기관내 삽관 및 발관이 혈압 및 심박동수에 미치는 영향

Abstract

[영문]

[한글]

전신마취하에서 직접후두경 삽입, 기관내삽관 및 발관은 고혈압 환자에서는 물론 정상

환자에서도 심혈관계에 자극을 가하여 혈압 및 심박동수가 일시적으로 증가하는데 (King

등, 1951; Takeshima 등, 1964; Forbes 및 Dally, 1970; Edde, 1979; 백등, 1980) 이는

기도의 기계적 자극에 의한 원심성 경부교감신경의 기능항진에 의한 것이며(Tomori 및 Wi

ddicombe, 1969;Forbes 및 Dally, 1970) 미주신경 자극으로 각종 심부정맥은 물론(Burste

in 등, 1950**ⓐ ; King등, 1951; Lander 및 Moyer, 1965; Forbes 및 Dally, 1970) 때로

는 심정지까지 일으킬 수 있다 (Dwyer, 1953; RAffan, 1954).

이러한 혈업 및 심박동수의 상승은 좌심실 부전 및 뇌출혈등의 위험을 초래할 수 있으

므로 이를 예방하기 위한 여러 가지 약리적 시도가 있었으나 현재까지 만족할만한 방법이

제시되지 않았다.

저자는 연세대학교 의과대학 부속 세브란스 병원에서 기관내삽관에 의한 전신마취하에

수술을 받은 건강한 성인환자중 삽관시는 85명, 발관시는 60명을 대상으로 각각을 대조군

, lidocaine 정주군 및 lidocaine 분무군으로 나누어 혈압, 심박동수 및 심전도 변화를

비교하여 다음과 같은 결과를 관찰할 수 있었다.

1. 기관내삽관시 수축기 혈압은 대조군에 비하여 lidocaine 정주군에서는 삽관 직후 및

30초후(P<0.05), lidocaine 분무군에서는 삽관 직후, 30초후 및 1분후(P<0.001) 그 증가

정도가 현저히 억제되었으며 마취유도 이전의 상태로 빨리 돌아왔다.

2. 기관내삽관시 이완기 혈압은 lidocaine 분무군에서 대조군에 비하여 삽관 30초후 (P

<0.05), lidocaine 정주군에 비하여 삽관 2분후 (P<0.001) 증가정도가 현저하게 억제되었

다.

3. 기관내삽관시 심박동수는 대조군에 비하여 lidocaine 정주군에서 삽관 1분후, lidoc

aine 분무군에서 삽관 30초후, 1분후 및 2분후의 증가정도가 현저하게 억제되었다(P<0.05

).

4. 기관내튜브 발관시 수축기 혈압은 대조군에 비하여 lidocaine 정주군에서 발관 30초

후 그 증가정도가 현저하게 억제되었으며 (P<0.001) 발관 이전의 상태로 빨리 돌아왔고,

lidocaine 분무군에서는 발관으로 인한 수축기 혈압상승이 억제되었다.

5. 기관내튜브 발관시 이완기 혈압상승이 lidocaine 정주군에서는 일어나지 않았고, li

docaine 분무군에서는 대조군에 비하여 발관이전의 상태로 빨리 돌아왔다.

6. 기관내튜브 발관시 심박동수의 증가는 대조군에 비하여 lidocaine 정주군에서 더 오

랫동안 지속되었으며, lidocaine 분무군에서는 발관이전의 상태로 빨리 돌아왔다.

7. 기관내삽관 및 발관시 lidocaine의 정주 및 분무는 심전도 변화 발생율을 감소시키

지 못했다.

이상의 결과를 종합하면 lidocaine의 정주 혹은 분무는 전신마취하에 기관내삽관 및 발

관시 혈압상승을 감소시키고 마취유도전의 상태로 빨리 돌아오게 하는데 유효하다고 사료

된다.

The Effect of Endotracheal Intubation and Extubation on the Blood pressure and

Heart Rate

Sun Hee Kim

Department of Medical Science

The Graduate School Yonsei University

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

Transient increases in blood pressure and heart rate following laryngoscopy,

endotracheal intubation and extubation are common (King et al, 1951; Takeshima et

al, 1964; Forbes and Dally, 1970; Edde, 1979; Paik et al, 1980).

Tomori and Widdicombe (1969) found these responses are associated with an

increased impulse traffic in the cervical sympathetic efferent nerve fibers. These

nervous activities were especially increased by mechanical stimulation of the

epi-and laryngopharyngeal regions (Forbes and Dally, 1970).

Also various arrhythmias were elicited by vagal stimulation during endotracheal

intubation (Burstein et al, 1950**ⓐ ; King et al, 1951; Lander and Moyer, 1965;

Forbes and Dally 1970), and it has been known that cardiac arrest could occur in

severe cases (Dwyer, 1953; Raffan, 1954). Increased blood pressure and heart rate

can produce cerebral hemorrhage, left ventricular failure and life threatening

cardiac arrhythmia. So pharmacologic attempts to attenuate these blood pressure and

heart rate elevations and appearances of arrhythmias have been tried but these

approaches have been only partially successful.

The present study was undertaken to observe the effects of intubation and

extubation on cardiovascular system. Adult patients who had received elective

surgery under general anesthesia with endotracheal intubation were randomly

selected at Severance Hostital. Eighty five and sixty patients were selected for

the response following intubation and extubation respectively, and were divided

into 3 groups each;

Group Ⅰ served as a control group for intubation (n=25) and extubation (n=20).

Group Ⅱ served as a intravenous lidocaine injected group for intubation (n=30)

and extubation (n=20).

Group Ⅲ served as a lidocaine sprayed group for intubation (n=30) and

extubation (n=20).

The changes of arterial blood pressure and pulse rate and appearances of

arrhythmias following intubation and extubation were analyzed and data were

compared among the groups.

The results were as follows:

1. In the lidocaine intravenous injected or sprayed group, systolic blood

pressure elevation following intubation was more decreased in magnitude than in the

control group (statistically significant) and rapidly returned to the pre-induction

level.

2. In the lidocaine sprayed group, the magnitude of diastolic blood pressure

elevation following intubation was more decreased than in the control and

intravenous lidocaine injected groups (statistically significant).

3. In the lidocaine intravenous injected or sprayed groups, the magnitude of

heart rate elevation following intubation was more decreased than in the control

group (statistically significant).

4. In the lidocaine intravenous injected group, the magnitude of systolic blood

pressure elevation following extubation was more decreased than in the control

group (statistically significant). In the lidocaine sprayed group, systolic blood

pressure elevation following wxtubation was prevented (statistically significant).

5. The diastolic blood pressure elevation following extubation was prevented in

the lidocaine intravenous injected group (statistically significant) and more

rapidly returned to pre-extubation levels in the lidocaine sprayed group than in

the control group.

6. The elevation of heart rate following extubation was prolonged in the

lidocaine intravenous injected group and more rapidly returned to pre-extubation

levels in the lidocaine sprayed group than in the control group.

7. The effects of lidocaine on the prevention of EKG abnormalities following

intubation and extubation were not signigicant.

It is suggested from the above results that lidocaine intravenous injection and

spray of the laryngopharyngeal region decreases the magnitude of blood pressure

elevation following intubation and extubation under general anesthesia and is

effective for rapid return to the awake level.