CAJ | 학술논문

目的：探讨全身麻醉下吸烟病人体温与体温调节性周围血管收缩反应的变化。方法全身麻醉下行择期开腹手术的成年男性病人23例（ASA1-2级），分为吸烟组（S 组，n＝12）与对照组（C 组，n＝11）。S 组患者烟龄13．58±8．38年、吸烟量17．08±5．82支／日，C 组患者无吸烟史，其他情况同 S 组；两组麻醉诱导相同，即用丙泊酚1-2 mg／kg、芬太尼4μg／kg、维库溴铵0．1 mg／kg，气管插管后行间歇正压通气（IPPV），维持 PETCO235-40 mmHg，麻醉维持用1-2％异氟烷，0．08-0．12μg／kg／min 瑞芬太尼，0．1-0．2 mg／kg／h 维库溴铵；监测食道温（TES ）、平均皮肤温（TMSK ）、前臂-指尖皮肤温度差（TFOR-FIN ）。以 TFOR-FIN ＝0℃时的 TES 作为体温调节性周围血管收缩阀值（threshold），以阈值下TES与 TFOR-FIN 间的线性回归斜率作为其增益（gain）。结果两组患者一般情况、血流动力学指标及麻醉诱导前（T0） TES、TMSK 、食道-平均皮肤温度差（TES-MSK ）、TFOR-FIN 无统计学差异（P ＞0．05）；TES：与 T0比，C 组 T20至 T180、S 组 T10至T180显著下降（P ＜0．05、P ＜0．01）；组间比较，S 组 T20至 T180显著低于 C 组（P ＜0．05、P ＜0．01），S 组 threshold 显著低于 C 组（P ＜0．01）。结论全身麻醉下长期吸烟病人食道温及体温调节性血管收缩阈值显著下降，易出现低体温的并发症，全身麻醉时对吸烟病人更应加强体温的监测与管理。
목적：탐토전신마취하흡연병인체온여체온조절성주위혈관수축반응적변화。방법전신마취하행택기개복수술적성년남성병인23례（ASA1-2급），분위흡연조（S 조，n＝12）여대조조（C 조，n＝11）。S 조환자연령13．58±8．38년、흡연량17．08±5．82지／일，C 조환자무흡연사，기타정황동 S 조；량조마취유도상동，즉용병박분1-2 mg／kg、분태니4μg／kg、유고추안0．1 mg／kg，기관삽관후행간헐정압통기（IPPV），유지 PETCO235-40 mmHg，마취유지용1-2％이불완，0．08-0．12μg／kg／min 서분태니，0．1-0．2 mg／kg／h 유고추안；감측식도온（TES ）、평균피부온（TMSK ）、전비-지첨피부온도차（TFOR-FIN ）。이 TFOR-FIN ＝0℃시적 TES 작위체온조절성주위혈관수축벌치（threshold），이역치하TES여 TFOR-FIN 간적선성회귀사솔작위기증익（gain）。결과량조환자일반정황、혈류동역학지표급마취유도전（T0） TES、TMSK 、식도-평균피부온도차（TES-MSK ）、TFOR-FIN 무통계학차이（P ＞0．05）；TES：여 T0비，C 조 T20지 T180、S 조 T10지T180현저하강（P ＜0．05、P ＜0．01）；조간비교，S 조 T20지 T180현저저우 C 조（P ＜0．05、P ＜0．01），S 조 threshold 현저저우 C 조（P ＜0．01）。결론전신마취하장기흡연병인식도온급체온조절성혈관수축역치현저하강，역출현저체온적병발증，전신마취시대흡연병인경응가강체온적감측여관리。
Objective To explore the changes of the temperature and the thermoregulatory peripheral vasoconstric-tion in smoking patients under general anesthesia.Methods 23 adult male patients undergoing abdominal operation un-der general anesthesia (ASA1-2),were divided into current smokers (group S,n=12,17.08±5.82 cigarettes/day for 13.58±8.38 years)and nonsmokers control group (group C,n=11).Demographic data was similar in the two groups. Both groups of patients were administered with propofol1-2 mg/kg,fentanyl 4 μg/kg and vecuronium 0.1 mg/kg for general anesthesia induction,followed by isoflurane 1%-2%,remifentanil 0.08-0.12 μg/kg/min and vecuronium 0.1-0. 2 mg/kg/h for anesthesia maintenance.;After trachea intubation,all patients were received intermittent positive pres-sure ventilation (IPPV)and the PETCO2 were maintained between 35-40 mmHg.The esophageal temperature(TES ), mean skin temperature(TMSK ),and forearm-fingertip temperature gradient(TFOR-FIN )were recorded.A forearm-fingertip temperature gradient of 0 (TFOR-FIN =0℃)was considered as onset of thermoregulatory vasoconstriction and the esopha-geal temperature(TES )that triggered the onset of vasoconstriction was defined as the thermoregulatory threshold.The slope of the linear regression of the forearm-fingertip temperature gradient-TES relationship below the threshold was calculated as its gain (gain).Results There were no significant differences in hemodynamic parameters,TES ,TMSK ,e-sophageal-mean skin temperature gradient (TES-MSK )and TFOR-FIN before anesthesia induction(T0 )between the two groups (P >0.05);TES were significantly decreased from T20 to T180 in group C and from T10 to T180 in group S when compared to T0 (P < 0.05,and P < 0.01,respectively).In addition,the TES were significantly lower in group S than that of group C fromT20 to T180 (P <0.05,and P <0.01,respectively).The threshold value in group S was lower than that in group C(P <0.01).Conclusion long-term smoking patients have reduced esophageal temperature and thermo-regulatory vasoconstriction threshold,and are prone to hypothermia complications during general anesthesia.It is sug-gested that smoker patients should be emphasized for temperature monitoring and management.