1 224

Cited 0 times in

산과 Ketamine 마취시에 혈중기체분압에 대한 관찰

Other Titles
 Effect of ketamine on blood gas of mother and newborn during the obstetric anesthesia 
Issue Date
[한글] Ketamine은 phencyclidine의 유도체로 근래에 산과에서 많이 사용되고 있으며 그에 대한 연구보고도 많이 나와있다. 그러나 아직도 ketamine 사용의 장단점이 늘어나고 있으며 Little등 (1972)에 외해서 태아에 대한 상태와 혈액가스 분석이 보고된 후 산모와 신생아에 대한 혈액가스 분석의 상쇄한 보고가 거의 없는 것으로 보아 본 연구는 ketamine이산모와 신생아에 미치는 영향과 마취전후의 산모 및 신생아의 혈액을 기체분석방법으로분석관찰하여 ketamnine의 유용성을 파악하고자 시도하였다. 실험대상 및 방법 6명의 제왕절개술 산모와 14명의 경질분만 산모를 대상으로 ketamine을 1.0-1.8㎎/㎏를 60초에 걸쳐 서서히 정주하면서 산모의 vital sign을 계속 측정하면서 마취 5분전과 마취 15분후에 산모에서 동맥혈을 채혈하고 신생아의 Apgar score를 1분후와 5분후 측정하고 제대정맥에서 채혈하여 혈액가스 PaO^^2, PaCO^^2 및 pH를 Asrup Radiemeter(BMS^^2 MK^^2 Blood Microsystem)에 의해 측정하였고 HCO^^2 및 Base excess(B.E.로 약함)는 pH및 PaC0^^2d의 측정치를 기준하여 Siggaard Anderson Curve Nomogram를 이용 산출하였다. 실험결과 1. Ketamine 1.0-1.8㎎/㎏는 제왕절개수술 혹은 경질분만 산모에게 좋은 마취제로 유용성을 나타났으며 vital sign 측정에서 아무런 변화가 없었다. 2. 출산 5분후 신생아의 Apgar score는 8-9로 정상치를 보였다. 3. 마취후 산모의 Pa0^^2, PaCO^^2 및 pH는 평균 각각 83.6㎜Hg 40.2㎜Hg 그리고 7.37로 정상치를 유지하였고 HCO^^3와 B.E.치도 각각 23.8mEq/ℓ, -1.32mEq/ℓ로 정상치를 나타냈다. 4. 신생아의 제대정맥혈의 PaO^^2는 평균 42.2mHg로 정상이었으며 PaC0^^2는 평균 41.7㎜Hg로 약간 증가 pH는 7.31로 산모보다 낮은 치를 나타냈다. HCO^^3는 19.7mEq/ℓ이고 B.E는 -7.14 mEq/ℓ로 대사성산증을 나타내었다.
[영문] Since Chodoff and Stella (1968), Ketamine, a phencyclidine derivative, has been used in clinical trials in obstetric Patients. It has been guggested for use in obstetric because of, among many other reasons, its rapid induction of anesthesia with profound analgesia; it is rapidly metabolized with a relatively quick recovery from anesthesia; it gives little maternal respiratory or cardiovascular depression; and it does not inhibit larrngeal and pharyngeal reflexes. Little et al (1972) investigated safety of ketamine to mother and baby at labor and derivery using single higher dose or continous infusion. They have measured pH, PaCO^^2 and PaO^^2 of blood from the scalp of fetus and umbilical satery and vein, They found that fetal pH dropped after administration of ketamine and little increase of PaCO^^2. The PaO^^2 appeared quite wide range but have little over all changes. Present study is intended to establish the right done of ketamine for anesthesia and to found out the effect of ketamine on blood gas of mother and newborn during and after the Cesarean section and vagina delivery. MATERIALS AND METHODE The materials used in this study consisted of 6 Cesarean section including emergency and elective operation, and 14 vaginal delivery cases. All cases, patient recieved 0.5㎎ of atropine sulfate 5 to 30 minutes before the ketamine administration. Ketamine was given 1.0-1.8㎎/㎏ slowly for over 60 seconds and supplement of ketamine and 66% N^^2 O or 0.1% succinylcholine were given some Cesarean section cases. Mother's vital sign and baby's Apgar score were examined. Blood was drawn from mother's radial artery 5 minutes before and 15 minutes after the ketamine anesthesia and from umbilical vein of newborn after de1ivery. Blood gas was analyzed using Radiometer BMS3-MK2 blood microsystem. RESULTS AND SUMMARY The following results were observed: 1. Ketamine, with dose ranges of 1.0 to 1.8㎎/㎏, did not affect maternal vital sign. 2. The use of ketamine had almost no affect on the Apgar score. 3. The mother's Pa0^^2, PaC0^^2 and pH during anesthesia remained in the normal range(83.6mmHg, 40.2mmHg and 7.37 respectively). Standard bicarbonate showed normal level of 23.8mEq/ℓ and Base Excess was -1.32mEq/ℓ. 4. Newborn PaO^^2 appeared normal range of 42.2㎜Hg and PaCO^^2 increased little(41.7㎜Hg), and pH dropped an average of 0.09 unit from normal level(74.0). Standard bicarbonate dropped to low level of 19.7mEq/ℓ and Base Excess also dropped to -7.14mEq/ℓ to show the metabolic acidosis immediately after delivery.
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
사서에게 알리기
교내이용자 서비스로 제공됩니다.
RIS (EndNote)
XLS (Excel)


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.