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홍용우,고광욱,김기환,Hong, Yong-Woo,Ko, Kwang-Wook,Kim, Ki-Whan 대한생리학회 1987 대한생리학회지 Vol.21 No.2
The activation mechanism of the sustained contractions induced by norepinephrine and K-depolarization was studied in renal vascular muscle. Helical strips of arterial muscle were prepared from rabbit renal arteries. All experiments were performed in Tris-buffered Tyrode solution which was aerated with 100% $O_2$ and kept at $35^{\circ}C$. Renal arterial muscles developed a contracture rapidly when exposed to a 40 mM K-Tyrode solution. In the absence of external $Ca^{2+}$, however, no K-contracture appeared. The contracture induced by K-depolarization was abolished by the treatment with $Ca^{2+}-antagonist\;(verapamil)$ or lanthanum $(La^{3+})$. From these results, it is obvious that K-contracture of renal arterial strip required $Ca^{2+}$ in the medium and this contracture was developed by the increased $Ca^{2+}-influx$ due to K-depolarization. Noradrenaline (5 mg/l) induced also a similar sustained contraction rapidly in all strips. Even on the K-contracture and in $Ca^{2+}-free$ Tyrode solution and also in the Tyrode solution pretreated with verapamil or $La^{3+}$, noradrenaline produced a contraction. However, the contraction in $Ca^{2+}-free$ Tyrode solution was not sustained and decreased gradually. The amplitude of noradrenaline-induced contracture was dependent on external $Ca^{2+}$; The contracture increased dose-dependently, but over 3 mM $Ca^{2+}$, decreased. The results of this experiment suggest that K-contracture was developed by an increased $Ca^{2+}-influx$ due to membrane depolarization, while noradrenaline-induced contracture was developed by both transmembrane $Ca^{2+}-influx$ and the mobilizaiton of cellular $Ca^{2+}$
개심술환자에 있어서 혈액희석을 통한 자가수혈법이 술중 및 술후 출혈량과 수혈요구량에 미치는 영향
홍용우,곽영란,이현숙 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1
To evaluate the safety and effectiveness of the intraoperative phlebotomy with acute hemodilution and autologous transfusion as an approach to blood conservation during cardiac operation, 126 patients were grouped into autologous transfusion group(Group I, n=54), prospective control group(Group II, n=22), and retrospective control group(Group III, n=50). Intraoperative hemodilution was practiced in autologous transfusion group before extracorporeal circulation. After an extracorporeal circulation, the units of blood phlebotomized were transfused. Hematocrit, platelet count, PT(prothrombin time), PTT(partialthromboplastin time), MAP(mean arterial pressure), and amount of homologous transfusion were measured immediately after induction, during bypass, and at the intensive care unit. Blood loss was measured at 12 hours and 24 hours after arrival at intensive care unit. Incidence of hemologous transfusion was 62% in group I, 86.4% in group II, and 100% in group III. Patients received 2.2±0.4 units in group I, 4.±0.8 units in group II and 6.7±0.5 units in group III. Coagulation studies showed no significant improvement in autologous transfusion group who received fresh autologous blood. There was no difference in blood loss postoperatively among 3 groupes. In conclusion, our data suggest that the use of autologous transfusion with hemodilution reduces usage of homologous blood in all cardiac surgery procedures.
경식도 심초음파(Transesophageal Echocardiography, TEE)를 이용한 심근운동장애의 조기 발견이 관상동맥 우회로술에 미치는 영향
유은숙,홍용우,곽영란,임현교,방서욱,윤동명 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.3
Background; Regional wall motion abnormalities(RWMA) detected by intraoperative transesophageal echocardiography(TEE) are thought to be sensitive indicators of myocardial ischemia. The present study was undertaken to elucidate management of RWMA with an immediate regraft in the area of RWMA or conventional drug therapy. Method; Twenty-six patients undergoing coronary artery bypass graft surgery were examined with TEE. After induction of anesthesia, TEE probe was inserted into esophagus and connected to Echo system. LV short axis views at the mid-papillary muscle level were viewed and recorded. TEE showed postbypass RWMA in 6 cases and one patient who did not have the TEE developed postbypass RWMA viewed by the epicardial echocardiography. Regraft was performed at the area of RWMA in 3 patients. The remainder was treated with intraaortic balloon pump(IABP) and/or inotropics. Results; The patients with regraft showed an immediate improvement of the new RWMAs. The patients treated with IABP and/or inotropics had improvement of hemodynamics but did not show any improvement of the RWMAs. All seven patients developed hypotension and ST segment changes. All patients with the conventional treatment and two out of 3 regraft patients developed the postoperative myocardial infarctions. Conclusion; In conclusion this study demonstrated that patients experiencing persistent RWMA would be more likely to have myocardial infarction than those having only transient changes and that TEE would be an excellent tool for early detection of myocardial ischemia and might improve treatment of ischemic events. (Korean J Anesthesiol 1995; 29: 351~357)
개심술시 술중 혈액희석과 aprotinin 이 출혈에 미치는 영향
한정선,홍용우,곽영란 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1
Blood transfusions in open heart surgery become increasingly dangerous in recent years because of hepatitis and the AIDS virus. For this reason, blood saving methods must be considered when assessing the quality of cardiac surgery. To evaluate different blood saving methods, seventy two patients undergoing open heart surgery were divided into 3 groups. Aprotinin group(group I, n=35) and aprotinin with acute normovolemic hemodilution group (group II, n=15) were compared with prospective control group (group III, n=22). We administered the serine protease inhibitor aprotinin in high dosage(loading dose of 4mg/kg and maintaing dose of 1mg/kg/hr) to group I, and II patients. Acute normovolemic hemodiluation(ANH) was done before heparinization in group II. One to three units of blood could be withdrawn with a desired hematocrit of 30%. After an extracorporeal circulation (ECC), autologous transfusion was undertaken. Hematocrit, platelet count, and partial thromboplastin time(PTT) were measured immediately after induction, during bypass and at the intensive care unit. Amount of blood loss was measured in 12 and 24 hours after arrival at an intensive care unit. Amount of homologous transfusion was counted in postbypass period and 12 hours after arrival at an intensive care unit. Hematocrit was elevated in group II(p$lt;0.05) after ECC Platelet counts were elevated and partial thromboplastin time was prolonged in group II in postbypass period and 12 hours after arrival at an intensive care unit compared with group I and III. Postoperative blood loss was 560.4±272.5cc in group I, and 282.0±98.6cc in group II, 819.3±428,0cc in group III. The use of homologus transfusion(packed red cells and fresh frozen plasma) in group I could be reduced by 49 & 66% and group II by 73 & 84% compared with group III. In conclusion our study suggests that administration of high-dose aprotinin is effective in reducing intraoperative and postoperative bleeding and therefore reduces transfusion requirement. In addition, combination of ANH and atinin can further reduce homologous blood usage.