氧化亚氮-氧气混合吸入口腔镇静效果及对老年口腔细胞DNA损伤和糖酵解的影响

发布时间：2018-06-02 20:01

本文选题：氧化亚氮-氧气 + 镇静　；参考：《中国老年学杂志》2017年17期

【摘要】：目的探讨氧化亚氮-氧气混合吸入对老年口腔镇静效果及其对口腔黏膜上皮细胞DNA损伤和糖酵解影响。方法拟行口腔颌面诊治的老年患者792例,随机分为氧化亚氮组392例和单纯局麻组400例。术前和术中记录患者心率和血氧饱和度;使用视觉模拟疼痛评分(VAS)和Ramsay法评估患者的疼痛和镇静情况。术中取牙龈黏膜,体外常规培养口腔黏膜上皮细胞,Western印迹法和细胞免疫荧光检测氧化亚氮-氧气处理不同时间细胞中γH2AX蛋白表达情况;RT-PCR检测细胞糖酵解酶基因(GLUT1、GLUT3、HK2、PK-M2)表达情况。结果单纯局麻组心率动幅较大,112例心率波动超出正常范围;氧化亚氮组术前和术中心率均在正常范围内;术中氧化亚氮组血氧饱和度高于术前和单纯局麻组(P0.05)。氧化亚氮组术中VAS低于单纯局麻组,镇静评分高于单纯局麻组(P0.05)。氧化亚氮-氧气处理口腔黏膜上皮细胞0.5 h后γH2AX蛋白表达明显上调,1 h达到高峰,之后逐渐降低;细胞免疫荧光检测γH2AX蛋白表达情况显示,处理2 h时荧光强度高于处理前,说明氧化亚氮-氧气诱导γH2AX表达上调,诱导细胞DNA损伤。口腔黏膜上皮细胞糖酵解基因经氧化亚氮-氧气处理后表达均上调,其中GLUT1和GLUT3基因明显上调,2 h后达到高峰,之后下降。结论氧化亚氮-氧气混合吸入配合局麻对老年口腔颌面手术患者具有较好的镇静镇痛效果;但氧化亚氮会诱导口腔黏膜上皮细胞DNA损伤,促进糖酵解,易引发术后口腔疾病,应加以预防。
[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 纬 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 纬 H2AX protein increased to a peak at 1 h, and then decreased gradually, and the fluorescence intensity of 纬 H2AX protein was higher than that of before treatment for 2 h. These results suggest that nitrous oxide-oxygen induces up-regulation of 纬-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.
【作者单位】：北京市崇文口腔医院综合治疗科;
【分类号】：R782.054

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