Glycopyrrolate와 atropine 전처치시 임산부의 위액 pH. 유리산도 및 총산도의 변화

Abstract

Aspiration of gastric contents produces severe effects that have characteristic clinical, radiologic and pathologic features. A critical pH below 2.5 appears necessary for pulmonary damage to occur. The hazard of acid aspiration in parturient is accentuated by delay in gastric emptying. The gravid uterus at term presses on the pyloric portion of the stomach, retarding evacuation of stomach contents. It can also increase the intra-abdominal pressure, which will be associated with an increased intragastric pressure. Many obstetrical patients enter the hospital in labor after having recently eaten. Various preventive measures have been advocated. Anticholinergic medications inhibit gastric juice production and acidity. The present invesgitation was designed to ascertain the effects of glycopyrrolate and atropine premedication on gastric juice pH in parturients and to compare such effect with that following none premedication. The investigation was limited to women scheduled for elective Cesarean section under general anesthesia. In a control group of 10 patients, no premedication was given, while another 10 patients, were given glycopyrrolate (0.2mg) premedication IM 60 minutes before induction of anesthesia. In a third group of 10 patients atropine (0.5mg) was used as premedication. After intubation, a Levin tube was introduced into stomach. A sample of gastric juice was aspirated after intubation and 1 hour later, and its pH, free acidity, total acidity were measured. The results were as follows: 1. There were not any significant changes in the mean gastric pH, free acidity or total acidity in any of the groups in pre and postanesthesia in parturients who underwent Cesarean section. 2. In the control group, the gastric pH was 1.88±0.08, the free acidity was 31.87±7.40 and the total acidity was 58.06±7.72. 3. In the glycopyrrolate pretreated group, the gastric pH was 4.41±0.41 and the total acidity was 33.31±3.78. Compared with the control group, the gastric pH in the glycopyrrolate pretreated group increased but the free acidity and total acidity both decreased significantly (p < 0.05). 4. In the atropine pretreated group, the gastric pH was 2.75±0.22 the free acidity was 6.22±0.83 and the total acidity was 33.90±7.35. The gastric pH in atropine pretreated group increased but the free acidity and total acidity both decreased significantly compared with the control group. 5. Compared with the control group, the gastric pH above 2.5 increased significantly in all group. 10% of the control group, 60% of the glycopyrrolate pretreated group and 50% of the atropine pretreated group had a gastric pH above 2.5 in preanesthesia while 20% of the control group, 80% of the glycopyrrolate pretreated group and 40% of the atropine pretreated group had a gastric pH above 2.5 in postanesthesia. In conclusion, it would seem that the incidence of severe aspiration pneumonitis can be decreased by glycopyrrolate or atropine pretreatment in parturients who undergo Cesarean section.;마취학의 발달에 따라 마취로 인한 합병증은 현저히 감소하였으나 위 내용물 흡인의 문제점은 아직 미해결된 과제로 남아있다. pH 2.5 이하의 위 내용물이 기관지 내로 흡인 될때는 심각한 폐손상을 초래하여 저 산소증으로 인해 높은 사망율을 나타내고 있다. 임신 말기의 임산부에서는 충분한 금식에도 불구하고 자궁이 위 유문부를 압박하여 위 공복 시간을 지연시키고 위내압을 상승시켜 위 내용물이 기관지내로 흡인되는 빈도가 증가하게 된다. 이에 저자는 위 공복 시간이 지연되는 임산부에게 선택적 제왕절개수술을 위한 마취시 항콜린제인 glycopyrrolate 0.2mg을 전투약한 경우와 atropine 0.5mg 전투약하여 위액 산도에 미치는 효과를 관찰하여 다음과 같은 결론을 얻었다. 1. 각 군 모두에서 마취전과 마취 1시간 후의 위액 평균 pH, 유리산도 및 총산도의 변화는 거의 없었다 (P > 0.05). 2. 대조군은 마취전 위액의 평균 pH가 1.88±0.08, 유리산도31.86±7.40 총산도 58.06±7.72였다. 3. glycopyrrolate 투여군에서는 마취전 위액의 평균 pH는 2.60±0.14, 유리산도 4.41±0.40, 총산도 33.31±3.78로 대조군에 비해 위액 평균 pH는 의의있게 증가하였다 (p<0.05). 4. atropine 투여군은 마취전 위액 평균 pH는 2.75±0.22, 유리산도 6.22±0.83, 총산도 33.90±7.35로 대조군에 비해 위액 평균 pH는 의의있게 증가하였다(p < 0.05). 5. 위액 평균 pH가 2.5이상일 경우는 대조군에서 마취된 10% 마취후 20%였고 glycopyrrolate 투여군에서는 마취전 60 %,마취후 80 %였으며 atropine 투여군에서는 마취전 50 %, 마취후 40 %였다.