1 0 0 0 OA 低濃度ミダゾラムと笑気吸入鎮静法の併用療法の検討
- 著者
- 仲西 修 山室 宰 亀山 秀一郎 天野 裕治 東 真実 今井 弘貴 梅田 健一郎 椎葉 俊司 西 正勝
- 出版者
- 九州歯科学会
- 雑誌
- 九州歯科学会雑誌 (ISSN:03686833)
- 巻号頁・発行日
- vol.48, no.4, pp.463-472, 1994-08-25 (Released:2017-12-21)
This study was undertaken to assess the effect of different concentrations of nitrous oxide combined with a low dosage of midazolam on pain sensation in the buccal region of the human face. Twenty healthy subjects (male : 16, female : 4), male and female varying in age from 23 to 28 years (mean ; 24.9 years) and from 23 to 30 years (mean ; 25.8 years), and weighing from 52 to 85 kg (mean ; 66.1 kg) and from 46 to 49 kg (mean ; 47.1 kg) respectively, were involved in this study. All subjects were administered midazolam (0.025 mg/kg) intravenously, and divided into three groups ; the first inhaled 25% N_2O and 75% oxygen (25% N_2O group), the second inhaled 40% N_2O and 60% oxygen (40% N_2O group), and the third inhaled 60% N_2O and 40% oxygen (60% N_2O group). All subjects were reclined on dental chair comfortably in the supine position 10 minutes prior to start of the experiment. Three control tests were carried out with inhalation of room air at 10 minute intervals. One of the three concentrations of nitrous oxide (25% N_2O, 40% N_2O and 60% N_2O) was inhaled within 5 minutes by face mask after injection of midazolam into the forearm without the subject's knowledge for 30 minutes, and the mask was removed after oxygen inhalation for 5 minutes in succession after turning off the nitrous oxide gas. Three tests each for thresholds of tactile sensation using nylon^[○!R] thread (point load 0.004 g, 0.01 g, 0.2 g), and of pain sensation using an esthesiometer (point load 1-10 g) on the buccal region of the face were made at 10 minutes' intervals during N_2O inhalation and withdrawal periods. The results obtained are as follows. 1) The threshold of tactile sensation in the buccal region increased 17% and 19% over the control in the 40% N_2O group and the 60% N_2O group, respectively, but there were no significant differences between the groups. 2) The threshold of pain sensation in the buccal region showed significant increases from the control value in the 40% N_2O group during N_2O inhalation period, and the 25% N_2O group and 60% N_2O group showed significant increases from the control value at the 10 minutes point and 30 minutes point in the inhalation period, respctively. Especially in 40% N_2O group, significant increases were seen much more than in the 25% N_2O group at the 30 minutes point in the inhalation period. 3) In the condition of consciousness of 25% N_2O group and 40% N_2O group, there were significant differences during the N_2O inhalation term, and significant decreases appeared in blood pressure and heart rate during the N_2O inhalation term. These results indicate that the analgesic effect of 40% nitrous oxide combined with midazolam and the sedative effect of 25% nitrous oxide combined with midazolam are better than those of the other concentrations of nitrous oxide. It is the best way of the dental treatment to use infiltration under the 25% nitrous oxide with midazolam (0.025 mg/kg) for patient pain and fear.
1 0 0 0 難治性疼痛へのインターロイキン-6の関与の検討
ラット坐骨神経を緩徐に縫合した疼痛モデル(CCI : chronic constriction injury)とcomplete Freund's adjubantを使用し神経炎症を誘発させたモデル(CFA)が神経因性疼痛を誘発することが明かにされた。これらのモデルは足底への熱輻射、冷刺激、ピンプリックテストに対し足底をなめたり逃避行動をとるなどの疼痛関連行動を起こす。これらの疼痛関連行動は免疫調整剤のサリドマイドや免疫抑制剤のサイクロスポリンSの投与によって抑制されることより炎症性の物質が神経因性疼痛に関与していることが予測される。そこで神経再生に深く関与しているインターロイキン-6(IL-6)に注目し、IL-6の抗体を前投与したところ全ての疼痛刺激に対する疼痛関連行動が抑制されることがわかった。免疫染色ではIL-6のがラット脊髄後根神経節(DRG : dorsal root gangrion)、脊髄後根および神経損傷部に神経障害直後より出現し障害後3日でピークとなり、障害後14まで継続した。これはラット疼痛関連行動の程度の経過と一致する。また、ラット坐骨神経を露出しIL-6溶液を浸したオキシセルで被覆したところCCIやCFAのように疼痛関連行動が出現した。以上のことより神経因性疼痛へのIL-6の関与が明らかになった。神経因性疼痛の治療法としてIL-6拮抗薬の神経損傷後早期に投与することが有効であると考えられる。
- 著者
- 中村 修一 河野 博之 松延 彰友 久保田 浩三 庄野 庸雄 冨永 和宏 牧 憲司 椎葉 俊司 小野 堅太郎 岡部 幸子 森本 泰宏
- 出版者
- 九州歯科学会
- 雑誌
- 九州歯科学会雑誌 (ISSN:03686833)
- 巻号頁・発行日
- vol.58, no.5, pp.178-186, 2004
- 参考文献数
- 13
The aim of this study was to elucidate the significance and problems of Kyushu Dental College Hospital as a key hospital for neighborhood dental offices. We sent out questionnaires to 322 dentists in neighboring dental offices. Within 2 weeks, we received the questionnaires by mail, and analyzed them. A total of 128 questionnaires were returned (response rate, 40%). Of the respondents, 89% had attended dental-related lectures within the previous year. A total of 95% of respondents had at least one patient a year for whom they could not carry out the care alone. The majority of these patients received care related to oral surgery, and 67% of these patients were transported to Kyushu Dental College Hospital. The major reason for choosing Kyushu Dental College Hospital was that the dentists working there had good skills and also had personal communication with the referring dentists. Systematic improvement and skill preparedness in all departments, and in particular, oral surgery, and establishment of personal communication between our hospital's dentists and dentists in neighborhood dental offices should lead to success for our hospital and for neighborhood dental offices.