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데페록사민 전처치가 토끼 심근경색 크기의 감소에 미치는 효과
양관모,오동렬,박승현,박규남,이원재,김형국,황두영,최승필,채장성 대한응급의학회 1998 대한응급의학회지 Vol.9 No.4
Background: Reperfusion of ischemic myocardium has been postulated to result in a specific oxygen radical mediated tissue injury. Iron may liberate during ischemia and we hypothesized that administration of the iron chelator, deferoxamine during ischemia would result in improved recovery after postischemic reperfusion. Purpose: To test whether iron-catalyzed processes contribute to myocardial necrosis during ischemia and reperfusion, deferoxamine was administered to block iron catalyzed hydroxyl radical formation in rabbits. Methods: Eleven rabbits were divided into two groups : control group (n=5) and deferoxamine pretreatment group (n=6). The left circumflex coronay artery was ligated for 30 minutes and reperfused for 180 minutes. Area at risk (AR) was measured by non-stained area with methylene blue injection into left atrium after left circumflex coronary artery ligation. Infarct size was measured by weighing after triphenyltetrazolium chloride staining. Heart rate was measured using electrocardiographic recording and systemic blood pressure was monitored by pressure transducer connected to the catheter in the left ventricle. Results: 1. There was no significant difference of heart rate and blood pressure in deferoxamine pretreatment group compared with control group. 2. There was significant decrease of serum iron concentration after continuous infusion of deferoxamine compared with serum iron concentration before ligation of coronary artery(P<0.05). 3. There was no significant difference of area at risk between control and deferoxamine pretreatment group. 4. Area at necrosis to area at risk was significantly reduced in deferoxamine pretreatment group compared with control group(P<0.05). The results suggest that deferoxamine infusion prior to coronary artery occlusion has a significant benefit in reducing infarct size in this model.
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토끼 심폐소생술에서 에피네프린 단독사용과 에피네프린과 바소프레신 혼합사용시 뇌의 비재관류 현상
채장성,유은영 대한응급의학회 1997 대한응급의학회지 Vol.8 No.4
Background: The more vital organ blood flow during cardiopulmonary resuscitation(CPR), the more successful outcome. The worldwide CPR drug of choice, epinephrine also has some limitations and is often challenged by another catecholamine drug. This study was designed to compare the effects of epinephrine with those of vasopressin and epinephrine mixture on cerebral no-reflow during closed-chest CPR in a rabbit model of ventricular fibrillation Design: Prospective, randomized, experimental study. Setting: University research laboratory. Subjects: Domestic rabbits, 3 to 6 months of age Interventions: Four rabbits were randomly allocated to receive only 0.020 mg/kg of epinephrine(group 1) and another four rabbits were received both 0.020 mg/kg of epinephrine and 0.8 U/kg of vasopressin after 5 mines of cardiac arrest(group 2). Measurements and Main Results: Carotid arterial blood flow and arterial gas analysis were showed no ststistical difference between two groups but in the points of cerebral no reflow area and fluorescence exposure time, there were significant differences(group 1,515 ±.45%, group 2,6.38 ±.54% , p=.029/group 1; 29.65 ±17.09 seconds, group 2; 17.98 ±18.75seconds, p=.014). Conclusions: In cardiac arrest there is some synergistic effect with epinephrine and vasopressin mixture on cerebral no-reflow phenomenon.
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급성 심근경색증의 정맥 혈전용해요법에 대한 임상적 관찰
채장성(Jang Seong Chae),전승석(Seung Sok Chun),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi),김학중(Hak Joong Kim) 대한내과학회 1987 대한내과학회지 Vol.34 No.1
N/A Progress in reducing mortality and morbidity has been slow in spite of increased understanding of the pathophysiology af myocardial infarction. By the use of coronary care units together with improved therapy for life threatening arrhythmias, cardiac pump failure has emerged as the principal cause of in-hospital death. The objectives of thrombolytic therapy are to lyse coronary thrombi during the early phase of transmural myocardial infarction to salvage jeopardized myocardium, preserves ventricular function and may enhance survival by lysing thrombotic coronary artery occlusion which is commonest cause of transmural myocardial infarction. To evaluate the usefulness of thrombolytic agents (Urokinase : UK) for acute myocardial infarction, we analized 51 patiens who admitted within 6 hours after symptoms developed and treated with UK (0.3 million u bolus and daily 0.3 million u continuous IV infusion for 3-4 days) in case who did not have any evidence of contraindication of thrombolytic therapy and compared with 57 patients who were treated by conventional method. The results were as follows: 1) The annual cases of acute myocardial infarction showed increasing tendency and peak frequency of onset was from 6 a.m. to noon throughout the day. 2) The ratio of male to female for acute myocardial infarction was 3:1 and the average age was 59. 3) The common preceding disease were hypertension (31 cases), angina pectoris (21 cases) and diabetes mellitus (12 cases). The cholesterol level over 201 mg/dl was 40% of patients. 4) Anterior wall infarctions were observed in 59 cases, inferior wa11 infarctions in 46 ca and subendocardial infarctions were 3 cases. In anterior myocardial infarction, 20% and 29.4% expired with thrombolytic and conventional therapy respectively. In inferior myocardial infarction, 31.8% expired with conventional therapy but there was none with thrombolytic therapy, 5) Arrhythmias were observed in 83.6% of all cases and ventricular arrhythmia (60.2%) was the msot common. Conduction disturbances were observed in 24.1% and more frequent in inferior than anterior myocardial infarction. 6) Five of 51 patients (9.8%) were expired with thrombolytic therapy and 17 of 57 patients (29.8%) with conventional therapy were expired (P<0.01), and overall mortality was 20.4% 7) The mortality for killip classification III k IV was 38.5% and 66.7% with thrombolytic and conventional therapy respectively (P<0.1). The mortality who had Norris coronary prognostic index over 10 were 25% and 69.2% with thrombolytic and conventional therapy respectively (P <0.05). 8) Only one case of tarry stool was observed as a complication of thrombolytic therapy, In conclusion, intravenous thrombolytic therapy in early phase of acute myocardial infarction improved survival.
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혈관내 초음파 영상에 의한 형태 및 조직병리 소견 평가
채장성(Jang Seong Chae),최규보(Kyu Bo Choi),(Robert J . Siegel) 대한내과학회 1992 대한내과학회지 Vol.43 No.1
N/A Background: To evaluate geometric accuracy of intravascular ultrasound and histopathologic validation of ultrasound and angioscopy we studied postmortem human arterial segments and phantoms in vitro. Method: We used 7 to 9 French fiberoptic angioscopes and 30 MHz intravascular ultrasound imaging catheter. We assessed the area and wall thickness on 9 phantom vessels and 12 arteries with different imaging media and 30 angle of incidence. To evaluate histopathologic validation of ultrasound and angioscopy, the images of 12 normal and 55 abnormal (stable atheroma, disrupted atheroma and thrombi) vessels were compared with histology. Results: Geometric accuracy: The measured area were smaller in blood (7.2-7.6%) and gel (10,8-13.6%) than that of saline. A 30 angle of incidence resulted in 14.2%-16.3% increase in lumen area and 10,6% increase in wall thickness. Ultrasonic wall thickness of human vessels correlated closely with the actual measured thickness (r=0,93). Histopatholgic validation: the sensitivity specifictiy and accuracy of both method were greater than 96% in normal vessel and 90% in stable atheroma. For normal vessel predictive value was better for angioscopy than for ultrasound. For stable atheroma the predictive value were 77%. for angioscopy and 78% for ultrasound due to classification of disrupted atheroma to stable atheroma. For thrombus detection sensitivity was 62% for ultra- sound due to false negative interpretation of lamina clots and atheroma in vessel. Conclusion: With ultrasound measurement, lumen area and wall thickness were accurate when the catheter placement was coaxial. For histopathologic validation, angioscopy and ultrasound images had significant agreement with the results obtained from histology.
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채장성,강동헌,이광수,권순애,김세경,임근우,박승현,오동렬,이기중,승기배,황주일,박규남,이원재,채규보 대한응급의학회 1994 대한응급의학회지 Vol.5 No.2
Background : Recent studies have demonstrated improved cardiopulmonary circulation during cardiac arrest with the use of a hand-held suction device(AMBU Cardio Pump) to perform active compression-decompression cardiopulmonary resuscitation in animal. The purpose of this study was to compare active compression-decompression with standard CPR during cardiac arrests in emergency department patients. Design : Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomised to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association : 80 compressions per minute, compression depth of 3.8 to 5cm, 50% duty cycle, and constant-volume ventilation. End-tidal carbon dioxide(ETCO2) concentration and hemodynamic variables were measured. In one case, Transcranial doppler sonography was used to assess cerebral blood flow velocity. Results : Twelve patients were enrolled. The mean ±SD ETCO2 was 8.33±2.72mmHg with standard CPR and 12.42±8.3mmHg with ACD-CPR(P<.001). Systolic arterial pressure with standard CPR was 74.75±11.31mmHg and with ACD-CPR, 88.58±16.91mmHg(P<.005). Diastolic arterial pressure with standard CPR was 2.66±6.14mmHg and with ACD-CPR, 1.16±8.11mmHg(P=NS). Base exess with standard CPR was -11.50±5.37 and with ACD-CPR, -11.42±5.37(P=NS). In one case, mean cerebral blood flow velocity with standard CPR was 25.2cm/sec, with ACD CPR, 30.5cm/sec. Conclusion : ACD-CPR is a simple manual technique that improved cardiopulmonary circulation in 12 patients during cardiac arrests.
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