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기관내 삽관시 Sodium nitroprusside가 심혈관계에 미치는 영향

Title
기관내 삽관시 Sodium nitroprusside가 심혈관계에 미치는 영향
Other Titles
(THE) EFFECT OF SODIUM NITROPRUSSIDE ON RESPONSES OF THE CARDIOVASCULAR SYSTEM DURING ENDOTRACHEAL INTUBATION
Authors
이명애
Issue Date
1984
Department/Major
대학원 의학과
Keywords
기관삽관심혈관계Sodium nitroprusside
Publisher
이화여자대학교 대학원
Degree
Master
Advisors
이춘희
Abstract
일반적으로 전신마취시 기관내 삽관은 안전한 흡입마취제 투여를 위하여 반드시 필요한 것이나 정맥마취제와 탈분극성 근육이완제 투여후, 직접 후두경하에 기관내 삽관을 시행할 시 심혈관계의 변화로 일시적인 혈압상승과 빈맥이 나타난다. 특히 고혈압환자는 기관내 삽관시 더 민감한 심혈관계반응을 나타내며 급격한 혈압상승을 초래하여 좌심실부전과 뇌졸증 등의 치명적인 결과를 초래할 수 있다. 이에 저자는 정상혈압군과 고혈압군에서 기관내 삽관시 혈압상승을 감소시킬 목적으로, 강력하고 신속한 혈관확장제인 sodium nitroprusside (이하 SNP라함) 1 ug/㎏를 정맥마취제와 근이완제 투여후 단 일회 신속정주하여 기관내 삽관시 일어나는 심혈관계 변화를 관찰하였다. 시험대상은 미국 마취과학회 환자상태 분류에 따른 class Ⅰ-Ⅱ에 해당하는 남녀환자 80명으로 전신흡입마취 유도시 기관내 삽관중 혈압 및 심박수변화와 SNP전처치후의 심혈관계 변화를 관찰하여 다음과 같은 결론을 얻었다. 1. 기관내 삽관시 수축기혈압은 정상혈압군(제Ⅰ군)에 비해서 SNP를 투여하지 않은 고혈압군(제Ⅱ군)에서 의의있게 높았다.(P< 0.001) 2. 기관내 삽관시 수축기혈압은 SNP를 투여하지 않은 고혈압군(제Ⅱ군)에 비해 SNP를 투여한 고혈압군(제Ⅲ군)이 의의있는 수축기혈압 상승억제를 나타냈다.(P<0.001) 3. 각 군에서 기관내 삽관시 심박수 변화는 있었으나 통계적 유의성은 없었다.;Transient increases in blood pressure and heart rate following laryngoscopy and endotracheal intubation are well documented in normotensive patients. These circulatory effects are elicited by mechanical stimulation of the laryngopharynx and trachea via efferent cervical sympathetic fibers. The hypertension during induction of anesthesia in hypertensive patients can be accompanied by cerebral hemorrhage, left ventricular failure and life-threatening cardiac arrhythmia. The present study was undertaken to observe the effects of sodium nitroprusside (SNP) on the change in systolic blood pressure and heart rate during and after laryngoscopy for tracheal intubation. Eighty adult patients who had received elective operation under the general anestheia with endotracheal intubation were randomly selected and devided into 3 groups. Group Ⅰ served as a normotensive group Group Ⅱ served as a hypertensive group without SNP Group Ⅲ served as a hypertensive group receiving 1 u㎍/kg of SNP 15 seconds before starting laryngoscopy The changes of systolic blood pressure and pulse rate were analyzed and data were compared between groups. The results were as follows: 1. Attenuation of increase in blood pressure was statistically significant in hypertensive group with prior SNP compared with that group not receiving SNP (p < 0.05). The magnitude of blood pressure increase in hypertensive group without prior SNP was significantly greater than normotensive group (p < 0.001). 2. SNP had no effect on the increase in heart rate associated with tracheal intubation. In conclusion, it is suggested that a single rapid intravenous injection of SNP is a practical pharmacological method to attenuate blood pressure increase during direct laryngoscopy and tracheal intubation in hypertensive patients.
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