과산화수소수 관장이 저산소증 인체의 동맥혈 산소분압에 미치는 영향에 관한 연구

Abstract

[한글]

청색증(靑色症)을 나타내는 선천성심장질환. 신생아초자성양질환 및 다른 폐질환으로

인하여 폐포내 까스교환이 원활하지 못하여 생기는 저산소증 상태는 기도를 통한 산소흡

입이나 환기량을 증가시킴으로써 폐기능을 호전시키는 방법으로 혈중 산소분압을 증가시

킬 수 없는 경우가 있다. 이와같은 저산소증 환자에게 혈중 산소함량을 증가시키기 위하

여 산소를 직접 정맥내로 주입하는 방법 즉 폐외 산소 공급법이 오래 전부터 이미 시행되

었다.

Oliver및 Murphy(1920)는 비경구적으로 과산화수소수를 주입하여 인체 및 실험동물에서

헐중 산소분압을 증가시킨다고 보고하였으며, Feldman등(1966)은 호츱이 정지된 가사상

태의 고양이에게 과산화수소수를 흉부대동맥내 주입시켜 1시간 동안 생존케했다.

그러나 Lorincz등(1948)및 Fuson등(1967)은과산화수소수를 정맥내 주입으로 산소전색증

, 메트헤모글로빈증(methemoglobinemia) 및 적혈구 용혈현상(White 및 Teasdale, 1966)이

생겨 부적당하다고 하였다. 한편 Morgan 등(1968)은 저산소증 가토의 복막강내로 과산화

수소수를 주입하여 초기에는 동맥혈중 산소분압은 약간 증가하였으나 점차 감소되여 37분

경과 후에는 과산화수소수 투여전보다 오히려 감소된다고 하였다.

Yun(1969)은 개에 사람의 혈액과 과산화수소수를 관장함으로서 산소전색중의 발생없이

문맥혈 , 및 하대공정맥혈의 산소분압이 현저하게 증가된다고 하였으며, 白(1970)은 0.75

% 이하의 과산화수소수 관장시에는 장간막 혈관내 기포형성 및 간조직에 이상이 없으며

안전하다고 하였다. 金(1971)은 저산소상태의 고양이에게 사람의 혈액과 과산화수소수 관

장으로 동맥혈의 산소분압이 현저하게 증가하며, pH및 이산화탄소분압은 변화가 없다고

하였으며, 李(1972)는 고양이 및 토끼에게 과산화수소수를 동일한 방법으로 투여시 메트

헤모글로빈형성이 거의 없음을 관찰했으며, 金(1973)은 사람의 혈액내 충분한 catalase

및 peroxidase가 있으므로 사람의 혈액과 과산화수소수를 함께 관장하면 과산화수소수가

분해되어 장에 흡수되어 동맥혈의 산소분압이 증가된다고 하였다. 저자는 청색증을 나타

내는 선천성 심장질환 환자 19예와 포도상구균성 폐염 환자 1예를 연구대상으로 하여 특

별히 고안된 직장용 고무관을 통하여 사람의 혈액 (1ml/kg)과 0.5% 과산화수소수(10m1/kg

)를 1회 관장하여 5, 10, 15, 30및 60분 경과 후에 동맥혈을 채취하여 혈중pH, 산소 및

이산화탄소 분압을 측정하였고 또한 매 채혈시에 혈압, 맥박, 호흡 및 헤마토크리트치를

측정하여 다음과 같은 성적을 얻었다.

1. 과산화수소수 관장후 약간의 혈압하강이 있었으나 유의한 변화가 없었다.

2. 과산화수소수 관장후 맥박, 호흡 및 헤마토크리트치는 유의한 변화가 없었다.

3. 과산화수소수 관장후 동맥혈의 pH는 유의한 변화가 없었다.

4. 과산화수소수 관장후 동맥혈의 산소분압은 5분 경과후부터 증가하기 시작하여 30분

에 가장 현저하게 증가하여, 60분에서는 약간 감소되었으나 관장전에 비해 증가되어 있었

다.

5. 과산화수소수 관장후 동맥혈의 이산화탄소분압은 유의한 변화가 없었다.

6. 0.5% 과산화수소수를 사람의 혈액과 함께 1회 관장함으로 동맥혈의 산소분압은 증가

하며, pH 및 이산화탄소분압은 변화가 없으며, 혈압, 맥박 및 호흡은 변화가 없이 안전하

게 사용될 수 있었다.

[영문]

Cyanosis in patients with congenital heart disease such as tetralogy of Fallot is

due to a shunt of desaturated blood, and this desaturated blood may also contribute

to hypoxemia in pulmonary diseases such as hyaline membrane disease and severe

pneumonia. The partial pressure of oxygen in the blood of these cases can not be

increased by increasing the respiratory rate or oxygen inhalation.

Since Oliver and Murphy(1920) first administered hydrogen peroxide intravenously

for the treatment of influenzal pneumonia, attempts have been made to use it

parenterally as a source of oxygen, both in humans and in animals.

Lorincz et al. (1948) investigated the effect of hydrogen peroxide on the blood

of several animals and concluded it was of little therapeutic value because of the

formation of oxygen emboli.

Feldman et al. (1966) reported that cats have been kept alive for periods up to

one hour in the absence of pulmonary ventilation by an infusion of hydrogen

peroxide into the thoracic aorta.

Stern and Brennock(1967) investigated the effect of the continuous lydrogen

peroxide infusion, and reported that there were massive emboli in dogs but not in

cats.

Fuson et al. (1967) observed that intravenous hydrogen peroxide could supply up

to 27% of oxygen consumption in pigs, but they observed severe methemoglobinemia

and suggested that it was a hazardous technique.

Urschel et al. (1966) suggested possible future applications to systemic hypoxia

through the experiments employing diluted hydrogen peroxide given by peritioneal or

rectal administration.

Morgan et al. (1968) investigated the effectiveness of intraperitoneal

administration of 0.3% hydrogen peroxide in hypoxic rabbits and suggested that this

method for the purpose of extrapulmonary oxygenation was ineffective and hazardous

Yun(1969) investigated the effect of 0.2% hydrogen peroxide serial enemas on

dogs, rabbits and one case of human with tetralogy of Fallot and reported the

elevation of arterial oxygen tension without gas emboi.

Paik(1970) undertook a histological study on rabbits liver following hydrogen

peroxide enema and reported no pathological changes below 0.75% hydrogen peroxide.

He recommended that hydrogen peroxide could be used safely below 0.75% by enema.

Kim(1971) investigated the effect of 0.5% hydrogen peroxide enema in hypoxic cats

and observed significant elevation of arterial oxygen tension without change of pH,

carbon dioxide tension and hematocrit.

Lee(1772) reported that in the intravenous hydrogen peroxide administration,

there ware marked elevation of methemoglobin in dogs but in the hydrogen peroxide

enema with human blood, no change of methemoglobin leval was noted.

Cheun(1973) reported that human whole blood contain a lot of catalase and

peroxidsse as a catalyst of hydrogen peroxide to breakdown and hydrogen peroxide

enema with human whole blood was very effective to increase arterial oxygen tension

as an extrapulmonary oxygenation.

The present investigation is aimed at studying the effect of 0.5% hydrogen

peroxide enema in hypoxic state of humans and to demonstrate its effectiveness as

an adjunct in extrapulmonary oxygenation.

In this experiment 20 hypoxic state of humans who had cyanotic congenital heart

diseases and severe pneumonia, were rosed.

Under general anesthesia with injection of Ketalar (1mg/kg), blood sampling was

done at the site of femoral artery with puncture as a control.

A specially made baloon catheter was inserted from anus. and human whole

blood(1ml/kg) was infused throush tube. After then, o.5% hydrogen peroxide

(10ml/kg) was infused.

The arterial blood samplings were collected at 5, 10, 15, 30 and 60 minutes after

respectively and pH, PO^^2 and PCO^^2 were measured and hematocrit was checked in

each sample.

Blood pressure, pulse rate and respiration rate were recorded at the time of each

sampling.

The following results were obtained.

1. There was no significant change in B. P., pulse rate and respiratory rate

after enema of hydrogen peroxide.

2. The values of hematocrit were 54.10, 53.50, 53.05, 52.80, 52.25 and 52.40% in

before enema and 5, 10, 15, 30 and 60 minutes respectively. There was no difference

in hematocrit after enema.

3. The values of arterial pH were 7.338, 7.321, 7.332, 7,330, 7.324 and 7.324 in

before enema and 5, 10, 15, 30 and 60 minutes after enema. There was no significant

change in arterial pH after enema.

4. The values of arterial PO^^2 were 40.10, 42.35, 45.49, 50.71, 58.82, and 51.92

mmHg in before enema and 5, 10, 15, 30 and 60 minutes after enema respectively. It

showed there was a significant elevation of arterial PO^^2 after hydrogen peroxide

enema.

5. The values of arterial pCO^^2 were 30.30, 30.44, 30.42, 30.05, 30.60, and

30.20 mmHg in before enema and 5, 10, 15, 30 and 60 minutes after enema

respectively. There baa no significant change in arterial PCO^^2 after enema.

From the results obtained by these experiments the single enema with human whole

blood and 0.5% hydrogen peroxide cou1d he used to increase arterial oxygen partial

pressure of humans in the hypoxic state without any change of vital signs, and it

may be useful in raising oxygen tension in hypoxic state due to various causes.