생체간이식 수술에서 이식간 재관류 후 급성 저체온기 동안의 심실부정맥의 심전도상 징후 변화 / 박수경

저자 박수경
형태사항 26 cm
일반주기 지도교수: 황규삼
학위논문사항 Thesis(doctoral)-- 울산대학교 : 의학과 의학전공 2015. 2
발행국 대한민국
언어 영어
출판년 2015
소장기관 울산대학교 도서관

 
초록
Background: During hepatic graft reperfusion, fatal ventricular arrhythmia and occasionally cardiac arrest may occur in patients undergoing liver transplantation (LT). To more clearly comprehend the changes in electrocardiography (ECG) during the period of sudden influx of cold blood containing preservation solution, we evaluated the detailed profile of acute hypothermia and ECG manifestations of ventricular arrhythmogenicity.

 Methods: We retrospectively reviewed electronically archived medical record system (n = 148) and analyzed beat-to-beat ECG, arterial pressure waveform and rapidly changing blood temperature (BT) in patients undergoing living-donor LT. We analyzed the ECG data at each stage of reperfusion as follows : 1) baseline (1-min data before BT drop), 2) BT drop period (from the start of BT drop to the initiation of systolic hypotension), 3) hypotension period (from the initiation of hypotension to the nadir of hypotension). The ECG data were analyzed using Labchart ECG analysis software, and averaged over the period.

 Results: On reperfusion, the square root-shaped hypothermia of < 34℃, < 33℃ and < 32℃ developed in 75%, 37% and 12% of patients, respectively. BT decreased from 35.0 ± 0.8 ℃ to 33.3 ± 1.0℃ and changes in BT (ΔBT) was 1.7 ± 0.5℃. The time to nadir of BT was 11.4 ± 6.2 sec and systolic hypotension started 16.2 ± 4.6 sec after influx of cold blood. ST height was declined (P < 0.001), and PR interval and T wave amplitude was increased (P < 0.001), and the trend continued to the nadir of systolic hypotension. QT interval, corrected QT (QTc) interval by Fridericia’s formula (F), and Tpe interval (interval between the peak and end of T wave) were prolonged significantly (P = 0.013, P = 0.016, and P < 0.001, respectively) during the period that only BT dropped even before hypotension occurred. And arrhythmogenic indices of Tpe/QT, Tpe/QTc by Bazett’s formula (B) and Tpe/QTc (F) ratio were also increased significantly during BT drop period before hypotension period (P < 0.001, P < 0.001, and P = 0.038, respectively).

 Conclusion: Rapid BT drop developed immediately after portal vein unclamping during rapid flooding of cold blood containing preservative solution into heart and the systemic circulation, in patients undergoing living-donor LT. Increased arrhythmogenicity already appeared during the period that only BT dropped even before hypotension occurred.

 
목차

Contents
Abstract i
Lists of tables and figures iv
Introduction
Methods
Results
Discussion
Conclusion
References
Korean abstract