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기관내 삽관시 심혈관계에 미치는 trimethaphan의 효과

Other Titles
 The Effects of Trimethaphan on Responses of the Cardiovascular System During Endotracheal Intubation 
Authors
 백상기 
Issue Date
1979
Description
의학과/석사
Abstract

[영문] [한글] 전신마취 하에서 직접 후두경삽입과 기관내 삽관은 정상환자에서 심혈관계에 자극을 가 하여서 동맥혈압과 심박동수의 증가를 가져오는데(Reid 및 Brace 1940: Burstein 등 1950 : King 등 1951: Take-shima등 1964: Forbes 및 Dally 1970) 이는 기도의 기계적 자극에 위한 경부의 원심성 교감신경섬유의 기능항진으로 인해 일어난다고 하며(Tomori 및 Widdi combe 1969) 또한 기관내 삽관시에는 미주신경 자극으로 각종 심부정맥을 일으킬 수 있고 (Burstein 등 1950: King 등 1951: Forbes 및 Dally1070) 경우에 따라서는 심정지까지 일 으킬 수 있는 것으로 알려져 있다(Burstein 등 1950: Dwyer 1953: Raffan 1954: Lander 및 Mayer 1965). 특히 고혈압 환자는 항진된 Vasopressive response를 나타내므로 급격한 혈압 상승시 좌심실부전과 뇌출혈등의 위험을 초래할 수 있고 또한 생명의 위험을 주는 심부정맥도 나타날 수 있다 (Dingle 1966: Masson 1964). 이러한 혈압 및 심박동수의 상 승과 부정맥의 출현을 줄이기 위한 여러 가지 약리적인 시도가 행해져 왔으나 현재까지 만족할만한 완전한 방법은 발견되지 않았다. 저자는 1979년 8월부터 9월 사이에 연세대학 교 의과대학 부속 세브란스 병원에서 기관내삽관에 의한 전신마취하에 수술을 받는 성인 환자 중 정상 혈압환자 40명과 고혈압환자 20명을 무작위 선택하여 각각을 대조군과 trim ethaphan camphosulfonas 투여군으로 분류하여 기관내삽입관시의 혈압과 심박동수의 변동 및 부정맥의 출현을 비교 검토하여 다음과 같은 결과를 관찰하였다. 1. 정상 혈압군에서는 대조군에 비해 trimethaphan투여군의 혈압상승이 약간 억제되었 지만 통계학적인 의의는 없었다. 그러나 고혈압군에서는 trimethaphan투여군의 혈압상승 억제가 통계적으로 의의 있게 나타났다(P<0.05). 2. 전신마취 하에 직접 후두경삽입시 심박동수에 대한 소량의 .trimethaphan의 효과는 통계상 별 의의가 없었다. 3. 비정상심전도 소견은 고혈압군에서 대조군에 비해 trimethaphan 투여군이 적게 나 타났다. 이상의 결과를 종합하면 전신마취 하에 직접 후두경삽입시 고혈압 환자에서 trimethaph an을 소량(0.1㎎/㎏) 정주하면 위험한 hypertensive crisis를 막을 수 있는 한 방법으로 사용할 수 있을 것으로 사료된다. The Effect of Trimethaphan on Responses of the Cardiovascular System During Endotracheal Intubation Sang Ki Paik Department of Medical Science, The Graduate School, Yonsei University (Directed by Prof. Kwang Won Park, M.D.) Tachycardia and hypertension are well documented complications of laryngoscopy and tracheal intubation in normal patients(Reid and Brace, 1940; Burstein et al, 1950; King et al 1951; Takeshima et al, 1964; Forbes and Dally, 1970). This phenomenon has been studied in detail in cats by Tomori and Widdicombe(1969), who found it to be associated with an increased impulse traffic in the cervical sympathetic efferent fibers. This nervous activeity was especially increased by stimulation of the epipharyngeal and laryngopharyngeal regions, and was accompanied by the largest hypertensive response(Takki et al, 1972). Also various arrhythmias were elicityed by vagal stimulation during endotracheal intubation (Burstein et al, 1950; King et al, 1951; forbes et al, 1970), and it has been known that cardiac arrest could be observed in severe cases(Burstein et al, 1950; Dwyer, 1953; Raffan, 1954; Lander and Mayer, 1965). That hypertension during induction of anesthesia in critically ill patients may be harmful is substantiated by reports of cerebral hemorrhage, left ventiricular failure and life threatening cardiac arrhythmia(Forbes and Dally, 1970; Dingle, 1966; Masson, 1964; Katz and Bigger, 1970). Pharmacologic attempts to attenuate these blood pressure and heart rate elevations and appearances of arrhythmia have been tried but these approaches have been only partially successful. We selected at random 60 adult patients who had received operation under the general anesthesia with intubation at Severance Hospital from August to September, 1979. They were divided into 4 groups. Group Ⅰ was normotensive without trimethaphan(n=20), Group Ⅱ was normotensive with trimethaphan(n=20), Group Ⅲ was hypertensive without trimethaphan(n=10) and Group Ⅳ was hypertensive with trimethaphan(n=10). The changes of arterial blood pressure and pulse rate, and appearance of arrhythmia were analyzed and data were compared between groups. The results were as follows; 1. In the trimethaphan injected group, during induction attenuation of increase in blood pressure was not significant in the normotensive group but was statistically significant in the ypertensive group. 2. The effects of trimethaphan on changes of pulse rate were not significant during laryngoscopic insertion under general anesthesia. 3. On EKG of hypertensive patients the trimethaphan injected group revealed fewer abnormal EKG findings than the control group. It is suggested from the above results that intravenous injection of a small amout(0.1mg/kg) of trimethaphan in a hypertensive patient just before endotracheal intubation can be used as one method to prevent a dangerous hypertensive crisis.
Full Text
https://ymlib.yonsei.ac.kr/catalog/search/book-detail/?cid=CAT000000046182
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1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
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https://ir.ymlib.yonsei.ac.kr/handle/22282913/135299
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