균형마취시 근육이완제 d-tubocurarine의 정맥 주입속도에 따른 심혈관계 영향

Abstract

균형마취란 강력한 진통제, 진정제와 함께 筋肉弛緩劑를 주입하여 마취를 시행하는 방법이다. 균형마취시 환자의 동통과 의식 소실을 위하여 강력한 진통제와 진정제인 meperidine, diazepam 사용과 함께 非脫分極性 筋肉弛緩劑인 d-tubocurarine 정맥 주입시 histamine 遊離로 인해 동반되는 혈압하강을 감소시키고자 d-tubocurarine(0.4 mg/kg)의 정맥 주입속도에 따른 심박수 및 혈압의 변화를 관찰하였다. 이화여자대학교 부속병원 마취과에서 마취 받은 30명의 환자를 대상으로 각群을 10명씩 세 群(5초 이내, 60초, 180초)으로 나누어 관찰하여 다음과 같은 결론을 얻었다. 1. d-tubocurarine(0.4mg/kg) 정맥 주입후 심박수는 세 群 모두에서 의의있는 감소를 나타냈다. 2. d-tubocurarine(0.4mg/kg) 정맥 주입후 혈압은 제1군과 제2군에서 의의있게 감소하였으나 제3군에서는 거의 감소하지 않았다. 3. d-tubocurarine(0.4mg/kg) 투여후 제1군에서는 2분후 (12.3%)와 6분후(11.5%), 제2군에서는 6분후(10.6%)에 대조치에 비해서 혈압의 감소를 나타냈다.;d-Tubocurarine, which is one of the non-depolarizing muscle relaxants, is commonly used in balanced anesthesia with meperidine and diazepam. Blood pressure reduction following d-tubocurarine administration to anesthetized patients is an important side-effect, most likely due to histamine release. The amount of histamine released after injection of any drug that acts as a histamine release substance depends on the plasma level of the drug achieved and thus on the rapidity of intravenous administration of that drug. Therefore, I measured changes in arterial blood pressure and heart rate in normal patients during and after intravenous injection of 0.4mg of d-tubocurarine per kg of body weight at varying rate of administration (as a bolus, over 60 seconds, and over 180 seconds). This study was undertaken on thirty patients undergoing elective operations at the department of anesthesiology in Ewha Womans University Hospital. The results were as follows: 1. The decreases in heart rate after d-tubocurarine administration were significant in all three groups. 2. The decrease in systolic blood pressure after d-tubocurarine administration was significantly less in patients receiving the drug over 180 seconds (group 3) than it was following as a bolus (group 1) or over 60 seconds administration (group 2). 3. Maximum reductions in systolic blood pressure were present two and six minutes after administration of d-tubocurarine as a bolus, and six minutes after administration over 60 seconds, and the values of decrease from the control were 12.3% 11.5%, and 10.6%, respectively.