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Epinephrine이 백서피부변에 미치는 효과에 관한 연구

Title
Epinephrine이 백서피부변에 미치는 효과에 관한 연구
Other Titles
Studies on effect of epinephrine on skin flap survival in rats
Issue Date
1981
Publisher
연세대학교 대학원
Description
의학과/석사
Abstract
[한글] 피부 또는 피하조직의 결손을 보충하기 위하여 피부변을 형성하고, 전이할 때에 epinephrine을 국소마취제와 함께 사용하여 왔다. 그러나 epinephrine을 사용하여 때때로 피부변의 원위 일부가 괴사(necrosis)되는 경우를 많은 사람들이 경험하였으므로 이는 매우 위험한 조작으로 알려져 있다. Reineish와 Myers(1974)는 피부면의 자연형성(delay)을 시행할 때 epinephrine을 주사하면 피부변의 손실이 증가되어 나타났고, 피부변의 지연형성을 하지 않고 직접 피부변을 형성시에는 epinephrine이 아무런 해가 없다고 보고하였다. 저자는 피부변의 지연형성을 시행한 경우와 지연형성을 시행하지 않은 경우에 epinephrine을 사용하여 피부변에 어떠한 영향을 미치는지에 관하여 추구하고자 본 실험을 실시하였다. 백서의 배부에서 정중선의 외측 양측으로 폭 2㎝, 길이 10㎝되는 피부변을 형성하되 지연형성을 하지 않은 실험군과 지연형성을 시행한 실험군으로 나누었다. 그리고 지연형성을 하지 않은 실험군에서는 각각의 주사군으로 나누어서 1 : 100,000, 1 : 200,000, 그리고 1 : 400,000 epinephrine을 진피내 주사하여 농도에 따른 변화를 관 찰하였다. 또한, 지연형성을 시행한 실험군에서는 각각 7일, 10일, 그리고 14일간 지연형성을 하고 1 : 200,000 epinephrine을 주사하였으며, 지연형성 기간에 따른 변화를 관찰하였다. 본 실험의 결과는: 1. 피부변의 지연형성을 하지 않은 실험군에서 epinephrine의 농도에 따른 피부변 손실의 차이가 없었고, 2. 지연형성을 한 후에 피부변을 형성하면서 epinephrine을 주사한 실험군에서 지연형성 기간에 따른 피부변 손실의 차이도 없었다. 3. 그러나 피부변에 지연형성을 한 후 epinephrine을 주사한 전체의 실험군에서 epinephrine을 주사하지 않은 대조군에 비하여 짝 비교로서 통계학적으로 유의하게 피부변 손실이 증가되어 나타났다. 그러므로 지연형성을 하지 않은 피부변에 epinephrine을 사용하는 것은 무관하나, 지연형성하면서 epinephrine을 주사하는 경우에 피부변의 첨단부가 괴사되거나 피부변의 손실이 증가되어 나타나므로, epinephrine의 국소주입은 피부변의 지연형성시에는 매우 유해한 것으로 사료된다 STUDIES ON EFFECT OF EPINEPHRINE ON SKIN FLAP SURVIAL IN RATS Byung Kee Han, M.D. Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Jae Duk Lew, M.D) In clinical practice, certain surface defects are not amenable to skin graft coverage, in such skin situation skin flaps are preferred. The use of epinephrine in a local anesthetic solution is common in such a surgical practice. The addition of a vasoconstrictor to a local anesthetic solution reduces its toxicity, prolongs its effectiveness, and provides a relatively bloodless operative field. However, surgeons generally were hesitant to use chemical vasoconstrictor in skin flaps, but the adverse effects of such a vasoconstrictor on skin flap survival have recieved little attention and the significance of available studies, often remains unappreciated. Klingenstrom et al(1966) reported that the epinephrine has a detrimental effect on the survival of direct skin flap. Reinisch & Myers (1974) had shown that epinephrine was not detrimental to survival length in non-delay flaps, significantly reduced the survival length in delayed skin flaps in pigs. We intended to study the effects of local anesthesia with epinephrine on skin flap survival in rats. Two groups, non-delayed and delayed, of study were undertaken; The paired longitudinal and caudally based pedicle flaps were outlined on the back of each rat, each measuring 2㎝. in width and 10㎝. in length, and these flaps were symmetrically placed, with their between-space of 2㎝. The delayed flaps injected with epinephrine concentration of 1:200,000 demonstrated significant increase in loss regardless the duration of delay. However, the non-delayed flaps injected with epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 did not demonstrate to be harmful in regard to the flap loss. In conclusion, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps, following close observation of the experiments using paired longitudinal flaps on the back of the rats.
[영문] In clinical practice, certain surface defects are not amenable to skin graft coverage, in such skin situation skin flaps are preferred. The use of epinephrine in a local anesthetic solution is common in such a surgical practice. The addition of a vasoconstrictor to a local anesthetic solution reduces its toxicity, prolongs its effectiveness, and provides a relatively bloodless operative field. However, surgeons generally were hesitant to use chemical vasoconstrictor in skin flaps, but the adverse effects of such a vasoconstrictor on skin flap survival have recieved little attention and the significance of available studies, often remains unappreciated. Klingenstrom et al(1966) reported that the epinephrine has a detrimental effect on the survival of direct skin flap. Reinisch & Myers (1974) had shown that epinephrine was not detrimental to survival length in non-delay flaps, significantly reduced the survival length in delayed skin flaps in pigs. We intended to study the effects of local anesthesia with epinephrine on skin flap survival in rats. Two groups, non-delayed and delayed, of study were undertaken; The paired longitudinal and caudally based pedicle flaps were outlined on the back of each rat, each measuring 2㎝. in width and 10㎝. in length, and these flaps were symmetrically placed, with their between-space of 2㎝. The delayed flaps injected with epinephrine concentration of 1:200,000 demonstrated significant increase in loss regardless the duration of delay. However, the non-delayed flaps injected with epinephrine concentrations of 1:100,000, 1:200,000, and 1:400,000 did not demonstrate to be harmful in regard to the flap loss. In conclusion, we found evidence to support the findings of previous investigators regarding the toxic effects of injecting local anesthetic solutions containing epinephrine into delayed flaps, following close observation of the experiments using paired longitudinal flaps on the back of the rats.
URI

http://ir.ymlib.yonsei.ac.kr/handle/22282913/117305
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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