Fallot 4증후군의 개심술마취의 임상적 고찰

Abstract

[영문]

[한글]

Fallot 4증후군은 청색중을 동반한 선천성 심질환중 가장 많은 비율을 차지하는테 해부

학적으로 심실중격절손, 폐동맥협착, 대동맥기승 및 우심실비대의 4가지 이상이 동반된

경우를 말하며 이중에서도 기본적인 기형은 심실중격결손과 폐동맥협착이며 대동맥기승이

나 우심실비대는 이차적으로 오는 것이라고 하였다(Edward등, 1965:Guntheroth등, 1965:L

ev 및 Eckner, 1964). 이 질환의 기본증상은 첫째, 폐동맥협착과 심실중격결손 및 전실혈

관저항에 의해 결정되는 우좌전류의 변화와 둘째, 만성적으로 낮은 PaO^^2에 대한 생체반

응의 두 범주로 설명할 수있다(田등, 1978). 그러한 병태생리적 상태는 다른 어느 질환보

다도 수술 및 마취관리에 있어 중요한 문제가 되므로 이 질환의 기본적 병태생리, 증상,

검사소견, 마취시의 문제점 및 수술후의 관리에 대한 다각적인 이해가 필요할 것이다.

저자는 1971년 1월부터 1980년 12월까지 연세대학교 의과대학 부속 세브란스 병원에서

전실마취하에 체외순환을 이용해 완전교정수술을 받은 Fallot 4증후군 환자 121예를 대상

으로 마취관리에 대한 임상적 고찰을 하여 다음의 결론을 얻었다.

1 .성별은 남자가 82예(67.8%), 여자가 39예(32.2%)였으며 연령별로는 6세에서 10세 사

이가 가장 많았고(44.6%) 다음은 11세에서 15세 사이(22.3%)였다.

2.총 121예중 91예(75.2%)에서 청색증이 동반되었고 집단별로는 Falleot 4증후군만 있

던 예가 81예(66.9%)로 가장 많았다.

3. 마취전 투약으로는 ,secobarbital이 28.1%로 가장 많았고 마취유지는 methoxylurane

좌 N^^2 O의 병용이 43.8%로 가장 많았다.

4. 체외순환은 고관류법으로 시행하였고 체외순환층 평균동맥압은 최고 89.09±1.21mmH

g였고 최저는 36.33±1.21mmHg였다.

5.중요한 합병증으로는 부정맥(13.1%)이 가장 많았고 늑막삼출, 수술부위 감염(각각 10

.3%), 출혈과 신부전(각각 8.3%), 심부전(6.9%), 저심박출상태(4.1%) 및 공기전색에 의한

뇌경색(2.7%)등이 있었다.

6. 총121예중 28예가 사망하였으며(23.1%), 사망원인으로는 심부전(50%), 신부전(14.3%

), 뇌경색(14.3%)의 순으로 많았다.

A Clinica1 Study for the Anesthetic Care of Tetralogy of Fallot

Hae Keun Kil

Department of Medica1 Science, The Graduate School Yonsei University

(Directed by Prof. Kwang Won Park, M.D.)

Tetralogy of Fallot constitutes the highest proportion of cyanotic congenital

heart disease and has 4 basic abnormat anatomical pictures includinng ventricular

septal defect, pulmonary stenosis, aortic overriding and right veatricular

hyperrophy.

The work of Edwards, et al,(1965), Guntheroth, et al(1965)and Lev and

Eckner(1964) has shown that the anatomical picture the combination of just first

two morphological characteristics, the aortic overriding and right ventricular

hypertrophy being a consequence of the ventricular septal defect and pulmonary

stenosis.

Basic signs involve two categories, one is change of shunt rate depending on

pulmonnary stenosis, centricular septal defect and systemic vascular resistance,

and the other is physiological response to the chronically lowared Pa02. thus the

pathophysiologic status presents to us more problems than other congenital heart

disease in the care of patients during operation and anesthessia. Therfore, the

anesthesiologist must understand the basic pathophysiology, various findings of

examination, symtoms and signs, the problems during anesthesis and postoperative

cars.

The puspose of this study was to evaluate the anesthetic management in total

corractive surgery of tetralogy of Fallot which was performed at Severance

Hospital.

Out of consecutive 160 cases of tetralogy of Fallot in our past ten year's

experiences from 1971 to 1980, we selected the clinical results on anesthetic care

of 121 cases which received total corrective surgery under hypothermis and

extracorporeal circulation.

The results werd as follows:

1. 0ut of 121 cases, 82 cases were male(67.8%) and female was 39 cases(32.2%).

The grouaging from 6 to 10 year old was the highest prortion(44.6%) and the next

proportion was the griup aging from 11 to 15(22.3%)

2. Out of 121 cases, 91 cases were cyanotic(75.2%)

On the diagnostic distribution, tetralogy of Fallot without any other anomaly was

the most common(66.9%).

3. As for prrmedicants, secobarbital was the highest proportion(28.1%). For

anesthetic maintenance, methoxyflurane with nitrous oxide was the most

common(43.8%).

4. During catdio-pulmonary bypass, high flow perfusion was commonly used and the

highst mean arterial pressure was 89.09±1.21 mmHg and the loweset mean arterial

pressure was 36.33±1.21 mmHg.

5. The major complications after operation and anesthesia were

dysrrhthmia(13.1%), pleural effuesion(10.3%), main wound infection(10.3%),

hemorrhage(8.3%), acute renal failure(8.3%), heart failure(6.9%), low output

syndrome(4.1%) and carebral infarction due to air embolism(2.7%).

6. Out of 121 cases, 28 cases were expired and hoapital mortallty was 23.7%.

The causes of death were heart failure(50%), acute renal failure(14.3%) and

cerebral infarction(14.3%).

In conclusion, aneothetic care for total corrective surgery of tetralogy of

Fattot should be based upon the understanding of the pathophysiology of disorder

itself.