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가토 신장기능에 미치는 K+ 통로 개구제 WAY120491의 영향
손수창 ( Soo Chang Son ),문금복 ( Jin Fu Wen ),이단 ( Dan Li ),김선희 ( Suhn Hee Kim ),조경우 ( Kyung Woo Cho ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1
목적 : 이 연구는 K^+ 통로 개구제(channel opener)가 신장기능에 미치는 영향을 구명하고자 한 것이다. 방법 : 이 연구에서는 benzopyran 유도체 WAY120491의 신혈류역학적 효과와 신세뇨관의 기능에 미치는 영향을 밝히고자 정상 가토와 신성고혈압 가토 (two-kidney on clip Goldblatt hypertensiv rabbits)에서 일측 신동맥내 약물 투여 방법으로 그 효과를 관찰하였다. 결과 : 정상 가토에서 WAY120491의 신동맥내 투여는 전신혈압의 변화 없이 사구체 여과율과 신혈장류량을 용량 의존적으로 증가시켰다. WAY120491은 요량, 유리수분 배설량, 요중 Na^+ 및 K^+ 배설량을 용량 의존적으로 증가시켰다. 소량의 glibenclamide 투여는 WAY120491의 신혈류역학적 효과와 요량 및 유리수분 배설량 증가 효과를 효과적으로 차단하였다. 이때 요중 Na^+ 배설 증가 효과는 glibenclamide에 의하여 차단되지 않았다. 신성고혈압 가토에서 WAY120491은 대조군과 정량적으로 차이 없는 신혈ㄹ 역학적 효과와 신세뇨관 효과를 보였으나 WAY120491 투여 중지 후 관찰돤 요량 감소 효과는 신성고혈압 가토에서는 관찰되지 않았다. 결론 : K^+ 통로 개구제인 WAY120491은 신장내 ATP 의존적인 K^+ 통로를 경유하여 사구체 여과율, 신혈장류량, 요량 및 유리수분배설량 그리고 요중 K^+ 와 Na^+ 배설량의 증가를 일으키며, 이러한 효과는 신성고혈압 가토에서도 비슷하게 나타난다. Background : K^+ channel opener has been considered as a vasorelaxing agent working through hyperpolarization of vascular smooth muscle cells. Renal tubules-proximal, thick ascending limb of Henle and cortical collecting duct-are the site of the diversity of the K^+ channel. ATP-sensitive K^+ channel has been observed in the apical membranes of the thick ascending limb of Henle and collecting duct, and basolateral membrane of the proximal tubule. It was also shown that K^+ channel opener increased renal hemodynamics and elicited diuretic and natriuretic effects. Methods : To clarify the renal effects of WAY120491, a K^+ channel opener, experiments were performed in unanesthetized normotensive and renal hypertensive rabbits allowing unilateral renal arterial infusion of agent. Results : Intrarenal arterial infusion (0.13, 0.32 and 0.64 ㎍/kg/min), of WAY120941 increassed C_PAH, C_Cr, urine volume, U_NaV, U_KV and C_H2O, Renal hemodynamic effects and increments of urine volume and free water clearance were complately blocked by glibenclamide (8.2 ㎍/kg/min), while increments of U_NaV and FE_Na were not significantly affected. Fenal hemodynamic and tubular effects of WAY120491 were not significantly different in two-kidney one clip Goldblatt hypertensive rabbits from sham-operated rabbits. Conclusions : These results suggest that WAY120491 elicits renal effects through ATP-sensitive K^+ channel in the renal vasculatures and renal tubules and the renal effects of WAT120491 may not be altered in the hypertension.
완전정맥마취에 의한 수술 중 Hydroxyethyl Starch (130/0.4) 용액의 동시투여가 혈소판 기능에 미치는 영향
조호연 ( Ho Yeon Cho ),신용섭 ( Yong Sup Shin ),손수창 ( Soo Chang Son ),이선열 ( Sun Yeul Lee ),조완호 ( Wan Ho Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. Methods: Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n=15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n=15). ADP-and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. Results: Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP -and collagen-induced platelet aggregation were recovered postoperatively in both groups. Conclusions: The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia. (Korean Aens-En)
임상연구 : 소아에서 Propofol과 Ketamine을 사용한 전신마취 유도 시 호흡역학의 비교
임채성 ( Chae Seong Lim ),이호영 ( Ho Young Lee ),윤희석 ( Hee Suk Yoon ),손수창 ( Soo Chang Son ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Propofol and ketamine are believed to reduce airway resistance. The aim of the present study was to compare the effect of propofol and ketamine on respiratory mechanics after endotracheal intubation in children. Methods: Forty pediatric patients were assigned randomly to two groups: propofol (n = 20) and ketamine (n = 20). Patients were anesthetized with propofol (2 mg/kg) or ketamine (2 mg/kg). All patients were paralyzed with rocuronium (0.8 mg/kg) and intubated and ventilated mechanically (ETCO2: 30-40 mmHg, tidal volume: 10 ml/kg, respiratory rate: 15-25 time/min). Peak inspiratory pressure (PIP), respiratory resistance (Rr), dynamic compliance (Cdyn) and expiratory tidal volume (Vte) measurements were recorded at five time points; 0.5 min after intubation without sevoflurane (baseline), following 2.5 min, 5 min, 7.5 min and 10 min of ventilation with 2% sevoflurane- 50% nitrous oxide. Results: Rr at 0.5 min after intubation was 27.4 ± 12.7 cmH2O/L/s in the propofol group, and 30.0 ± 13.5 cmH2O/L/s in the ketamine group. Cdyn at 0.5 min after intubation was 28.0 ± 9.9 ml/cmH2O in the propofol group, and 25.1 ± 10.6 ml/cmH2O in the ketamine group. There was no significant difference in the response of PIP, Rr, Cdyn and Vte between two groups and within groups. Conclusions: We suggest that the effects of propofol and ketamine on respiratory mechanics were similar during anesthetic induction in children. (Korean J Anesthesiol 2006; 51: 690~4)
척추 측만증 수술을 받는 청소년기 환자에서 운동 유발 전위 감시를 시행한 마취 경험: 7예 -증례보고-
김정현 ( Jeong Hyun Kim ),김윤희 ( Yoon Hee Kim ),양준영 ( Jun Young Yang ),손수창 ( Soo Chang Son ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Intraoperative monitoring of motor evoked potential (MEP) is a modality for preventing spinal cord injury during spinal surgery. However, inhalation anesthetics and muscle relaxants depressing MEP responses, must be restricted for monitoring MEP. Therefore, anesthetic management needs careful attention for preventing recall and unintentional movements during surgery and special techniques for monitoring adequate MEP. We report here on 7 cases of successful intraoperative monitoring of MEP with total intravenous anesthesia using propofol and remifentanil for scoliosis surgery in adolescent patients. (Korean J Anesthesiol 2009; 57: 780∼4)