• Journal of Chest Surgery
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• 제35권6호
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• pp.420-429
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• 2002

심장수술시 체외순환은 저체온 기법으로 실시되지만 최근의 동향은 정상체온 체외순환 기법을 사용하려는 경향이 늘고 있다. 그러나 심장수술 동안 뇌 대사에 대한 정상 체온 체외순환의 임상적 유용성이나 안전성은 아직 완전히 이해되거나 확립되지 않은 상태이다. 저자들은 심장수술 동안 뇌 대사에 대한 정상 체온 체외순환 기법과 중등도 저체온 체외순환 기법의 영향을 비교 평가하기 위해 전향적 연구를 시행하게 되었다. 대상 및 방법: 36명의 성인 심장수술 환자들은 연구목적에 따라 정상 체온 체외순환군(이하 정상체온군, 비인두 온도＞34.5$^{\circ}C$, n=18)과 중등도 저 체온 체외순환군(이하 저체온군, 비인두 온도 29~3$0^{\circ}C$, n=18)으로 한 뒤 비박동성 체외순환을 실시하였다. 전체 환자들에 대해 중대뇌 동맥 뇌혈류 속도(뇌혈류 속도), 뇌동정맥 산소 함량차, 뇌산소 추출률, 수정 뇌산소 대사율, 뇌산소 운반율, 뇌정맥 산소 불포화도(내경 정맥구 혈액 산소포화도$\leq$50%), 기타 동맥 및 내경 정맥구 혈액의 가스분석 등을 체외순환 전(기준치), 체외순환-10분, 재가온-1기(저체온군의 비인두 온도 34$^{\circ}C$때), 재가온-2기(양 그룹의 비인두 온도 37$^{\circ}C$때), 체외순환 종료 직후, 흉부 피부 봉합기 때 측정하였다. 수술 후 신경학적 합병증 역시 관찰하였으며, 전술한 모든 변수들을 양 그룹간에 비교 분석하였다. 결과： 뇌혈류 속도는 재가온­2 때 저체온군(153.11$\pm$8.98 %)이 정상체온군(131.18$\pm$6.94 %) 보다 유의하게 높았다(p＜0.05). 체외순환 10분 때의 뇌동정맥 산소함량차(3.47$\pm$0.21 vs 4.28$\pm$0.29 mL/dL, p＜0.05), 뇌산소 추출률(0.30$\pm$0.02 vs 0.39$\pm$0.02, p＜0.05), 그리고 뇌산소 대사율(4.71$\pm$0.42 vs 5.36$\pm$0.45, p＜0.05)은 저체온군이 정상체온군 보다 유의하게 낮았다. 뇌산소 운반율은 저체온군이 정상체온군 보다 체외순환 10분(1,527.60$\pm$25.84 vs 1,368.74$\pm$20.03, p＜0.05), 재가온-2기(1,757.50$\pm$32.30 vs 1,478.60$\pm$27.41, p<0.05), 흉부 피부봉합기 때(1,734.37$\pm$41.45 vs 1,597.68$\pm$27.50, p＜0.05) 유의하게 더 높았다. 체외순환 10분 때 내경 정맥구의 산소분압(40.96$\pm$1.16 vs 34.79$\pm$2.18 mmHg, p＜0.05), 산소포화도(72.63$\pm$2.68 vs 64.76$\pm$2.49 %, p＜0.05), 그리고 산소함량(8.08$\pm$0.34 vs 6.78$\pm$0.43 mL/dL, p＜0.05)은 저체온군이 정상체온군 보다 유의하게 더 높았다. 수술 후 신경학적 합병증(섬망) 발생 환자 수는 저체온군이 정상체온군 보다 유의하게 적었고(2 명 vs 4 명, p＜0.05) 섬망증세의 지속시간 역시 저체온군이 정상체온군 보다 훨씬 짧았다(60 시간 vs 160 시간, p＜0.01). 결론: 이상의 연구 결과들을 볼 때 정상 체온 체외순환 기법은 고령환자나 장시간 수술환자에 있어 일상적 방법으로 적용하기에 문제가 있을 것 같으며 중등도 저체온 체외순환이 정상 체온 체외순환보다 뇌대사 및 수술 후 신경학적 결과에 더 바람직 할 것으로 판단된다.

• Journal of Chest Surgery
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• 제25권5호
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

• Biomolecules & Therapeutics
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• 제8권1호
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• pp.99-106
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• 2000

Aspalatone [3-(2-methyl-4proponyl)]-2-acetyloxybenzoate, CAS 147249-33-0) is a compound having an antithrombotic action. General pharmacological properties of aspalatone were studied. Aspalatone had no effect on central nervous system and no anticonvulsant effect up to 1200 mg/kg p.o. However, the compound has hypothermic and analgesic effect. When administered intravenously in rabbits, aspalatone did not affect blood pressure, heat rate and respiration rate and depth, and it did not inhibit transient hypotensive effect of acetylcholine. The compound did not affect isolated guinea-pig ileum and tracheal strip at a concentration of 1${\times}$$10^{-4}$, and did not inhibit histamine-induced contraction of guinea-pig ileum. It also did not affect isolated rat stomach fundus and estrogenated rat uterus at 1${\times}$$10^{-4}$, and did not inhibit contraction produced by acetylcholine or oxytocin. The pupil size and intestinal propulsion were not influenced at a large dose of was shown. The compound showed a slight increase in urine volume and led to decreased excretion of potassium in urine of rats. The results suggest that aspalatone may have no considerable adverse effects in general pharmacological aspect.

• 약학회지
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• 제34권3호
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• pp.171-179
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• 1990

The recombinant gamma-interferon (LBD-001) which was produced by yeast as host system was investigated on the pharmacological activities. This gamma-interferon exhibited potent inhibitory effect on adjuvant induced arthritis, but no effect on carrageenin induced paw edema in rats. It did not show any sedative, anticonvulsive, analgesic and hypothermic activities in animals. It also had no influences on isolated tracheal muscle and ileum of guinea pig, isolated uterus and fundus strip of rats, and on blood pressure and respiration in situ experiments of rabbits.

• 생약학회지
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• 제24권3호
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• pp.231-234
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• 1993

Neuropharmacological profile of Humulus lupulus (hop) extract was studied in mice. At doses above 100 mg/kg(i.p.), it decreased spontaneous locomotor activity and raised the nociceptive threshold in the hot-plate test. At doses above 250 mg/kg (i.p.), it increased pentobarbital-induced sleeping time and produced muscle relaxant effect. At the dose of 500 mg/kg, anticonvulsive effect against pentylenetetrazole-induced convulsion and hypothermic effect was observed.

• Journal of Chest Surgery
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• 제29권9호
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• pp.989-995
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• 1996

체외순환을 이용한 개심술후 혈소판기능부전에 의한 비정상적인 출혈은 수술 사망율 및 이환율의 증가를 초래한다. 본 논문에서는 체외순환시 aprotinin을 투여하여 임상적 지혈 및 혈소판기능보존에 대한 효과를 관찰하기 위해 인공판막치 환술을 받은 40명의 환자를 대상으로 low-dose aprotinln 투여군 20명, 대조군 20명으로 나누어 그 효과를 비교 분석하였다. Aprotinin 투여군에서 대조군에 비해 약 40%의 출혈감소(622.0$\pm$ 186m1 versus 1021 $\pm$483.5ml, p<0.01) 및 약 63%의 혈색소 손실(14.7 $\pm$6.8g versus 39.7$\pm$ 16.4g, p<0.01)을 줄일 수 있었으며 약 70%의 수혈감 소(197.7$\pm$ 56.3ml versus 651.2 $\pm$ 147.5ml, p<0.01) 효과를 얻을 수 있었다. 또한 투여 군에서 혈소판 응집 능이 효과적으로 보존되었다(P<0.05). 체외순환중 activated clotting time이 투여 군에서 연장되어 heparin의 항응고작용에 대해 상승효과가 있었으며 aprotinin의 투여와 관련된 합병증은 없었다. 이상의 결과에서 체외순환을 이용한 개심술에 있어서 low-dose aprotinin의 투여는 술후 출혈량 및 혈 액과 혈액제제의 사용감소에 효과가 있으며 이는 혈소판응집능의 효과적 \ulcorner보존에 의한 것으로 사료된다.

• 대한수의학회지
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• 제38권4호
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• pp.867-881
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• 1998

The studies were carried out to investigate the phygiological changes in deep hypothermia in rabbits. Sixty rabbits were continuously cooled with femoral arterio-venous bypass circulation to rectal temperatures of $34.0{\pm}0.3^{\circ}C$(mild hypothermia), $30.0{\pm}0.3^{\circ}C$(moderate hypothermia), and $25.0{\pm}0.3^{\circ}C$(deep hypothermia). The results obtained in these experiments were summarized as follows : In mild, moderate, and deep hypothermia, MAP, HR, RR, pH, $pCO_2$, $pO_2$, $Na^+$, $K^+$, HCT, PLT, glucose, L-lactate, BUN, and creatinine were analyzed. During hypothermia, a statistically significant decrease of MAP occurred between $30^{\circ}C$ and early $25^{\circ}C$(Start) of rectal temperature while significant increases occurred between baseline($38.7^{\circ}C$) and $30^{\circ}C$. Significant decreases of HR and RR were observed in the rabbits, particularly those changes appeared to similar patterns in proportion to hypothermia. Significant decreases of pH occurred between $34^{\circ}C$ and $25^{\circ}C$, and significant increases of $pO_2$ and $pCO_2$ were observed continuously in the hypothermic rabbits. The hypothermia had no significant effect on blood $Na^+$ and serum creatinine. Blood $K^+$ significantly decreased from $3.1{\pm}0.5$(baseline) to $2.6{\pm}0.6mmol/l$($34^{\circ}C$) with the hypothermia for about 30 minutes, and significantly increased from $2.4{\pm}0.6$($25^{\circ}C$(S)) to $2.7{\pm}0.5mmol/l$($25^{\circ}C$(E)) with the hypothermia for 2 hrs. HCT significantly increased to $34^{\circ}C$, thereafter, continuously increased to $25^{\circ}C$(Start, End). PLT increased to $34^{\circ}C$, thereafter, continuously decreased to $25^{\circ}C$(Start, End). Also PLT decreased significantly from 414.3($30^{\circ}C$) to $308.8{\times}103/mm^3$($25^{\circ}C$, Start). Significant increases of blood glucose and L-lactate occurred between $30^{\circ}C$ and $25^{\circ}C$ (Start, End). Slight increase of serum BUN continuously appeared with the hypothermia. These results, such as characteristic changes of the significant decrease of pH and PLT at $34^{\circ}C$, the significant decrease of MAP at $30^{\circ}C$, and the significant increase of glucose and l-lactate at $30^{\circ}C$, suggest that homeostasis of rabbits to hypothermia rapidly decreases at $34{\sim}30^{\circ}C$ of rectal temperature. Therefore, we suggest that, during the period with the rapidly decreased homeostasis, the very carefully control and treatment need to recover hypothermic animals under the circumstances of the various hypothermic experiments and emergency medicine.

• Journal of Chest Surgery
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• 제39권3호
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• pp.194-200
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• 2006

배경: 흉복부대동맥치환술은 흉강과 복강 및 횡격막의 절개가 필요한 광범위한 수술로 수술합병증과 사망률이 높은 질환으로 알려져 있다. 본 교실에서 2001년까지의 성적은 이미 보고한 바 있었으나 그 후 극저체온하 순환정지법을 사용하여 좋은 결과를 얻었기에 비교하여 보고하고자 한다. 대상 및 방법: 96년에서 2005년 8월까지 흉복부대동맥치환술을 20명의 환자에서 시행하였다. 원인질환은 동맥경화성흉복부대동맥류가 8예, 박리성흉복부대동맥류가 12예였다. 치환범위로는 Crawford분류법으로 I형이 2예, II형이 7예, III형이 1예, IV형이 7예, V형이 3예였다. 이들의 결과를 이미 보고한 시점인 2001년을 기준으로 구분하여 비교하였다. 걸과: 2001년 이전에 수술한 흉복부대동맥치환술 환자 9명중에 5명이 사망하였는데 type I, II의 3명은 모두 사망하였었다. 그 후에는 기존의 방법을 바꾸어 Crawford type I, II의 광범위 흉복부치환술 6명에서 극저체온하순환정지법을 사용하고, type III, IV, V의 국소 흉복부 치환술 5명에서 대퇴동정맥체외순환으로 적극적인 늑간동맥문합을 시행한 결과 11 명 모두에서 허혈성 합병증 없이 모두 치료되어 외래 경과 추적 중이다. 결론: 극저체온하 순환정지법은 광범위 흉복부대동맥을 안전하게 치환하게 하는 수기이다.

• Archives of Pharmacal Research
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• 제16권1호
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• pp.71-74
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• 1993

The protective effect of adenosine triphosphate (ATP) on gastic ulcer induced in rats has been studied. Gastic ulceration was induced by hypothemic restraint stress or dicolofenac sodium. Gastic acid secretion and mucosal injury produced by the hypothemic restraint stress was greater as compared with those produced by diclofenac sodifum. ATP significantly reduced area of injury, however, increased cyclic adenosine monophosphate (cATP) content. Administration of dipyridamole along with ATP did not change the total lesion area in both models when compared to ATP alone. Aminophyline antagonized antagonized the protective effect of ATP on the injured area. Famotidine was found to be effective in reducing gastric acid output as well as the total injured area without any change in cAMP content when given along with ATP.

• Clinical and Experimental Pediatrics
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• 제57권5호
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• pp.222-225
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• 2014

Purpose: A recent study analyzing several cytokines reported that long cardiopulmonary bypass (CPB) time and long aortic cross clamp (ACC) time were accompanied by enhanced postoperative inflammation, which contrasted with the modest influence of the degree of hypothermia. In this present study, we aimed to examine the effect of CPB temperature on the clinical outcome in infants undergoing repair of isolated ventricular septal defect (VSD). Methods: Of the 212 infants with isolated VSD who underwent open heart surgery (OHS) between January 2001 and December 2010, 43 infants were enrolled. They were classified into 2 groups: group 1, infants undergoing hypothermic CPB ($26^{\circ}C-28^{\circ}C$; n=19) and group 2, infants undergoing near-normothermic CPB ($34^{\circ}C-36^{\circ}C$; n=24). Results: The age at the time of the OHS, and number of infants aged<3 months showed no significant differences between the groups. The CPB time and ACC time in group 1 were longer than those in group 2 (88 minutes vs. 59 minutes, P =0.002, and 54 minutes vs. 37 minutes, P =0.006 respectively). The duration of postoperative mechanical ventilation was 1.6 days in group 1 and 1.8 days in group 2. None of the infants showed postoperative neurological and developmental abnormalities. Moreover, no postoperative differences in the white blood cell count and C-reactive protein levels were noted between two groups. Conclusion: This study revealed that hypothermic and near-normothermic CPB were associated with similar clinical outcomes and inflammatory reactions in neonates and infants treated for simple congenital heart disease.