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과산화수소수 관장시 고양이의 장관내압력 변화에 관한 실험적 연구

Other Titles
 Experimental studies on the changes of bowel pressur by hydrogen peroxide enema in cats 
Issue Date
1976
Description
의학과/박사
Abstract
[한글] 청색증(靑色症)을 나타내는 선천성심장질환, 신생아초자양막질환 및 다른 폐질환으로 인해 폐포내 가스교환이 원활하지 못하여 생기는 저산소상태는 기도를 통한 산소흡입이나 환기량을 증가시켜도 혈중 산소분압을 상승시킬 수 없는 경우가 있어, 혈중 산소함량을 증갓시키기 위한 폐외산소공급법의 연구가 계속되었다. Oliver 및 Murphy(1920)는 비경구적으로 산화수소수(H^^2 O^^2)를 인체 및 실험동물에 주입하여 혈중 산소분압을 증가시킨다고 보고하였으며, Feldman등(1966)은 호흡이 정지된 고양이에게 H^^2 O^^2를 동맥에 주입시켜 1시간동안 생존케 하였다. 그러나 폐외산 소공급의 한 방법으로 H^^2 O^^2를 혈관내로 투여하였을 때 가스전색이나 메트헤모글로빈혈증의 형성 때문에 곤란을 겪어왔었다. (Ziegler, 1941 ; Grodins 등, 1843 ; Lorincz등, 1948 ; Urschel등, 1966 ; Stern 및 Brennock, 1967 ; Fuson등, 1967). Yun(1969)은 개에게 사람의 혈액과 H^^2 O^^2를 관장하므로서 가스전색중의 발생없이 문맥 및 하대공정맥혈의 산소분압이 증가된다고 하였으며 白(1970)은 0.75%이하의 H^^2 O^^2관상시에는 장간막 혈관내에 기포형성 및 간조직에 이상이 없다고 하였다. 金(1971)은 저산소상태의 고양이에게 사람의 혈액과 0.5% H^^2 O^^2관장으로 동맥혈의 산소분압이 증가하며 pH 및 이산화탄소분압은 변화가 없었다고 하였으며 李(1972)는 고양이 및 가토에게 0.5%와 0.75% H^^2 O^^2를 동일한 방법으로 투여시 메트헤모글로빈혈중 형성이 거의 없음을 관찰하였고, 金(1973)은 사람의 혈액내에 충분한 catalase 및 peroxidase 가 있으므로 사람의 혈액과 H^^2 O^^2를 함께 관장하면 H^^2 O^^2가 분해 흡수되어 동맥혈의 산소분압이 증가된다고 하였다. 金(1975)은 선천성심장질환 환자와 심한 폐염환자에게 사람의 혈액과 0.5% H^^2 O^^2를 관장하여 동맥혈 산소분압이 현저하게 증가하였으며 pH 및 이산화탄소분압의 변화는 없었다고 하였다. 이상에서 언급한 바와 마찬가지로 H^^2 O^^2의 관장이 설험동물에 미치는 영향중 동맥혈 pH, 산소분압 및 이산화탄소분압 그리고 메트헤모글로빈혈증 형성등에 대하여는 많은 보고가 dLTdmsk 장관내압력 변화에 관하여는 연구가 없었으므로, 저자는 고양이에서 여러 가지 농도의 H^^2 O^^2와 그에 따른 사람의 혈액이나 catalase의 양을 달리하여 관장할 때 장관내 압력에 어떠한 영향을 미치는가를 관찰하고저 본 연구를 시행하였으며, 아울러 동맥혈의 pH, 산소분압 및 이산화탄소분압 변화와 메트헤모그로빈혈증 형성 및 까스전색에 대하여서도 관찰하고 다음과 같은 결과를 얻었다. 1. 동맥혈의 pH 및 이산화탄소분압은 혈액 혹은 catalase양의 변화와 H^^2 O^^2의 농도변화에 의해서 혈액과 H^^2 O^^2를 동시 관장한 혈액군에서나 catalase와 H^^2 O^^2를 동시 관장한 catalaserns에서나 관장전에 비하여 각군에 유의한 변화를 볼 수 없었다. 2. 동맥혈의 산소분압 변화는 혈액군이나 catalase 군 모두에서 대조군에서는 관장후 유의한 변화는 없었으나 2% H^^2 O^^2군에서는 산소분압이 가장 높이 상승하였고 다음이 1%군, 0.5%군의 순이었으며 3%와 4%군에서는 오히려 0.5%군보다 낮았다. 그러나 각군의 동맥혈 산소분압의 상승정도에는 유의한 차이는 없었다. 그리고 혈액군과 catalase 군 사이의 각 농도에 해당되는 H^^2 O^^2군간의 산소분압 상승정도도 유의한 차이가 없었다. 3. 동맥혈의 메트헤모그로빈치 변화는 혈액군이나 catalase 군에서 관장전에 비하여 관장후 유의한 차이가 없었으며, H^^2 O^^2의 농도를 증가시켜도 각군의 대조군에 비해서 유의한 차이가 없었다. 4. 관장후 장관내압력 변화는 혈액군이나 catalase 군의 대조군에서는 유의한 장관내압력 상승은 없었으나 0.5% H^^2 O^^2 군에서는 대조군의 약 2배, 1%군은 약 2.5배 그리고 2%군은 약 3배의 장관내압력 상승을 보였고 고양이의 정상혈압보다 낮았으나 3% 및 4%군에서는 정상혈압보다 높은 장관내압력 상승을 볼 수 있었다. 따라서 장관내압력 상승이 고농도 H^^2 O^^2 관장시 동맥혈의 산소분압상승의 저해요인임을 발견하였다. 5. 관장 후 문맥 및 장간막 혈관내 가스전색은 혈액군에서는 2% H^^2 O^^2 군까지도 가스전색이 형성되지 않았으나 3%군에서 가스전색이 형성되었고, catalase 군에서는 0.5% 군의 낮은 농동에서도 가스전색이 형성되었다. 그리고 혈액군과 catalase 군의 3%와 4%군에서 실험동물의 일부가 각각 사망하였다. 이상의 성적으로 저산소상태에 있는 고양이에게 장관내에서 H^^2 O^^2를 분해할 수 있는 사람의 혈액과 H^^2 O^^2를 동시 관장하므로서 동맥혈의 산소분압을 올릴 수 있으며, 고농도의 H^^2 O^^2 관장으로 장관내압력이 비상하게 상승하므로 동맥혈 산소분압이 0.5% H^^2 O^^2를 관장하였을 때보다 더 상승하지 않는 것을 발견하였다. 따라서 0.5% H^^2 O^^2를 관장하므로서 장관내압력을 비교적 적게 올리고, 가스전색이나 메트헤모글로빈혈증 형성없이 동맥혈의 산소분압을 최고로 올릴 수 있다고 사료되었다.
[영문] Hydrogen perxide is a good source of oxygen and has been used parenterally by some investigators as a means of extrapulmonary oxygenation for humans and in animals. However, because of the formation of gas emboli and of methemoglobinemia when given by the intra-arterial or by the intra-venous route the hazards of such treatment have been strongly emphasized (Oliver and Murphy, 1920; Ziegler, 1941; Grodins et al, 1943; Lorincz et al, 1948; Feldman et al, 1966; Urschel et al, 1966; Stern and Brennock, 1967; Fuson et al, 1967). Morgan et al. 1966; urschel et al, 1966 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. Yon(1969) investigated the effects of 0.2% hydrogen peroxide serial enemas on dogs, rabbits and one human case with tetralogy of Fallot and reported the elevation of arterial oxygen tension without gas emboli. Paik(1970) undertook a histological study on rabbit livers following hydrogen peroxide enema and reported no pathological changes below 0.75% hydrogen peroxide. He suggested that hydrogen peroxide could be used safely below 0.75% by enema. Kim(1971) investigated the effects of 0.5 hydrogen peroxide enema in hypoxic cats and observed the significant elevation of arterial oxygen tension without any change of pH, carbon dioxide tension or hematocrit, Lee(1972) reported that after intravenous hydrogen peroxide administration, there were marked elevations of methemoglobin in dogs but after hydrogen peroxide enema with human blood, no change of methemoglobin level was noted. Cheun(1972) reported that human whole blood contains a lot of catalase and peroxidase which act as a catalyst in the breakdown of hydrogen peroxide. Therefore hydrogen peroxide enema with human whole blood was very effective to increase the arterial oxygen tension as an extrapulmonary oxygenation. Kim(1975) reported that a single enema with human whole blood and 0.5% hydrgen peroxide could be used to increase the arterial oxygen partial pressure of human in the hypoxic state (cyanotic congenital heart diseases and severe pneumonia) without any change of vital signs. The present investigation is aimed at studying on the changes of bowel pressure by hydrogen peroxide enema. Also the effects of hydrogen peroxide enema on arterial pH, Po^^2, Pco^^2, methemoglobin formation and gas embolism were studied. In this experiment 120 adult cats of either sex were used and after 12 hourts fasting state glycerine enema was done. Under general anesthesia with injection of seconal (30mg/kg) intraperitoneally the right femoral artery was exposed and a polyethylene tube was inserted and fixed with suture for easy blood sampling. A long rectal tube was inserted for enema and another long rectal tube having a balloon tip was also inserted in order to check changes of bowel pressure, and also was sutured at the anus to prevent leakage after the infusion of hydrogen peroxide or physiologic saline with blood or catalase. Tracheostomy was performed and a cannula was connected to the respirator (Model 607, Harvard Apparatus Co.) to control the respiratory rate and tidal volume. The respiration was made with room air, and then with hypoxic gas of 10% oxygen in 90% nitrogen. Under this arterial desaturation with hypoxic gas an enema was given. 2 groups were divided according to the substances administered; 1. Human blood groups 1) Control group which was administered human whole blood (1 ml/kg) and saline solution (10 ml/kg) 2) 0.5% H^^2 O^^2 group which was administered human whole blood (1 ml/kg) and 0.5% hydrogen peroxide (10 ml/kg) 3) 1% H^^2 O^^2 group which was administered human whole blood (2 ml/kg) and 1% hydrogen peroxide (10 ml/kg) 4) 2% H^^2 O^^2 group which was administered human whole blood (4 ml/kg) and 2% hydrogen peroxide (10 ml/kg) 5) 3% H^^2 O^^2 group which was administered human whole blood (6 ml/kg) and 3% hydrogen peroxide (10 ml/kg) 6) 4% H^^2 O^^2 group which was administered human whole blood (8 ml/kg) and 4% hydrogen peroxide (10 ml/kg) 2. Catalase group; catalase 6,760 unit/ml 1) Control group which was administered catalase (1 ml/kg) and saline solution (10 ml/kg) 2) 0.5% H^^2 O^^2 group which was administered catalase (1 ml/kg) and 0.5% hydrogen peroxide (10 ml/kg) 3) 1% H^^2 O^^2 group which was administered catalase (2 ml/kg) and 1% hydrogen peroxide (10 ml/kg) 4) 2% H^^2 O^^2 group which was administered catalase (4 ml/kg) and 2% hydrogen peroxide (10 ml/kg) 5) 3% H^^2 O^^2 group which was administered catalase (6 ml/kg) and 3% hydrogen peroxide (10 ml/kg) 6) 4% H^^2 O^^2 group which was administered catalase (8 ml/kg) and 4% hydro gen peroxide (10 ml/kg) Blood samples were collected through femoral artery during air breathing hypoxic breathing, and then at 15, 45 and 75 minutes after enema was started in order to evaluate arterial pH, Po^^2 and Pco^^2 in each group. blood samples were also collected before enema and at 40, 90 and 180 inutes after enema in order to evaluate the methemoglobin level in each group. The bowel pressure was checked before enema and at 15, 45, 90 and 180 minutes after enema in each group, and autopsies were performed on all experimental cats for the evaluation of exygen emboli. The following results were obtained; 1) There were no significant changes in the arterial pH and Pco^^2 before and after enema in all of the experimental groups. 2) In the human blood groups and the catalase groups there were marked elevations of Po^^2 after hydrogen peroxide enema in the hypoxic state. Elevation of Po^^2 after hydrogen peroxide enema was achieved in 2%, 1%, 0.5%, 3% and 4% H^^2 O^^2 group in order of increment. But there were no significant differences of elevation of the Po^^2 level between 0.5%, 1%, 2%, 3% and 4% H^^2 O^^2 groups in both the human blood and the catalase groups. Also there were no significant changes of elevation of the Po^^2 level at each of the corresponding concentration for hydrogen peroxide between the human blood groups and the catalase groups. 3) There were no differences in methemoglobin level before and after enema in any of the experimental groups. 4) There were significant elevations of the bowel pressure after hydrogen peroxide enema in all of the hydrogen peroxide groups. The elevation of the bowel pressure after enemas of 0,5%, 1% and 2% hydrogen peroxide were about 2, 2.5 and 3 times that of the control bowel pressure respectively but did not exceed the normal blood pressure of the cat. But after 3% and 4% hydrogen peroxide enema, the bowel pressure did exceed the normal blood pressure of the cat. 5) In the human blood groups oxygen emboli were detected in the mesenteric vein and the portal vein after 3% hydrogen peroxide enema and in the catalase groups oxygen peroxide. The number of cats that expired after hydrogen peroxide enema were as follows; After 3% and 4% hydrogen peroxide enema in the human blood groups one of ten and four out of ten cats respectively expired but in the catalase groups one out of ten cats expired after each enema. From the results obtained by this experiments the increment of bowel pressure after hydrogen peroxide enema of high concentration can be suggested as a detrimental factor for the elevation of arterial Po^^2 on the cats. Therefore a single enema with human blood and 0.5% hydrogen peroxide could be used to obtain the maximum level of arterial Po^^2 without gas embolism and methemoglobinemia or with lesser increment of bowel pressure in the hypoxic state.
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http://ir.ymlib.yonsei.ac.kr/handle/22282913/116500
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2. 학위논문 > 1. College of Medicine (의과대학) > 박사
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