本文選題：氧化亞氮-氧氣 + 鎮(zhèn)靜��； 參考：《中國老年學雜志》2017年17期

【摘要】：目的探討氧化亞氮-氧氣混合吸入對老年口腔鎮(zhèn)靜效果及其對口腔黏膜上皮細胞DNA損傷和糖酵解影響。方法擬行口腔頜面診治的老年患者792例,隨機分為氧化亞氮組392例和單純局麻組400例。術(shù)前和術(shù)中記錄患者心率和血氧飽和度;使用視覺模擬疼痛評分(VAS)和Ramsay法評估患者的疼痛和鎮(zhèn)靜情況。術(shù)中取牙齦黏膜,體外常規(guī)培養(yǎng)口腔黏膜上皮細胞,Western印跡法和細胞免疫熒光檢測氧化亞氮-氧氣處理不同時間細胞中γH2AX蛋白表達情況;RT-PCR檢測細胞糖酵解酶基因(GLUT1、GLUT3、HK2、PK-M2)表達情況。結(jié)果單純局麻組心率動幅較大,112例心率波動超出正常范圍;氧化亞氮組術(shù)前和術(shù)中心率均在正常范圍內(nèi);術(shù)中氧化亞氮組血氧飽和度高于術(shù)前和單純局麻組(P0.05)。氧化亞氮組術(shù)中VAS低于單純局麻組,鎮(zhèn)靜評分高于單純局麻組(P0.05)。氧化亞氮-氧氣處理口腔黏膜上皮細胞0.5 h后γH2AX蛋白表達明顯上調(diào),1 h達到高峰,之后逐漸降低;細胞免疫熒光檢測γH2AX蛋白表達情況顯示,處理2 h時熒光強度高于處理前,說明氧化亞氮-氧氣誘導γH2AX表達上調(diào),誘導細胞DNA損傷。口腔黏膜上皮細胞糖酵解基因經(jīng)氧化亞氮-氧氣處理后表達均上調(diào),其中GLUT1和GLUT3基因明顯上調(diào),2 h后達到高峰,之后下降。結(jié)論氧化亞氮-氧氣混合吸入配合局麻對老年口腔頜面手術(shù)患者具有較好的鎮(zhèn)靜鎮(zhèn)痛效果;但氧化亞氮會誘導口腔黏膜上皮細胞DNA損傷,促進糖酵解,易引發(fā)術(shù)后口腔疾病,應加以預防。
[Abstract]:Objective to investigate the effects of mixed inhalation of nitrous oxide and oxygen on oral sedation and DNA damage and glycolysis of oral mucosal epithelial cells in the elderly. Methods 792 elderly patients were randomly divided into nitrous oxide group (392 cases) and local anesthesia group (400 cases). The heart rate and oxygen saturation were recorded before and during operation, and the pain and sedation were evaluated by visual analogue pain score (VAS) and Ramsay. Gingival mucosa was harvested during operation. The expression of 緯 H2AX protein was detected by Western blotting and immunofluorescence in vitro. RT-PCR was used to detect the expression of glycolytic enzyme gene (GLUT1GLUT3PK-M2). Results the heart rate fluctuation of 112 cases in the simple local anesthesia group exceeded the normal range, the preoperative and operative center rates in the nitrous oxide group were within the normal range, and the blood oxygen saturation in the nitrous oxide group was higher than that in the preoperative group and the local anesthesia group during the operation (P 0.05). The intraoperative VAS of nitrous oxide group was lower than that of local anesthesia group, and the sedation score was higher than that of pure local anesthesia group (P 0.05). After treatment with nitrous oxide and oxygen for 0.5 h, the expression of 緯 H2AX protein increased to a peak at 1 h, and then decreased gradually, and the fluorescence intensity of 緯 H2AX protein was higher than that of before treatment for 2 h. These results suggest that nitrous oxide-oxygen induces up-regulation of 緯-H2AX expression and induces DNA damage. The expression of glycolytic genes in oral mucosal epithelial cells was up-regulated after treatment with nitrous oxide and oxygen. The expression of GLUT1 and GLUT3 genes reached the peak after 2 h, and then decreased. Conclusion the combination of nitrous oxide and oxygen inhalation combined with local anesthesia has a good sedative and analgesic effect on the elderly patients undergoing oral and maxillofacial surgery, but nitrogen oxide can induce DNA damage of oral mucosal epithelial cells, promote glycolysis, and cause postoperative oral diseases. It should be prevented.
【作者單位】： 北京市崇文口腔醫(yī)院綜合治療科;
【分類號】：R782.054

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