이중관을 이용한 체외순환식 탄산가스 제거법에 관한 연구

함병문,곽일룡,성시옥 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO₂R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completelyfree from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO₂R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). V ECCO₂R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula(14 Fr.) and the inner perfusion cannula(8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO₂R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values der hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO₂ removal(ECCO₂R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33±0.08 and 7.28±0.08 in ECCO₂R and CMV, respectively. PaCO₂ in control was 69±9mmHg and it was decreased to 41±4mmHg and 47±7mmHg in ECCO R and CMV respectively. PaCO₂ in control was 62±15 mmHg and it was increased in AO, ECCO₂R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO₂R and CMV. The bypass flow enough to remove CO₂ was 30∼50% of cardiac output. It is concluded that ECCO₂R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support

Ventilatory management in I . C . U

함병문 대한외과학회 1988 대한외과학회 학술대회자료집 Vol.- No.-

호기말양압이 급성 호흡부전증개에서 심혈관계의 혈역학적 변화에 미치는 영향

함병문,곽일용 한림대학교의료원 1982 人間科學 Vol.6 No.9

Ativan(r)의 마취전처치제로서의 효과에 관한 연구

함병문,김용락,이상동 한림대학교의료원 1985 人間科學 Vol.9 No.4

지연성 용혈성 수혈부작용에 관한 연구

함병문,김종성 한림대학교의료원 1984 人間科學 Vol.8 No.4

급성 호흡부전증견에서 호기말양압의 크기가 산소운반량에 미치는 영향

함병문,염광원 한림대학교의료원 1983 人間科學 Vol.7 No.3

정상인에서 Nalbuphine Hydrochloride 정주가 이산화탄소 반응곡선에 미치는 영향

함병문,염광원,백희정 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3

Nalbuphine, a recently introduced agonist-antagonist analgesic is considered to have analgesic potency similar to morphine in common clinical doses and has been reported to possess an ceiling effect on respiratory depression and to be effective in reversing respiratory depression induced by oxymorphone or hydromorphone. To evaluate the respiratory depression of nalbuphine hydrochloride, we use displacement of CO₂ response by a rebreathing method as the index of respiratory depression. Eight healthy male subjects were given the nalbuphine at a dose of 0.1 mg/kg(nalbuphine group) or same volume of normal saline as a placebo(placebo group) intravenously, at interval of 2 weeks by a double blind test. We measured end-tidal PCO₂(P_(ET)CO₂), minute ventilation (V_E), tidal volume(V_T), and respiratyory frequency(f) at 10 min, 30 min, 60 min and 90 min after the injection. The linear regression equations of V_E in response to PCO₂ 10 min, 30 min, 60 min and 90 min after injection are y=-11.3+0.34x(R=0.66), y=-11.5+0.3x(R=0.53), y=-9.85+0.33x(R =0.61) and y=-11.8+0.37x(R=0.67) in placebo group and y=-11.1+0.30x(R=0.54), y= 13.1+0.35x(R=0.64), y=-11.3+0.33x(R=0.66) and y=-13.4+0.37x(R=0.63) in nalbuphine group. There were no significant differences in the slope of the CO₂ response curves between placebo group and nalbuphine group. But there were rightward displacements of the CO₂ response curves, which were significant rightward displacements at 60 min and 90 min after the injection(P$lt;0.05). These findings demonstrate that nalbuphine hydrochloride might be a respiratory depressant.

수술중 1-5 unit의 성분수혈이 환자의 혈색소, 헤마토크럴치, 전해질 및 동맥혈가스 분석에 미치는 영향

함병문,오영철 大韓血液學會 1991 大韓血液學會誌 Vol.26 No.2

경피 요골동맥 카테터 거치법

함병문,김광우,김용락,김행식 대한마취과학회 1975 Korean Journal of Anesthesiology Vol.8 No.2

It was presented the precise technique of percutaneous radial-artery catheterization with -testing methods for assessment of status in the collateral circulation of the hand, and also presented contineous measurement of arterial blood pressure with connecting to Arenoids blood pressure manometer for blood pressure and commented the easiness numerous arterial blood samplings for the critically illed patients without pain.

개심술 환자에서 혈량증가를 위한 혈장단백제와 10 % 펜타스타치가 심혈관계 및 혈액응고에 미치는 영향

함병문,정남영 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.12

Ten percent pentastarch is a low-molecular weight hydroxyethyl starch with greater on- cotic pressure and shorter intravascular persistence than 6% hetastarch The purpose of this study was to determine the safety and efficacy of pentastarch as a plasma-volume expander as compared to plasmanate infusion in patients undergoing heart surgery. We were par- ticularly interested in assesaing hemodynamic responses and effects of pentastarch on bleeding and coagulation, and prospectively studied 24 patients undergoing open heart surgery or coronary revascularization. 12 patients were randomized to receive 10ml/kg of either plasmanate(group I) or 10% pentastarch(group II) and simultaneously to predonate the blood as the same amounts of colloid solution. Hemodynamic and coagulation profiles were measured after induction of anestheaia and 5min and 30min after following colloid infusion. The effects of colloid infusion with pentaatarch on hemodynamic profiles(heat rste, mean arterial pure, mean pulmonary arterial preasure, cardiac index, pulmonary capillary wedge pressure, central venous pressure, systemic venous resistsnce, pulmonary venous resistance) were not significantly different from those of plasmanate. The studies for five patients in plasmanate group were stopped because of severe hypotension during colloid infusion. The decrease in hemoglobin and platelet count were significantly greater in the pentastarch group than in the plasmanate group. Changes in PT, aPTT, serum osmolarity, PaO₂ and PvO₂, were similar between tbe two groups. We conclude that pentastarch is a safe and effective colloid as similar to plasmarate to use as a plasma-volume expander.