• 대한약리학회지
• /
• 제23권1호
• /
• pp.15-23
• /
• 1987

만성 간문맥 고혈압에 동반하는 내장 충혈에 대한 발생 기전을 규명하기 위하여 고양이의 간문맥을 결찰하고 그 경과에 따라 비 -간 교감 신경성 반사 흥분의 변동과 동시에 순환 역동학적 변동을 관찰하였다. 1. 대조 고양이 (Sham 수술군)에서 비동맥을 통하여 capsaicin, bradykinin 및 vasopressin을 주사 하였을 매에는 전신 동맥압의 반사 흥분뿐만 아니라 비정맥압의 상승을 초래하였다. 그러나 심박동수는 변화가 없었다. 동시에 비장(비-비 반사) 및 간장 (비 -간 반사)에서 교감 신경의 만사 흥분을 일으켰다. 2. Capsaicin을 간 표면에 도포하였을 때는 간 신경 흥분 (간-간 반사)과 등시에 승압 반사를 유발시켰다. 3. 문맥 결찰 후에는 비정맥압은 시간 경과에 따라 증가 하였고 이에 동반하여 전신 동맥압은 감소하였다. 그러나 승압반사 항진은 제2일에 현저하게 야기되었고 그후 대조치로 회복되었다. 비-비 또는 비-간 교감 신경 반사 흥분은 제8일에 현저히 감약되었다. 4. 이상의 성적을 종합하면 비장 및 간장에 분포하는 교감 신경 반사 흥분은 동일한 중추 지배에 의하여 조절되고, 간문맥 결찰 후 내장 반사 흥분의 감소는 내장 충혈의 발생과 밀접한 관련이 있을 것으로 사료되었다.

• The Korean Journal of Pain
• /
• 제3권2호
• /
• pp.108-118
• /
• 1990

Splanchnic nerve block (SNB) is performed to relieve intractable upper abdominal pain caused by carcinoma of the upper G-I tract. Not all patients achieve satisfactory pain relief; therefore, a second or third nerve block trial may need to be performed. In this study, an attempt was made to analyze the possible factors which might affect the result of repeated SNB in 42 the patients among 264 patients who received SNB at Severance Hospital during the period from January 1985 to December 1989. The results are as follows: 1) Among the 42 patients, including 30 males and 12 females, the fifties and forties were the major age groups. 2) Among the underlying diseases, stomach cancer was the most common (18 cases) and pancreatic cancer was next (14 cases). 3) The main locations of pain were the upper abdomen, epigastrium and entire abdomen in decreasing order. 4) Among the thirty-nine cases of first SNB combined with ascites, 13 cases received a repeat block, 81.0% of whom had had metastatic lesion. 5) There were 54.2% who had had single or combined treatment, operation, chemotherapy or radiotherapy before SNB. 6) Twently seven cases (64.3%) had received opioid medication for pain control. 7) In the 75% alcohol group, 11.7% of patients required a second block, and in the pure and 50% alcohol group, 9.6% of patients required a second block within two weeks of the first block. Three cases in both of these repeated block groups required a third block; representing 3.9%, of the 75% alcohol group and 1.6% of the pure and 50% alcohol group. 8) The volume of alcohol used was more than 16 ml bilaterally in both cases. 9) The points of the inserted needle were positioned in the upper and anterolateral part of the $L_1$ vertebra on both sides on the anteroposterior roentgenogram. The contrast media was spread upward along the anterior margin of the vertebral body and posteriorly in repeat block. The frequency of repeat block was higher in cases with ascites or metastasis. The instance of repeat block within 2 weeks of the first block was lower in the pure and 50% alcohol group than in the 75% alcohol group. Thus, alcohol concentration and patient status may be considered factors which influence the result of repeated SNB. We suggest early application of SNB in upper abdominal cancer patients.

• The Korean Journal of Pain
• /
• 제2권2호
• /
• pp.135-144
• /
• 1989

Celiac plexus block is recommended in patients with intractable upper abdominal cancer pain. The success rate of a celiac plexus block is variable among the authors. One of the causes of this is the anatomical variations of the celiac plexus. There has not been a study concerning anatomical observations of the celiac plexus in Korean cadavers. So, anatomical dissections were performed and observations were made of the celiac plexus and related structures in Korean cadavers. The results were as follows: 1) The subjects were 21 male bodies and 5 female bodies. The mean age at death was $69.9{\pm}15.5$ years (range 37~93). The mean height was $155.5{\pm}8.3\;cm$ (range 143~172). 2) The number of celiac ganglia ranged from 1~4. The mean numbers were $2.3{\pm}1.9$ in the right plexus and $1.9{\pm}0.8$ in the left, and the mean sizes were $18.9{\pm}7.7{\times}8.0{\pm}3.8\;mm^2$ and $18.5{\pm}8.3{\times}9.5{\pm}3.9\;mm^2$ respectively. 3) Celiac ganglia were most frequently located at the level of the upper third and middle third of L1 in both sides (65.5% in right, 64.0% in left). The vertical range of celiac ganglia ranged from 1 space, which is one third the height of one vertebral body, to 4 spaces. Mean vertical ranges were $1.5{\pm}0.6$ spaces in the right plexus and $1.6{\pm}0.7$ spaces in the left. The celiac ganglia located at the level of the upper third of L1 in the right and the lower third of L1 in the left side, had the largest vertical ranges respectively ($1.8{\pm}0.5$ spaces in right, $2.3{\pm}0.6$ spaces in left) 4) Right side celiac ganglia were located near the midline of the vertebrae compared to the left ones (mean 5.0 mm) The horizontal dimension was greater in the right ganglia ($24.2{\pm}9.2\;mm$) than in the left ganglia ($l8.8{\pm}7.0\;mm$). 5) There was no vertebral level difference between both celiac ganglia in most cases (60%). However, of the 40% of cases at different levels, in half of these (20%) the right ganglia were located higher than the left ganglia; and in the other 20%, this was reversed. 6) The origin sites of the celiac artery were most frequently in the upper third and middle third of L1 (61.6%). The celiac ganglia were usually located at the same level as the site of origin of the celiac artery (61.6% in right, 52.0% in left). 7) The vertebral level of the splanchnic nerves piercing the abdominal surface of the diaphragm was most frequently in the upper third and middle third of L1 (66.6% in right, 66.7% in left). 8) The level of the origin of diaphragmatic crura from the anterior surface of the vertebral bodies varied from the L1-L2 interspace to the L3-L4 interspace. Right crura most frequently originated at the level of the lower third of L2 to the upper third of L3 (57.6%), while left crura originated from the level of the L2-L3 interspace to the middle third of L3 (69.3%). From the above results, we realized that there were some anatomical variations of the celiac plexus and its relations to adjacent structures in Korean bodies. However, when the needle point is behind the anterior margin of the upper third of L1, it is possible to perform a successful retrocrural splanchnic nerve block.