음압형 혈액여과기와 비음압형 혈액여과기간의 혈액여과 효과및 혈액손상 비교 : 개심술 환자를 중심으로

Abstract

[한글]

John Gibbon에 의해 인공심폐기가 발전되면서 개심술이 성공적으로 시행된 이후, 개심술의 수술 효과를 높이기 위한 보조기구들이 개발되었는데, 그 중 한가지로 혈액여과기를 들 수 있다. 이 혈액여과기는 그 지질인 할로섬유의 반투과성막을 통해 작용하는 물리적인 힘에 의해 체외순환 회로를 순환하는 혈액성분에서 수분과 분자량이 작은 용질을 여과시키는 기구로서 개심술시 발생하는 혈액희석 현상을 효과적으로 교정할 수 있는 기구이다. 그러나 이 기구는 혈액여과 효과의 많은 잇점에도 불구하고, 용혈과 같은 혈액손상의 문제를 지니고 있다.

이에 본 연구는 현재 혈액여과기로 흔히 사용되는 음압형 혈액여과기와 비음압형 혈액여과기간의 혈액여과 효과와 혈액손상 정도를 비교하여 각각의 혈액여과기의 장단점을 파악한 후 환자에게 적절하게 적용하기 위해 시도되었다.

본 연구의 설계는 비교조사연구로서 연구대상은 Y대학 C센터에서 심장수술을 한 성인환자이며, 음압형 혈액여과기와 비음압형 혈액여과기를 각각 15명에게 짝짓기표집을 통해 적용하였다.

자료수집 기간은 1993턴 9월 20일부터 동년 11월 12일까지이며. 혈액학적 검사로 두 혈액여과기간의 혈액여과 효과비교를 위해 헤마토크릿과 교질삼투압을 측정하였고, 혈액손상 비교를 위해서는 혈장유리혈색소와 유산탈수소효소를 측정했다.

수집된 자료는 SPSS-PC를 이용하여 전산처리 하였다. 대상자의 일반적인 특성은 실수, 평균과 표준편차를 구하였고, 두 군간의 동질성 검증을 위해 x**2-test, t-test를 이용하여 분석하였다. 두 군간의 혈액여과 효과와 혈액손상 비교는 t-test를 사용하였다.

본 연구의 결과는 다음과 같다.

1) 음압형 혈액여과기와 비음압형 혈액여과기간의 혈액여과 효과비교에서 헤마토크릿은 두 군간에 유의한 차이가 없었고(t=-.73, p>.05), 교질삼투압은 음압형 혈액여과기군의 적용 전후차 평균이 3.63, 비음압형 혈액여과기군의 적용 전후차 평균이 5.07로 두 군간

에 유의한 차이를 나타내었다(t=-2.07, p<.05).

2) 음압형 혈액여과기와 비음압형 혈액여과기간의 혈액손상 비교에서는 혈장유리혈색소와 유산탈수소효소 모두 유의한 차이가 없었다(t=1.28, 0.33,p>.05)

이상의 연구결과로 미루어 개심술 환자에게 혈액여과기를 적용함에 있어 혈액여과 효과면에서는 비음압형 혈액여과기의 적용이 음압형 혈액여과기의 적용보다는 더 효과적이라고 생각된다.

A Comparative Study between the Vacuum Hemofilter and the Non-vacuum Hemofilter on

the Hemofiltration Effect and BIood Damage.

- Centered on Open Heart Surgery Patients -

Chung, Ji Hyun.

Department of Nursing Science, The Graduate School, Yonsei University

(Directed by Prof. Kim, Cho-Ja Ph.D.)

After open-heart surgery was done successful by John Gibbon who improved

heart-lung machine, assist devices have been developed to improve surgical effect.

One of them is hemofilter.

The hemofilter works by a process involving the physical movement of water and

solutes (lese than 2,000-20,000 molecular weight) from the blood through the

semipermeable membrane of the hollow fiber.

And hemofilter is a safe, effective means for the removal of body water and the

prevention of the further accumulation of such water during hemodilution

CPB(cardiopulmonary bypass).

The study was done comparing the effect of hemofiltration and blood damage

between the vacuum hemofilter and the non-vacuum hemofilter.

The 30 subjects were adult open heart surgery patients in the C center of Y

university arts were selected using selection criteria and divided into two groups

by a matching method.

The vacuum hemofilter was used by one group and the non-vacuum hemofilter was

used by the other.

The data were collected during the period from September 20, 1993 to November 12,

1993.

The hematocrit and colloidal oncotic pressure were measured for the effect of

hemofiltration between the pre and post hemofilter.

The free plasma hemoglobin and lactic dehydrogenase were measured for blood

damage between the pre and post hemofilter.

The data was analyzed using the SPSS-PC program.

The results were summarized as follow ;

1. The difference in the hemoglobin value was not significantly different between

the vacuum hemofilter group and the non-vacuum hemofilter group(t=-.73, p>.05). The

difference in colloidal oncotic pressure value was significantly different between

the vacuum hemofilter group and the non-vacuum hemofilter group(t=-2.07, p<.05).

2. The difference in the free plasma hemoglobin and lactic dehydrogenase were not

significantly different between the vacuum hemofilter group and the non-vacuum

hemofilter group(t=1.28, 0.33, p>.05).

In conclusion, thin study showed that the non-vacuum hemofilter is more effective

than the vacuum hemofilter. Accordingly, the use of the non-vacuum hemofilter

method is recommended for adequate hemodilution during open heart surgery.

[영문]

After open-heart surgery was done successful by John Gibbon who improved heart-lung machine, assist devices have been developed to improve surgical effect.

One of them is hemofilter.

The hemofilter works by a process involving the physical movement of water and solutes (lese than 2,000-20,000 molecular weight) from the blood through the semipermeable membrane of the hollow fiber.

And hemofilter is a safe, effective means for the removal of body water and the prevention of the further accumulation of such water during hemodilution CPB(cardiopulmonary bypass).

The study was done comparing the effect of hemofiltration and blood damage between the vacuum hemofilter and the non-vacuum hemofilter.

The 30 subjects were adult open heart surgery patients in the C center of Y university arts were selected using selection criteria and divided into two groups by a matching method.

The vacuum hemofilter was used by one group and the non-vacuum hemofilter was used by the other.

The data were collected during the period from September 20, 1993 to November 12, 1993.

The hematocrit and colloidal oncotic pressure were measured for the effect of hemofiltration between the pre and post hemofilter.

The free plasma hemoglobin and lactic dehydrogenase were measured for blood damage between the pre and post hemofilter.

The data was analyzed using the SPSS-PC program.

The results were summarized as follow ;

1. The difference in the hemoglobin value was not significantly different between the vacuum hemofilter group and the non-vacuum hemofilter group(t=-.73, p>.05). The difference in colloidal oncotic pressure value was significantly different between

the vacuum hemofilter group and the non-vacuum hemofilter group(t=-2.07, p<.05).

2. The difference in the free plasma hemoglobin and lactic dehydrogenase were not significantly different between the vacuum hemofilter group and the non-vacuum hemofilter group(t=1.28, 0.33, p>.05).

In conclusion, thin study showed that the non-vacuum hemofilter is more effective than the vacuum hemofilter. Accordingly, the use of the non-vacuum hemofilter method is recommended for adequate hemodilution during open heart surgery.