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CTOMATOfl O!'IqECKOfr NPAKThKE
DM.
po0Be
Hra
.rM
lr,!R
nu-
UE
03,
Eyrunoocxni Arercangp Banepremr, HaH[uaT rcllq[florlrx ttay[, Aoqeilr 2.i raQe4pu repanerumcltol
cloilaTofioffI Eenopyccroro rocyflapcTBeflHoro ilefllqlffifioro yrrrepcmera, ilnncn
Saxapora
llpma AnaroaleBfla, accrclerT 2-I ra$egpbt repaneul+croi cTomlo,loill
ilellqlilcfloro prrepcrera, lllmcn
Eempyccnoro rocyflapcToeHfloro
rc-
Borolremq finrtpril lleon4omq,
l0-i
Bpaq-croraTonor
ltl[[c[,
ropopron cToilaToflorilqecfio[ nomxnmrru,
Alexander Butvilovsky,
Eerapycr
PhD, Asociate Profesor
of the 2nd
of the
Irina Zakharova,
of lhuapeutic
Depailment
Belarusian
Stah iledhal
Dentistry
University, ilinsk
Assistant of the 2nd lhpartment of Therapeutic Dentistry of the Belarusian State iledical University, itinsk
Dmitriy Ualadkevich,
Dentist
of the t0th City Dental Clinic, ltinsk,
Ane$hesia
in therapeutic dental
Belarus
practice
Pespue. B nexquu npeqcraBneHa xapaKTepucruKa MecTHHx aHecreruKoB, IUAIB MecrHNx auecresurt u
BapuaHTu urn, ucnohayeMux Ha auiynaropxont repaneBTuqecKoM u oproneAuqecKoM croMaTolnruqecKoM
npueMe. Paccuorpeuu npeuMyqecrBa apTuKauHa KaK MecrHoro aHecreruKa au1opa u aonpoc o1ee6onueauun
npu neofiparuuou BocnafieHuu nyfibn*.
Kngeeue cnoaa: aHecreaufr, 6on4 crouaronorun, apTuKauH, nuAoKauH, MenuBaKanH.
Corpeuennar croMarororrs.
Sunmary.
-
2019.
-
J\!2.
C. 13-f6.
-
The lecture presents the characteristics of local anesthetics, types of local anesthesia and variants
of
needles used at an outpatient therapeutic and orthopedic dental reception. The advantages of afticaine as a local
anesthetic of choice and the issue of anesthesia in,the non-reversible inflammation of the pulp are considered.
Keywords: anesthesia, pai n, dentistry articaine, lidCcaine, mepivacaine.
Sovremennaya stomatologiya.
fi a6ora epaqa-cToMaTonoTa 3aHa
pc vacrurtr npoBeAeHueM MecTHoro
I c6ee6onuBaHufl, nocKonbKy npoTocBf,
rcnb .e.eruf, 6onuuJuHcrsa sa6oneeaHilfi
x TrE1r pra BKrIoqa0T gran o6es6on[Ai{ecre3uf, no3Bonf, er noBbtctrrb
rpoooAr4Moro reqeHun. SQSex"TG{!F ;]€cre3uf, noMoraeT cHH3LtTb pr4cK
mrr
raffi
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i FccHam€cxr4x ocroxHeHufi
, cengaHHurx
:1rErcra..ErcflanbHbtM cTpeccoM, xoropuM
Gbtcrr
naqI4eHTH, a TaoKe peuilTb ST[I-
rwrE to6rcuy
npravuHenun 6onu.
Hacro
ilEElEG {H(ilMtrr e${exruenoro
o6es-
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sprTr. Effinrfpcu Ha ou.lyqeHun na-
-
2019.
queFna; orcyrcTBueoneuenun
-
N2.
-
P. 13-16.
ry6, lt1eK, f,3bxa
noBblueHilo qacToTbl t ctlltbt cepAe'{Hbtx
coxpaqenufi , aprepilanbHoro AaBneHufl ,
nocre reqeHuf, o6ecneqilsaer xou$opr.
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npu TqaTeflbHolvr c6ope aHaMHe3a u npa-
B KpoBt4, rtTo, HecoMHeHHo,
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or o6paqenun
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-
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Lr
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y Bpaqa-croMaTonora 6eg aHecre3uu AonxH0 npoBoAr4Tbcf rolbKo npu Hanuquu npo-
anuKanbHoro oTBepcTnfl 6onee rovno, veu
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aHecTestrtr.
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MaronoruqecKofi nomoqu.
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ocnoxnenufi, cBt3aHHbtx c ncuxogMotlt/o-
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or pH (7,4
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a raKxe cnoco6xue
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tsbrsHBaTb
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Csseu*anue c
&nxan. Axecrer:
peqefrropor..
uro6u orxpuru xarpreari raxan. tler
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rfl
fi/rreltr€e
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nuAoxaxHa - 65%.
aHecre3xf,. CaRatnalc c
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6"
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7- ilero+rponayeuoe noBb[ueHue ap-
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8" tleranponpye*rfi runeprupeos.
9- fbonponpye*,ti caxapxrfi gua6er.
t.
{Deo4ouo4rroua.
11.
BoryI
naqperra go 4 ner.
fhr rcmogrucru
r 6es EErrxoxcrpilKropa npeAnoqTeHue
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HOBOKAUH.
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HHe aHecreTrKH pa3pylrnErcn B ,B€rf.
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ecrepa3aMlr nra3Mu xposf,(9s%), rrub
Cnoxnwe auugw : nuAoKauH; TpuMeKauH;
MenuBaKauH; npunoKauH; 6ynuaaxaun;
tl€HetX.
t{eu uenuue BpeMf, nonyBHBegerm axe
llerrereerg)F-91.
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creruKa,
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cnoxxofi eQr,lpxofi
r,r
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n 6esonacHocTb aHecTe3uu 3aBucfiT or
geficreyroqero Beu.lecrBa (pKa, xupopacTBopr4Mocrb, cBfl3uBaHue
c 6enxauu,
oco6enxocru eueeAeH[n) u Sopurynur /
5o/o apTnKaUHa l,lHaKT!4BXpyeTCR B
reu 6egonacxee ero nplrretefle
(uenuu:e prcK nepeAo3upoaxu). Bpeun
nonyBHBeAeHus
y nrrAoKauHa
114
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y apruKalrHa
-
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96 ut,tx, y MenuBaxalHa
-
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- aprlilculr (10 ur s 1 un pacraopa
-
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;
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uux.
lrlcxogn us caoilcrB npenaparoB, aprt,tKauH
flBrrneTcfl npenaparoM
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pacraopa);
-
coruHan xlrcrlom luru ruApoKcl4A HaTpufl
TOpHOM CToMaTOrOrUqeCKoM
npueMe, n0pnA
cKonbKy uMeeT
npeuMyqecre: 6ucrpoe
go sa4axxoro pH;
no-
HacrynneHue aHecresuu (exonouun pa6ouero
cToflHHafl BeIUqUHa, f,Bnf,lou.lafcf, xapaK-
apeuenu), AocraroqHaf, rny6una u npoAonxuTenbHocrb gefi craun gnn 6onuuuncrea
1:100000, 1:200000, 1:400000 co cra6unu3aropoM narpnn uera6ucynu$r,rrour
6penga (ra6n. 1).
pKa
-
roxuaHTa fquccor{uaquu
-
repucruxofi KaxAoro axecreruxa. 3ro
3HaqeHue pH, npu KoropoM 50%
uonexyn
aHecTeTuKa HaxoAf,Tcf, B aKTL|BHOM C0crorHrnr (pr,rc. 1).
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HocTb MoneKynbr npoxoArrTb r{epes
KrerKu.
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leu
nyque
cnoco6-
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aHecTeTr4K npoHuKaeT B HepBHHe
xnerxu (guuJe eS$exruaxocrb
-
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ocnoxnenufi), Manoe BfluflHr4e Ha qacrory
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B cocraB aHecreruKa
KoHcTpr/KTop
-
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aApeHafl uH (entane$pun).
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B
Mecre BBe-
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17. Burcoxyro xr4popacTBopr,rMocTb
BaHUlo Aeno aHecTeTltKa B Mf,rKlitx TKaHflx
aprurauna o6ecneiusaer TuoQeHoBoe KoJb-
n nponoHrupyer geficreue aHecre3xx.
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qo
B
ero xuuuqecxoil cTpyKrype.
-
conu aApeHafluHa B pa3BeAeHuu
;
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uoHoB MeraflnoB, KG
Toptle Moryr RrAeftErbcn ue crexna xapnynur);
napa6exu (onr{r,tonanuno).
-
Epsryoexa npeflaparoB aprrKarHa
MaxcuuanuaR pa3oBan Ao3a
-
1 xapny-
na npenapaTa apTuKauHa na 10 xr uaccur
Tena naqx$rra. Baxno, wo eeoAurb naq[eH-
ry uoxno xe 6onee 5096 or uaxcurrranuxofi
pasoeofi gosu.
OAqrc npaouna npoBeAeHlrf, uHbeKqxormol anecreeuu
.
fl pegeapurefl bHaR annruKaquoHHan
aHecTe3ufl.
. O6pa6orxa Kapnyflbr 70% cnuprour.
llmqm
r
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t, sl.
Ioxaearenu
t:t3a-
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Aprurarx
7,9
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7,8
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qro BaxHo npu Hafluquu conyrcrayoqeil
naToll0ruu.
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KBaEpaHTOB B 0AH0
noceqeHue.
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aHecTBl{U:
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. Hanuque B aHaMHe3e
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g].
[5, 6,
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0,12-0,18 un I 7 cex Ha oAuH
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x gnuuoil ocu ey6a, npoABuxeHue Ha
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B PE
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-
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ocnoxnenufi npu npoBe4eH[[ aHecresul
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uu
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30G x 16
uu
0,3x16 (xoporxan, ronran)
30G x 21
r'irr'ir
0,3x21 (cpegneil 4nranu, ronr<ar)
30G x 25
r',rr'it
0,3x25 (cpepner,r Mr,rnu, ronxa.a)
r,rHTpanuraMeHTapHafl
27G x 30
t,tt',t
0,4x30 (Mr,lHHan,
27G x 35
uu
0,4x35 (Anr,tHHan, ToncTaff )
27G x 38
tutu
0,4x38 (gnr,lHHan, Toncras)
Tofl
/ Tu.larenunuril c6op anauneea co cBoe-
BpeMeHHbrM 3anoflHeHueM
ueguquncxofi
AOKyMeHTaLlur4.
un$unurpaquonnar
/
0r{enxa o6u.lero cocronHrlf, naLl!4eHTa
u ero AuHaMilqecxuil xonrponu.
r' Paquonansnufi au6op MeToAa aHecre-
cras)
np0BoAH14K0Bau
31414
r'
il neKapcTBeHHoro cpeAcTBa.
Koppexrnan rexHilKa aHecre3uu.
3axlpqeuue
-
Kotu6unaqun
fluauerp (anyrpennuil)
n,tecTHbrx aHecre3rail (Hanpr,t-
6onsuLe AaBneHue npu [HbeKllnr rI
BHUJe BepofTHOCTb nepeKpbrTl4fl TKaHf,-
-
Kour6unaquf, ?a3flur{Hbrx npenaparoB
aHecreruKa (crporo B coorBercTBr4rr c rrH-
-
cTpyKqueil npou3BoAurenn) [6, 7].
Bu6op urnu gnfl aHecrmuti
flnuna -ueu Kopoqe gnuna, reu 6onee
-
,Quauerp (napyxnurt) - ueM Tonqe ilrna,
TeM oHa 6onee ynpaenf,eMa !r MeHbue
pucK nonalaHun BHyrpb cocyAoB, Ho TeM
6onesHeHHee [HbeKquR.
rou, cnoco6creyer HopManbHoMy ncuxooMo
Cpee: gna nerKoro npoABrrxeHun noA
HarqKocrHrrqy - xoporxufi (70') r,t cpegnr,rfi
r_ll4oHanbHoMy cocTofiHr/lo KaK Bpaqa, TaK u
nefi - gnunrufi (10-20'), Mfl cHuxeHuf,
6onesxexxocru - Mynbrucpea (cnoxuufi,
rpoilnoil).
yBepeHHocl/ Bpaqa B 6eg6onesHeHHocril
BMeuJarerbcrBa (c cornacun naquenra).
uecrtoro o6e-
-
-
1997
-T.76,
C.25-29.
3. Aprou:xeauv A.C., l0Arxa H.A. 06eg6onugaHre s crouaronoruu, oco[enxocru
npoBeAeHufi aHecre3[r y naqueHroB rpynn pucxa. - Mr,ticx, 2013. - 180 c.
4. Pa6uHoeilq C.A.,3oprr E.B., Coxoe C.T. u gp.0r roeoxahHa K apruKauHy.
B cro-
248 c.
5. Pa6uHoet,t.r C.A. CoapervreHHue TexHofloflrLr MecTHoro o6es60rueaHtls
Marororru. - M., 2000. - 144 c.
6. J. Modaresi, A. Davoudi, H. Badrian, et al. // Anesth. Essay'S. Res. - 2016.
Vol.10, N1. - P.3-6.
7. Auleslia-Viera P.V, M.M. Braga M.A.
N8. - P.862-876.
8. Phero J.A. , Nelson B. , Davis
2017. - Vol.75. - P.688-Sgil.
B. ,
et al.
lrt
Bosati //
Endod. J.
Surgery. - 2016. - Vol.15. - P.$L.{E.
10. Whitcomb M., Dnrn M.,
A, e{
Vol.57. - P.59{6.
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ikh sochetariy s
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h oldaf ffi hbnrerr
p
h Rs*n)
Gderd &y{vila l<atplEzdG*Eai tpeqlaflies
crouarcnoilu
rocyppcraexxufi uqgn4rxcrri yxreepoler
Serrcpyccrurfi
r. [kxcr, yn. C]aan,28
22ffi 04, Pecn!6nrra Senapycs
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Syraunoacufi furercaxgp Banepeen {, email: ale$utv@ramblerru
*iffi f ffi ffiiffi
Vol.51,
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BeAeT K yCTaHoBneHUo KoHTaKra C naqileH-
naqnenra. IeveHue 6es aHecre3nu AonxHo
npoBoAl4Tbcn ToflbKo npil HaruL{14rr npoTl4B0-
-
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Bo BpeMn
(45'), Ann o6es6onuaax[f, MflrKltx rKa-
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ofa no3Boflfi eT
cHLr3r4rb BeponTHocrb HeoTnoxHbtx cocroRnufi
aiqpeHanr4Ha. Ses6onesHeHHocrb npoqeAypH
AHr4culroaa E.H. KnuHuqecxoe o6ocnoaatue au6opa cpepcra 4nn
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lrlcnonugoeaHue uecrnoil aHecre3uil
B npaKrHKe Bpaqa-cToMaTofi
Mn BbruJe pucK noxHoorpuqarenunofi
acnupaquoHHoi npo6ur.
O6pa6orxa KoH.tilKa urnw (ocrpora, no-
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1 .
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Ko$nrm rrrepecoa
Cornacxo sanenenuo aBTopoB, xoxSnurr uxrepecoB orcyrcTByer.
llocrynuna 08.11.208
llpuunra e neuan 15.03.2019
Address lor conespondence
2nd Depafinent of Therapeutic Dentisty
Belarusian State Medical Univemity
28, Sukhaya steet Minsk
2200p4, Republic of Belarus
drone: + 375 17 200-5t-36
Alexander Butvilovsky, e-mait alerbutv@ ramtrler.ru