤其对专性厌氧菌敏感。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 坏死性龈口炎、牙周炎、冠周炎、干槽症 Necrotizing gingival stomatitis, periodontitis, pericoronitis, alveolitis 2.根管冲洗 Root canal irrigation3.超声波洁牙前含漱 Application for rinse before ultr

36、asonic scaling 临床应用临床应用 Clinical application4.龈上洁治和龈下刮治术后冲洗 Irrigation in super/sub-gingival scaling5.用于顽固性龈缘充血、反复牙周基础治疗后效果不佳者Apply for patients who have refractory gingival congestion, or poor healing after repeated periodontal therapy6.牙齿漂白 Bleaching 四环素牙、氟牙症的脱色；变色无髓牙漂白 Bleaching for fading tooth that is caused by tetracycline, dental fluorosis; and discolored teeth for pulpless tooth. 临床应用临床应用 Clinical application1.勿使30%过氧化氢溶液碰触正常牙齿表面及黏膜；2.长期使用本品含漱，应与碳酸氢钠溶液交替， 可中和其酸性；3.根管冲洗时不可用力过猛；4.禁忌使用1%3%过氧化氢