개심술후 폐의 Physiologic dead space 와 Shunt 의 변화상 추적

이길노 대한흉부심장혈관외과학회 1985 Journal of Chest Surgery (J Chest Surg) Vol.18 No.4

It has been recognized that the proper matching of ventilation and perfusion within the lung is essential for the efficient exchange of gases following open heart surgery. Physiologic shunt reflects the amount of blood going to lung units with inadequate ventilation and these are also areas of the lung with adequate ventilation but inadequate blood flow. This can be quantified by measuring physiological dead space. From January to August 1985, The physiologic dead space and shunt during postoperative course had been taken in 30 patients of open heart surgery in Soonchunhyang University Hospital. Twenty cases had congenital heart disease and acquired valvular heart disease were noticed in 10 cases. The physiological dead space and shunt during postoperative periods were calculated and we made 5 items of conclusion: 1. There is high probability of ventilation-perfusion mismatch in the acquired heart disease group compared to the congenital group. 2. Duration of the CPB can exert significant influences in the physiological dead space but less in the shunt fraction. 3. There is positive relationship between Qs/Qt and Vd/Vt in the group B [CPB>90 min.] but less reliable in correlation. 4. Perfusion impairment is more significant in the diminished pulmonic blood flow group compared to the increased pulmonic blood flow [Qp/Qs>2.0] group. 5. There is no significant ventilation-perfusion mismatch within the lung during all postoperative courses.

흉선절제에 의한 근무력증 치료 2례 보고

이길노 대한흉부심장혈관외과학회 1980 Journal of Chest Surgery (J Chest Surg) Vol.13 No.4

Myasthenia gravis is a neuromuscular disorder manifested by fatigability and weakness of voluntary muscles. The basic defect in the myasthenia is reduction of available acetylcholine receptors at neuromuscuiar junctions by an autoimmune attack. Removal of the thymus gland now play an Important role in the management of this disease. We have two experiences of thymectomy for myasthenic patients. The 31-year-old housewife(J.H) was admitted to the Taegu Presbyterian Medical Center because of bilateral ptosis, mastication and swallowing difficulties. The presence of thymoma was strongly suggested by roentgenographic studies. A 99.8 gm thymoma was removed completely by total thymectomy. On the 2nd postoperative day respiratory failure developed. Tracheostomy was performed and ventilatory assist was given for 3 days. The patient was completely recovered with antichollestrase drug only. C.N. was 17-year-old girl who has the symptoms of bilateral ptosis and diplopia for 3 years. Tensilon test was positive and antichollnestrase was given for several months, but the patient showed no improvement. After thymectomy she was free from myasthenic symptoms with out anticholinestrase drug.

기관지 섬유경에 의한 폐암 진단[임상적 관찰]

이길노 대한흉부심장혈관외과학회 1981 Journal of Chest Surgery (J Chest Surg) Vol.14 No.3

개방성 동맥관의 진단과 치료

이길노 한국의학사 1986 診斷과治療 Vol.6 No.3

Carpentier-Edwards 豚瓣膜을 이용한 心臟瓣膜置換術에 관하여

李吉魯,李聖行 慶北大學校 醫科大學 1983 慶北醫大誌 Vol.24 No.2

1981년 1월부터 1983년 8월까지 계명의대 흉부외과에서 Carpentier-Edwards 隧瓣膜을 사용하여 瓣膜置換術을 시행한 70예의 성적을 분석하여 다음과 같은 결과를 얻었다. 1. 전체대상에서 남여의 비는 1:1.7로서 여자가 많고 年齡分布는 최소 13세에서 최고 58세 사이로 평균연령은 32.7세이었고 30代에서 25명(36%)으로 가장 많았다. 53예(76%)가 僧帽瓣膜患者이며 70예중 46예(66%)가 류마치스심근염이 원인으로 가장 많았고 18예(26%)에서는 원인을 알수 없었다. 2. 僧帽瓣置換術이 53예(76%), 大動脈瓣置換術이 10예(14%), 僧帽瓣과 大動脈瓣疾患이 겸한 2예는 판막을 모두 치환했고 三尖瓣閉鎖不全을 겸한 5예는 1예만 판막을 치환하고 4례는 瓣膜輸成形術을 시행하였다. 3. 70예 血淸電解質조사에서 K^+은 술전 4.1±2.8mEq/L에서 체외순환 30분에 3.5±0.6mEq/L로 유의한 감소(p<0.001)를 보였고 Ca^++은 술전 8.7±1.1㎎%에서 술중 9.3±1.5㎎%로 유의한 상승(p<0.01)을 관찰할 수 있었다. 4. 개심술과 血淸酵素値의 변화를 조사한 16예에서 術後 제1일 CPK는 234.58±46.75IU/L로서 術前보다 평균 7배가 증가(P<0.001)하였고, LDH는 술후 제3일 198.63±60.56IU/L, SGOT는 술후 제1일 71.75±16.78 units로 술전보다 각각 2배와 2.3(P<0.001)가 상승하였다. 대동맥차단을 60분 이상시킨 群이 이하차단시킨 群보다 CPK가 평균 60IU/L 증가(p<0.01)했고 LDH는 30IU/L(p<0.001)로 유의한 상승을 보였으나 SGOT는 변화가 없었다. 5. 術後合倂症(22예)은 低心搏出症(7예), 不整脈(5예), 手術部位出血(4예)의 순서이었으며 置換한 瓣膜자체의 機能不全은 1예에서 볼수 있었다. 6. 死亡은 70예중 8예(11.4%) 있었으며 주원인은 不整脈(3예)과 低心搏出症(2예)이 도합 5예(62.5%)로서 가장 많았다. 7. 術後生存 62명중에 class Ⅰ 및 Ⅱ가 도합 55명으로서 88.7%의 환자는 판막치환술후에 현저한 호전을 보았다. Between January, 1981 and August, 1983, 73 Carpentier-Edwards porcine bioprosthesis were implanted in 70 patients in Keimyung University Hospital. Of these patients, 53 had single mitral, 10 aortic, 5 mitral-tricuspid, and 2 mitral-aortic valve disease. The average age was 32.8 years, ranging from 13 to 58 years with most patients in the second and third decades of life. There were 44 women and 26 men. Rheumatic disease was held responsible for the valvular lesions in 46(66 per cent) patients and the other causes of valvular lesions were infective endocarditis in 3, congenital aortic bicuspid in 2, and ruptured cordae tendinae in 1. The remaining 18 patients had unknown etiology. Forteen patients were in Functional Class Ⅱ(NYHA), 44 in Class Ⅲ, and 12 in Class Ⅳ preoperatively. Fifty-three patients underwent mitral valve replacement, 10 aortic valve replacement, 4 mitral valve replacement with concomitant tricuspid annuloplasty, and 3 double valve replacement. Alterations in serum electroytes were studied. CPK, LDH, and SGOT in 16 patients were evaluated preoperatively and on postoperative days 1,3, and 7. The operative mortality rate was 11.4 per cent due to arrhythmia(3 patients), low cardiac output(2 patients), bleeding(1 patient), valve dysfunction(1 patient), and anaphylactic shock(1 patient). Functional improvement was noted 55 of 62 survivors of surgery, an 88.7 per cent improvement rate.

心筋의 深度低溫과 Nitroprusside가 心筋保護에 미치는 效果

李吉魯 순천향대학교 1988 논문집 Vol.11 No.1

To evaluate the protective effect of profound hypothermi a and nitroprusside on the rabbit myocardium after global ischemia, we studied 30 rabbits using isolated working heart model. Experimental time courses were; (1) nonworking retrograde perfusion(15min), (2) working perfusion(15min), obtained hemodynamic parameters for baseline value (3) hypothermic(10'C) ischemic arrest(60min) induced with St. Thomas Hospital cardioplegic solution, (4) nonworking reperfusion(15min), measured creatine kinase leadage, (5)working reperfusion(20min), re-checked hemodynamic values and expressed as percent recovery, (6) weighed the wet and dry heart. Experimental hearts were devided to 3 groups: (1) Group I-myocardial temprature 28'C (2) Group Ⅱ-10' C profound hypothermia, (3) GroupⅢ-28'C hypothermia, nitroprusside infusion with the cardioplegic agent(100 μ/L). There was no differences in the peak aortic pressure and heart rate between the groups, but these values showed excellent recovery rate. The Group Ⅱ had good percent recoveries in the aortic flow, coronary flow, and stroke volume, but in the Group Ⅲ, these were relatively lower than the control group. Differences of water content ant tissue water between groups were not so significant. Leakage of creatine kinase in the Group Ⅲ was a little higher than the other two with no statistical significance. Finally, we concluded that deep hypothermia(10'C) is far superior than moderate hypothermia(28'C) on the myocardial protection after global ischemia but not in the nitroprusside.

적출활동심장에서 Prostacyclin [PGI2]의 심근보호효과

이길노,김규태,Lee, Gil-No,Kim, Gyu-Tae 대한흉부심장혈관외과학회 1987 Journal of Chest Surgery (J Chest Surg) Vol.20 No.4

The effect of prostacyclin[PGI, ] on myocardial preservation during global ischemia was studied in the isolating working rabbit heart model. Forty hearts underwent a 15 minute period of retrograde nonworking perfusion with Krebs-Henseleit buffer solution [37*C] and were switched over to the working mode for 15 minutes. After baseline measurement of heart rate, peak aortic pressure, aortic flow, and coronary flow, all hearts were subjected to 60 minutes of ischemic arrest at 10*C induced with St. Thomas Hospital cardioplegic solution: Group I had single dose cardioplegia, Croup II double dose, Croup III oxygenated double dose, and Group IV single dose with PCI, infusion [10ng/min./gm heart weight]. Hearts were then revived with 15 minute period of nonworking reperfusion at normothermia, followed by 30 minutes of working perfusion. Repeat measurements of cardiac function were obtained and expressed as a percent of the preischemic baseline values. Oxygen content of arterial perfusate and coronary effluent was measured by designed time interval. Leakage of creatine kinase was determined during post-ischemic reperfusion period. Finally wet hearts were weighed and placed in 120*C oven for 36 hours for measurement of dry weight. In the PGI, treated group [IV], heart rate increased consistently throughout the period of reperfusion from 100*5.0% [p<0.001] to 107*6.2% [p<0.001]. The percent recovery of aortic flow showed 95*5.7% [p<0.001] at the first 3 minute and full recovery through the subsequent time. Coronary flow was augmented significantly in the 3 minute [96*6.2%, p<0.001] and then sustained above baseline values. Among the Croup I, II, and III, all hemodynamic values were significantly below preischemic levels. PGI2 relatively increased oxygen delivery [1.22*0.19ml/min, p<0.001] and myocardial oxygen consumption [0.90*0.13ml/min, p<0.001] during reperfusion period. Leakage of creatine kinase in the PGI2 group was 9.3*1.58IU/15min [p<0.001]. This was significantly lower than Group I [33.0*2.68 IU/15min]. The water content of PCI2 treated hearts [81*0.9%, p<0.001] was also lower than the other groups.

摘出作業心臟에서 心筋麻痺液의 投與回數와 心筋保護效果 : In the Isolating Working Rabbit Heart

조영철,이길노 순천향대학교 1990 논문집 Vol.13 No.3

For evaluation of the myocardial protection afforded by infusion frequency of the cardioplegic solution during global ischemia, the isolated rabbit hearts were studied in the working heart model. Thirty hearts were underwent a 15 minute period of retrograde nonworking perfusion with Krebs-Henseleit buffer solution(37℃) and were switched over to the working mode for 15 minutes. After baseline measurement of peak aortic pressure, heart rate, aortic flow, and coronary flow, all hearts were subjected to 60 minutes of ischemic arrest at 10℃ induced with St. Thomas Hospital cardioplegic solution: Group Ⅰ had single does cardioplegia, group Ⅱ double dose, group Ⅲ multi-dose infusion. Hearts were then revived with a 15 minute period of nonworking reperfusion at normothmia, followed by 30 minutes of working perfusion. Repeat measurement of hemodynamic function were obtained and expressed as percent of the preischemic baseline value. The oxygen content of the arterial perfusate and coronary effluent was meaasured by the designed time. Leakage of creatine kinase was determined from the coronary effrluent during 15 minutes of postischemic reperfusion period, Finally, wet hearts were weighed and placed in 120℉ dry oven for 36 hours for measurement of dry weight. There was no significant difference in the peak aortic pressure but heart rate of the group Ⅲ (100.44±1.08%, p<0.01) exceeded the baseline value. In the group Ⅲ, the percent recovery of the aortic flow(94.71±1.88%, p<0.0005), cardiac output (95.18±1.99%, p<0.005), stroke volume(94.75±1.58%, p<0.05), and stroke work(94.03±1.75%, p<0.005) were significantly better than the group Ⅰ or Ⅱ. Myocardial oxygen consumption was increased in the group Ⅱ (0.71±0.03㎖/min, p<0.0005) and the group Ⅲ (0.75±0.01/, p<0.0005) during reperfusion period. The water content and tissue water were significantly diminished in the group Ⅲ(82.78±0.28%, p<0.0005, 4.82±0.10gm/dry gm, p<0.005) and group Ⅱ (83.68±0.30%, p<0.01, 5.14±0.11gm/dry gm, p<0.0005) compaired with the group Ⅰ. Leakage of creatine kinase in the group Ⅲ (26.59±1.29I U/15min, p<0.0005) and group Ⅱ (30.58±0,84 IU/15min, p<0.05) was significantly redeced than the group Ⅰ (32.99±0.85 IU/15min). During ischemic arrest, the heart protected by double dose and multidose cardioplegia demonstrated superior preservation of myocardium compaired to the heart by single dose cardioplegia.

심내막상 결손증 - 2례 보고

노증기,이길노 순천향대학교 1985 논문집 Vol.8 No.4

Two patients at our institution underwent repair of endocardial cushion defect in April and August, 1985. The first case was 12 years old girl with complete ecdocardial cushion defect(Rastelli type A) and combined anomaly of cortriatriatum(Loeffler type D). Through a right atriotomy, the anomalous septum of left atrium was resected and the mitral cleft was approximated with interrupted sutures. The atrial septal defect was closed with Dacron patch but ventricular septal defect was closed with direct interrupted sutures. The second case was 12 years old girl with incompletely displayed form(VMT type) of endocardial cushion defect. Through the right atriotomy and interatrial septotomy, the mitral cleft was approximated with interrupted sures and ventricular septal defect was closed with direct sutures. Postoperative transient A-V block was noted in the second case but returned to regular sinus rhythm after 2 days.

개심술중 저온 심장정지에 의한 심근효소치 변화 추적

안상구,이길노 순천향의학연구소 1996 Journal of Soonchunhyang Medical Science Vol.2 No.2

Early detection of myocardial injury is a subject of considerable interest and investigation in patients undergoing cardiac surgery for evaluating the postoperative response. The diagnosis of myocardial damage depends upon the interpretation of historical, electrocardiographic, and serum enzyme data. The serial measurement of postoperative serum enzymes has been proposed as an important method for identifying myocardial infarction following open heart surgery. In order to assess the correlation of the myocardial damage and the duration of cardiopulmonary bypass, measurement of creatine phosphokinase(CPK), lactic dehydrogenase(LDH), serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT), MB band of CPK and LDH isoenzyme(LDH₁) were carried out on the immediate postoperation, first, second, third, fifth, seventh day in 25 patients following open heart surgery. The patients were divided into two groups according to the duration of aortic cross clamp time(ACT): Group Ⅰ(ACT<90 minutes,n=16) and Group Ⅱ(ACT>90 minutes,n=9). The results were as follows; 1) The leakage of CPK and SGPT in total patients increased to the highest level at POD 1(P<0.05) with gradual decrease and returned to the normal range on the 7th day after the operation. THE leakage of CPK in Group Ⅱ were greater than in Group Ⅰ at POD 1(P<0.05), and the value of SGPT between two groups were no signification. 2) the serum levels of LDH and SGOT in total patients reached to maximum on the second day after the operation(P<0.05) with slightly increase until 7th postoperative day in LDH. The levels of two enzymes in Group Ⅱ were higher than in Group Ⅰ at POD 2(P< 0.05). 3) LDH₁was reached to the maximum on the 2nd day after the operation(P<0.001), and returned to the normal range on the 7th postoperative day. The values of Group Ⅱ were higher than Group Ⅰ on the 2nd day after operation(P<0.05). 4) The value of CPK-MB in group Ⅱ was greater than Group Ⅰ on first postoperative day(P<0.0). It is concluded that the myocardial injury was closely related with the duration of cardiopulmonary bypass in open heart surgery.