牙髓失活剂的种类及用法

牙髓失活剂的种类及用法 多聚甲醛(三聚甲醛,简称"三甲") 多聚甲醛引起牙髓血运障碍而发生坏死,毒性弱于亚砷酸较安全,作用相对缓慢 封药时间:全牙髓14天 根髓7-10天 亚砷酸，又名三氧化二砷 它能使牙髓失活，达到杀死牙髓的目的。但是它具有很强的渗透性，对很多组织都有毒性，而且可呈跳跃性失活。 亚砷酸(As2O3)毒性强,细胞原生质,神经,血管 作用迅速:牙髓血运的影响 无自限性:化学性根尖周炎 严格控制封药时间:24-48 h 禁用于根尖孔未形成的患牙 复方三氧化二砷糊剂(上海) 成分: 本品主要成份及其化学名称为:三氧化二砷 ，为灰黑糊状。 适应症:用于成人牙髓失活 用法:取约粟米大小一点，置于露髓处，严密封闭，封药时间24-48小时内，必须及时取出。 六、不良反应:封药后可能出现疼痛症状。 七、禁忌:1、对盐酸普鲁卡因过敏者禁用。 2、前牙、乳牙或根尖未形成的牙齿禁用。 八、注意事项 1、本品含毒性药品，须按《医疗用毒性药品管理方法》规定管理。 2、不得内服 3、本品的使用剂量、放入位置、封药时间对其疗效影响极大，本品作用强且无自限性，使用最多24-28小时即可使用牙髓失活，但毒性大，故应在48小时内取出，以防继续破坏深部组织，产生药物性根尖周炎，甚至引起牙周组织坏死等。 4、窝洞一定要严密封闭，防止药物不慎溢出破坏牙龈组织和牙槽骨、牙周膜 。 九、儿童用药:本品不适于乳牙的失活 。 十五、药物过量:封药量过量，封药时间过长或病人延迟复诊，均可产生砷性尖周炎，如药物不慎溢出窝洞，去除暂封物。彻底刮除变色和无感觉的牙龈组织，用盐水冲洗，创面可用10%碘酊局部涂擦或填塞碘仿糊剂或沙条治疗，直至牙龈组织恢复正常颜色和感觉后再做进integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 一步治疗。 十六 、药物毒理:三氧化二砷是强烈的原生质毒类药物，能迅速与细胞酶系统的巯基(SH)结合，阻碍细胞的呼吸过程，使之丧失生理功能，三氧化二砷作用于牙髓，可使用其细胞坏死失活。 有效期:2年 三氧化二砷I型失活剂 (武汉) 一、主要成分:I型产品主要由三氧化二砷、赋型剂等组成，为黑色均匀糊状物，有一定塑型性。II型产品主要由金属砷、赋型剂等组成，为灰黑色絮状物，有一定塑型性。 二、使用方法 1、有执业医师掌握使用。使用牙髓失活材料前，应向患者说明使用的目的和材料具有的毒性。待患者同意并按患者可能的复诊时间，选择不同型号的牙髓失活材料进行治疗，避免因未能按时复诊，而造成牙髓失活材料使用时间超过规定的使用时间而引起根尖组织损伤。 2、清除龋洞内食物残渣和软化牙本质，在近髓处以挖匙或锐利球钻使牙髓暴露。注意动作轻快，避免造成剧烈疼痛。封牙髓失活材料之前，不必彻底除去腐质，可以待牙髓失活后再除去。 3、隔离唾液。擦干龋洞，置适量牙髓失活材料(一般如小球钻大小)于穿髓孔处，使其紧贴于暴露的牙髓组织，不可加压将牙髓失活材料压进髓腔内，以免失活过程中发生剧痛，封牙髓失活材料时如出血多，可用浸有酚或肾上腺素的小棉球压入窝洞中片刻，止血后再放入牙髓失活材料。 4、用氧化锌丁香酚粘固剂暂封窝洞，封粘固剂时，要注意不能推动牙髓失活材料，如果将其移位，未接触穿孔，则不能达到失活效果;邻面的龋洞更要注意，若将牙髓失活材料移位并接触牙龈，会损伤牙龈甚至牙槽骨，造成极为不良的后果。 5、I型牙髓失活材料使用时间为24~48小时，II型牙髓失活材料使用时间为7~14天，到时必须取出。 三、注意事项 1、本品含毒性物质，须按国家有关规定管理。 2、临床操作人员必须具有执业医师资格，并按本材料适用范围和使用方法选择和使用本材料。 3、牙髓失活材料使用时间须严格按照使用方法的规定，到时必须取出。 4、使用牙髓失活材料可能会发生疼痛，事先应告知患者，如患者发生剧烈疼痛，必须立即就诊，应去除暂封物，使髓腔内压力缓解，并将浸有丁香酚的棉球放入窝洞中，以减轻疼痛，随后重新置入牙髓失活材料，并将小棉球覆盖作为缓冲，以暂封物封闭窝洞，注意不要施加过大压力，若重封药后仍出现剧痛，则立即除去暂封物，最好在局部麻醉下彻底去除牙髓 。 5、牙髓失活材料使用不当可引起的牙周组织坏死，预防的方法是:A慎用牙髓失活材料B处理近牙龈处的窝洞，封牙髓失活材料前应特别注意干燥窝洞C位于牙龈下的窝洞可采用分层封材料的方法，即先用小棉球覆盖穿髓孔，在龈壁处紧贴牙龈封一层氧化锌丁香酚粘固剂然后取出穿髓孔处的小棉球覆盖穿髓孔，在龈壁处紧贴牙龈封一层氧化锌丁香酚粘固剂，然后取出穿髓孔处的小棉球，改换为牙髓失活材料，再用氧化锌丁香酚粘固剂密封。D如果牙integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 龈乳头出血多又不易止血，或牙髓长入龋洞中时，可在麻醉下将窝洞扩展到牙合面，行麻醉干髓术。当然，最好在麻醉下开髓，行根管治疗术。对已造成牙周损伤者，采取一些 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 :A若仅龈乳头表面坏死，可用锐利挖匙除去坏死部分，以3%过氧化氢溶液冲洗后除碘甘油，碘与砷剂结合成为稳定的碘化物，可防止砷剂对深部组织的继续破坏。B如果烧伤达牙槽骨时，应将牙龈及牙槽骨的坏死部分除去，直至刮到骨面使患者有感觉时为止，用3%过氧化氢液冲洗，擦干后敷以碘仿沙条于牙间隙的创面上，然后用氧化锌丁香酚粘固剂覆盖，碘剂可以与已进入组织内的砷剂结合成Asl3沉淀物，还可以保护创面，防止继发感染，促进愈合，开始时2~3天换药1次以后1~2次周更换一次，直到骨面有龈组织覆盖为止，牙髓失活材料使用不当造成的牙周组织损伤或坏死，往往创面需要数周才痊愈，由于牙槽骨不能再生，易造成牙间隙过大，食物嵌塞和邻牙根面过敏等后遗症，故操作时，应细心、谨慎力求避免这类问题的发生。 6、取出的牙髓失活材料应置入回收瓶中，并按毒性物质的管理规定管理，到达一定量后送回生产厂家集中处理或按毒性物质的管理中规定的方法处理。 7、对盐酸普鲁卡因过敏者禁用。 四、保质期:2年 三氧化二砷II型失活剂 (武汉) 一、主要成分:I型产品主要由三氧化二砷、赋型剂等组成，为黑色均匀糊状物，有一定塑型性。II型产品主要由金属砷、赋型剂等组成，为灰黑色絮状物，有一定塑型性。 二、使用方法 1、有执业医师掌握使用。使用牙髓失活材料前，应向患者说明使用的目的和材料具有的毒性。待患者同意并按患者可能的复诊时间，选择不同型号的牙髓失活材料进行治疗，避免因未能按时复诊，而造成牙髓失活材料使用时间超过规定的使用时间而引起根尖组织损伤。 2、清除龋洞内食物残渣和软化牙本质，在近髓处以挖匙或锐利球钻使牙髓暴露。注意动作轻快，避免造成剧烈疼痛。封牙髓失活材料之前，不必彻底除去腐质，可以待牙髓失活后再除去。 3、隔离唾液。擦干龋洞，置适量牙髓失活材料(一般如小球钻大小)于穿髓孔处，使其紧贴于暴露的牙髓组织，不可加压将牙髓失活材料压进髓腔内，以免失活过程中发生剧痛，封牙髓失活材料时如出血多，可用浸有酚或肾上腺素的小棉球压入窝洞中片刻，止血后再放入牙髓失活材料。 4、用氧化锌丁香酚粘固剂暂封窝洞，封粘固剂时，要注意不能推动牙髓失活材料，如果将其移位，未接触穿孔，则不能达到失活效果;邻面的龋洞更要注意，若将牙髓失活材料移位并接触牙龈，会损伤牙龈甚至牙槽骨，造成极为不良的后果。 5、I型牙髓失活材料使用时间为24~48小时，II型牙髓失活材料使用时间为7~14天，到时必须取出。 三、注意事项 1、本品含毒性物质，须按国家有关规定管理。 2、临床操作人员必须具有执业医师资格，并按本材料适用范围和使用方法选择和使用本材料。 3、牙髓失活材料使用时间须严格按照使用方法的规定，到时必须取出。 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 4、使用牙髓失活材料可能会发生疼痛，事先应告知患者，如患者发生剧烈疼痛，必须立即就诊，应去除暂封物，使髓腔内压力缓解，并将浸有丁香酚的棉球放入窝洞中，以减轻疼痛，随后重新置入牙髓失活材料，并将小棉球覆盖作为缓冲，以暂封物封闭窝洞，注意不要施加过大压力，若重封药后仍出现剧痛，则立即除去暂封物，最好在局部麻醉下彻底去除牙髓 。 5、牙髓失活材料使用不当可引起的牙周组织坏死，预防的方法是:A慎用牙髓失活材料B处理近牙龈处的窝洞，封牙髓失活材料前应特别注意干燥窝洞C位于牙龈下的窝洞可采用分层封材料的方法，即先用小棉球覆盖穿髓孔，在龈壁处紧贴牙龈封一层氧化锌丁香酚粘固剂然后取出穿髓孔处的小棉球覆盖穿髓孔，在龈壁处紧贴牙龈封一层氧化锌丁香酚粘固剂，然后取出穿髓孔处的小棉球，改换为牙髓失活材料，再用氧化锌丁香酚粘固剂密封。D如果牙龈乳头出血多又不易止血，或牙髓长入龋洞中时，可在麻醉下将窝洞扩展到牙合面，行麻醉干髓术。当然，最好在麻醉下开髓，行根管治疗术。对已造成牙周损伤者，采取一些措施:A若仅龈乳头表面坏死，可用锐利挖匙除去坏死部分，以3%过氧化氢溶液冲洗后除碘甘油，碘与砷剂结合成为稳定的碘化物，可防止砷剂对深部组织的继续破坏。B如果烧伤达牙槽骨时，应将牙龈及牙槽骨的坏死部分除去，直至刮到骨面使患者有感觉时为止，用3%过氧化氢液冲洗，擦干后敷以碘仿沙条于牙间隙的创面上，然后用氧化锌丁香酚粘固剂覆盖，碘剂可以与已进入组织内的砷剂结合成Asl3沉淀物，还可以保护创面，防止继发感染，促进愈合，开始时2~3天换药1次以后1~2次周更换一次，直到骨面有龈组织覆盖为止，牙髓失活材料使用不当造成的牙周组织损伤或坏死，往往创面需要数周才痊愈，由于牙槽骨不能再生，易造成牙间隙过大，食物嵌塞和邻牙根面过敏等后遗症，故操作时，应细心、谨慎力求避免这类问题的发生。 6、取出的牙髓失活材料应置入回收瓶中，并按毒性物质的管理规定管理，到达一定量后送回生产厂家集中处理或按毒性物质的管理中规定的方法处理。 7、对盐酸普鲁卡因过敏者禁用。 四、保质期:2年 Depulpin 多聚甲醛失活剂 Depulpin是一种不含砷的牙髓失活剂 适应症: 适用于做坏牙摘除后或切除前，使牙髓失活。还用于切除坏死的牙髓后，剩余部分的失活处理 特点: 不含砷 是安全有效的牙髓失活处理剂 具有杀菌消毒的作用 蓝色试剂便于牙医视觉操作 具有迅速的止疼效果 被证实同时具有牙髓消炎作用 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 注射剂包装，可直接使用 德国梅卡无砷失活剂Antipulp 产品说明书: 1、它不含砷、无毒不会对人体造成伤害，传统的产品含砷、有毒害。 2、它的失活作用安全而没有疼痛，7-12天可以完全麻醉神经，而不是杀死神经，使医生在拔髓时病人不会感觉到疼痛。 3、颜色为蓝色，容易辨认和清洁，气味芳香，病人比较容易接受。 4、适合用于任何人群，特别是小孩子的急性牙髓炎，涂上去5分钟即可止痛。 操作说明: 取米粒大小放在根管口，用小棉铧球或滴几滴丁香油，然后封上暂封膏即可。 目前市场上出售的牙髓失活剂，可塑性、粘结性差，易松散，在封入?、?类洞时易造成泄漏，灼伤牙龈。10年来我科对其进行改进，介绍如下: 1 材料 牙髓失活剂 6g(市售);棉块 1.5g;麝香草酚 0.5g;盐酸地卡因 1g;盐酸麻黄碱 0.1g;雷佛奴尔 0.5h;丁香油酚适量。 2 方法 将牙髓失活剂、麝香草酚、地卡因、麻黄碱、雷佛奴尔置于乳钵中，研磨湿润。加入丁香油适量，再加入消毒小棉碎片，使药物均匀渗入棉花中，然后置于密闭瓶中即可应用。 3 优点 成型好，操作方便，制作简单，不易造成泄漏，也不影响失活效果。 在临床上在对于活髓牙需要去髓时，一般进行麻醉下去髓，可如果麻醉效果不佳，则可先开髓，封失活剂，过几天后待牙髓完全失活后再进行后继治疗，这样可以减轻患者的痛苦，那么对于常用失活剂我们应该如何选择呢, 1.亚砷酸(三氧化二砷) 性能:麻痹神经纤维，破坏分解髓鞘及轴素，使血管扩张充血出血形成血栓造成循环障碍并通过细胞膜作用于线粒体，破坏细胞呼吸，使其丧失生活功能 用途:恒牙失活 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 注意事项:砷剂系剧毒，不可使药物漏出接触牙齿周围的软组织，砷剂在牙髓组织中渗透无自限性，易造成牙槽骨坏死，使用时要严格控制药物剂量和封药时间。还可出现全身过敏，神经麻痹。封砷过程中可能会封药疼痛，根尖处失活不充分，拔髓不适。 封药时间:24-48小时 2.金属砷: 与三氧化二砷相同，与牙髓接触后氧化为亚砷酸在失活与牙髓，作用缓慢。 用途:乳牙失活。 注意事项:同三氧化二砷。不可将失活剂压入髓腔，盐酸普鲁卡因过敏者禁用 封药时间:5-8天(7-14)乳牙2-4天 3. 三聚甲醛与多聚甲醛 性能:两者作用相同，缓慢释放甲醛，渗入牙髓，使血管神经末梢麻痹，血管扩张充血，形成血栓，牙髓坏死。同时脱水作用，使牙髓呈干随化，有利于牙髓被完整拔除，药物渗透较彻底。 用途:乳牙失活、恒牙失活。 封药时间:2周 3.中药制剂(蟾酥) 性能:短时间神经麻痹，无痛，较长时间使牙髓组织坏死。 封药时间:2-4天。 在封失活剂使用前检查是否有底穿，有底穿是封失活剂的禁忌症。牙龋坏死严重特别是牙颈部洞要注意暂封严密，用含碘仿的丁香油氧化锌糊剂暂封能防止砷失活剂泄漏，因碘可直接作用于砷剂而使后者失去毒性。 亚砷酸失活剂引起急性胃肠炎，是由于患者自行去除暂封物，使亚砷酸随唾液吞咽入胃，刺激局部，胃肠血管麻痹扩张，血清渗出，引起腹痛、呕吐、喉头灼痛、流涎等。在失活剂毒副作用病例中较为特殊，应引起医护人员的注意。如患者需要去除暂封物时，应彻底漱口之后才可吞咽。 对于失活剂的使用一定要慎用。 牙髓失活剂三氧化二砷泄漏烧坏牙龈处理方法: 首先将失活剂从烧坏牙龈局部取出，然后将坏死组织用锐利的挖匙刮尽，直至有鲜红的血液渗出患者有痛感为止，再用生理盐水和双氧水交替冲洗，局部放置碘仿糊剂，这样可以与残留的及进入深层组织的三氧化二砷发生中和反应，形成无毒的碘化砷沉淀物，同时还有消炎收敛的作用。 失活剂致药物性根尖周炎处理方法: 砷剂封入时间过长或根尖孔未形成过大，出现咬合痛,自发痛等症状， 处理时彻底清理根管，用生理盐水和双氧水交替冲洗根管，根管内封入碘制剂(氢氧化钙+加碘仿)，每周定期复查。 失活药剂过敏处理方法: integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, 暂封其出现全身过敏反应临床极少见，如出现一般反应是当天(或即可)身不适,胸闷,腹泻，粘膜广泛充血水肿，小板减少性紫癜，出现意识模糊，休克等情况，失活剂亚砷酸(俗称砒霜)中毒量是10~50mg，致死量为100~200mg。 医护人员应掌握失活剂引起毒副反应时的处理原则 无论引起何种不良反应，均应马上去除暂封失活剂，并彻底冲洗干净。引起组织坏死按颌面外科治疗原则进行治疗。引起神经损害按内科的治疗原则进行治疗，包括营养神经、物理理疗等手段促进神经的恢复。出现过敏反应特别是过敏性休克时，在抗过敏的同时去除暂封失活剂，彻底冲洗干净，能很快恢复。如果患者出现嗜睡反应时，会昏昏欲睡，不能行走，应让患者躺在牙椅上，不能马上离开，加强观察，无昏睡感才让患者离开，以免发生意外。 封药的时候注意造作细心，避免失活剂脱落患者吞食(特别孕妇和肠胃疾病严重患者)。 给予抗炎镇痛洽疗 维生素C 地塞米松 integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed, integrated energy, chemicals and textile Yibin city, are the three core pillars of the industry. In 2014, the wuliangye brand value to 73.58 billion yuan, the city's liquor industry slip to stabilise. Promoting deep development of integrated energy, advanced equipment manufacturing industry, changning district, shale gas production capacity reached 277 million cubic metres, built the country's first independent high-yield wells and pipelines in the first section, the lead in factory production and supply to the population. 2.1-3 GDP growth figure 2.1-4 Yibin, Yibin city, Yibin city, fiscal revenue growth 2.1.4 topography terrain overall is Southwest, North-Eastern State. Low mountains and hills in the city landscape as the main ridge-and-Valley, pingba small fragmented nature picture for "water and the second land of the seven hills". 236 meters to 2000 meters above sea level in the city, low mountain, 46.6% hills 45.3%, pingba only 8.1%. 2.1.5 development of Yibin landscapes and distinctive feature in the center of the city, with limitations, and spatial structure of typical zonal group, 2012-cities in building with an area of about 76.2km2. From city-building situation, "old town-the South Bank" Center construction is lagging behind, disintegration of the old city is slow, optimization and upgrading, quality public service resources are still heavily concentrated in the old town together. Southbank Centre has not been formed, functions of the service area space is missing. Meanwhile, peripheral group centres service was weak and inadequate accounting for city development, "suspicious" pattern could not be formed. As regards transport, with the outward expansion of cities, cities have been expanding, centripetal city traffic organization has not changed,