Oxytocin 주입분만이 신생아 혈청담적 소치에 미치는 효과에 관한 임상적 연구

Abstract

[한글]

oxytocin주입분만과 신생아황달의 연관성을 Mast등(1971)이 처음 시사한 이래 oxytocin이 신생아황달을 일으키는 하나의 유발인자가 된다고 인지되고 있다. 그러나 황달을 일으키는 병리기전 및 발생정도에 대하여는 논란의 대상이 되고있으며 증가된 신생아 혈청담

적소치는 oxytocin을 사용한 양 또는 사용한 양과 시간에 따르는 효과 (Buchan, 1979 )라고 하였다.

본 연구에서는 oxytocin주입분만이 신생아 혈청담적소에 미치는 영향 및 과담적소혈증의 발생정도를 연구하기 위하여 oxytocin 주입군 (유도분만 및 촉진분만군)과 대조군 (자연분만 및 선택적제왕절개술군) 각각 50예를 대상으로 생후 즉시 제대혈액 및 생후36 - 60시간에 신생아혈액을 채취하여 혈청담적소치를 측정 비교하였고, 나아가서 그 기전을 설명하기 위하여 혈청나트륨, 혈색소, 헤마토크리트, 적혈구수를 측정하였고 oxytocin의 주

입용량, 주입시간과의 관계를 조사하여 분석하였다.

연구결과를 요약하면 다음과 같다.

1. oxytocin주입군에서 제대혈액 및 신생아혈액의 혈청담적소치 대조군 보다 의의있게 증가하였다.

2. oxytocin주입용량 및 주입시간이 증가함에 따라 제대혈액 및 신생아 혈액의 혈청담적소치가 증가하였다.

3. oxytocin 주입 총량이 5 unit 이상인 경우 제대혈액 및 신생아혈액의 혈청담적소치는 의의있게 증가하였다.

4. 신생아 과담적소혈증은 oxytocin 주입군 50예중 4예 (8%)에서 발생하였다.

5. oxytocin 주입군에서 제대혈액의 혈색소, 헤마토크리트, 적혈구 수는 대조군 보다 증가하였고, 제대혈액 및 신생아혈액의 혈청나트륨치는 두군간에 변화가 없었다.

이상의 결과로 보아 oxytocin주입분만은 신생아 혈청담적소치를 증가시키고, 증가된 혈청담적소치는 oxytocin주입용량과 시간에 비례하는 것으로 사료되었다.

Clinical study of the effect of oxytocin on neonatal serum bilirubin levels

Dong Soo Cha, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Assistant Professor Kook Lee, M.D.)

The association between oxytocin and neonatal jaundice was first suggested by

Mast et al(1971), since then the role of oxytocin in causing neonatal jaundice is

now generally accepted. But the pathogenesis and the extent of such a neonatal

jaundice is still a matter of speculation. Recently, the increased neonatal serum

bilirubin level after oxytocin infusion is both a dose-related and time-related

effect of oxytocin, has been suggested.

To investigate the effect of oxytocin on serum bilirubin levels, we studied 100

term healthy newborn infants prospectively, of these, 50 were born after oxytocin

infusion (augmented labor and induced labor), other 50 were born without oxytocin

infusion (spontaneous labor and elective cesarean section) and measured the serum

bilirubin level in cord blood and in newborn blood at age 48±12 hours.

To explain the pathogenesis, we estimated serum sodium, plasma hemoglobin, plasma

hematocrit, and plasma red blood cell counts and analysed both the dose-related and

time-related effect of oxytocin in cord blood and newborn blood samples of all the

infants.

The results are as follows:

1. The mean serum bilirubin level was significantly raised in cord blood and

newborn blood of oxytocin group.

2. Raised serum billirubin levels in cord blood and newborn blood related to the

increased dose and duration of oxytocin.

3. When the total dose of oxytocin exceeded 5 units, serum bilirubin levels in

cord blood and newborn blood were significantly raised.

4. Of 50 infants born after oxytocin infusion, four (8.0%) showed neonatal

hyperbilirubinemia.

5. There was a significant increase in cord blood hemoglobin, in the hematocrit,

and in the red blood cell counts in oxytcoin group, but no difference in the serum

Na+ levels of cord blood and newborn blood between oxytocin and control group.

Our study has shown that higher doses of oxytocin administered increased neonatal

serum bilirubin level, which is thought to be both the dose-related and

time-related effect of oxytocin.

[영문]

The association between oxytocin and neonatal jaundice was first suggested by Mast et al(1971), since then the role of oxytocin in causing neonatal jaundice is now generally accepted. But the pathogenesis and the extent of such a neonatal jaundice is still a matter of speculation. Recently, the increased neonatal serum

bilirubin level after oxytocin infusion is both a dose-related and time-related effect of oxytocin, has been suggested.

To investigate the effect of oxytocin on serum bilirubin levels, we studied 100 term healthy newborn infants prospectively, of these, 50 were born after oxytocin

infusion (augmented labor and induced labor), other 50 were born without oxytocin infusion (spontaneous labor and elective cesarean section) and measured the serum bilirubin level in cord blood and in newborn blood at age 48±12 hours.

To explain the pathogenesis, we estimated serum sodium, plasma hemoglobin, plasma hematocrit, and plasma red blood cell counts and analysed both the dose-related and time-related effect of oxytocin in cord blood and newborn blood samples of all the

infants.

The results are as follows:

1. The mean serum bilirubin level was significantly raised in cord blood and newborn blood of oxytocin group.

2. Raised serum billirubin levels in cord blood and newborn blood related to the increased dose and duration of oxytocin.

3. When the total dose of oxytocin exceeded 5 units, serum bilirubin levels in cord blood and newborn blood were significantly raised.

4. Of 50 infants born after oxytocin infusion, four (8.0%) showed neonatal hyperbilirubinemia.

5. There was a significant increase in cord blood hemoglobin, in the hematocrit, and in the red blood cell counts in oxytcoin group, but no difference in the serum Na+ levels of cord blood and newborn blood between oxytocin and control group.

Our study has shown that higher doses of oxytocin administered increased neonatal serum bilirubin level, which is thought to be both the dose-related and time-related effect of oxytocin.