과산화수소 관장이 급성 일산화탄소중독의 회복에 미치는 영향

Abstract

Carbon monoxide(CO) poisoning has been one of the major environmental problems because of the tissue hypoxia, especially brain tissue hypoxia, due to the great affinity of CO with hemoglobin. Inhalation of the pure oxygen (02) under the high atmospheric pressure has been considered as the best treatment of CO poisoning by the supply of 02 to hypoxic tissues with dissolved from in plasma and also by the rapid elimination of CO from the carboxyhemoglobin(HbCO). Hydrogen peroxide (H2O2) was rapidly decomposed to water and 02 under the presence of catalase in the blood, but the intravenous administration of H2O2 is hazardous because of the formation of methemoglobin and air embolism. However, it was reported that the enema of H2O2 solution below 0.75% could be continuously supplied 02 to hypoxic tissues without the hazards mentioned above. This study was performed to evaluate the effect of H2O2 enema on the elimination of CO from the HbCO in the recovery of the acute CO poisoning. Rabbits weighting about 2.0 kg were exposed to If CO gas mixture with room air for 30 minutes. After the acute CO poisoning, 30 rabbits were divided into three groups relating to the recovery period. The first group T·as exposed to the room air and the second group w·as inhalated with 100% 02 under 1 atmospheric pressure. The third group was administered 10 ml of 0.5H H2O2 solution per kg weight by enema immediately after CO poisoning and exposed to the room air during the recovery period. The arterial blood was sampled before and after CO poisoning ana in 15, 30, 60 and 90 minutes of the recovery period. The blood pH, Pco2andPo2 were measured anaerobically with a Blood Gas Analyzer and the saturation percentage of HbCO was measured by the Spectrophotometric method. The effect of H2O2 enema on the recovery from the acute CO poisoning was observed and compared with the room air group and the 100% 02 inhalation group. The results obtained from the experiment are as follows: The pH of arterial blood was significantly decreased after CO poisoning and until the first 15 minutes of the recovery period in all groups. Thereafter, it was slowly increased to the level of the before CO poisoning, but the recovery of pH of the H2O2 enema group was more delayed than that of the other groups during the recovery period. Paco2 was significantly decreased after CO poisoning in all groups. Boring the recovery Period, Paco2 of the room air group was completely recovered to the level of the before CO Poisoning, but that of the 100% O2 inhalation group and the H2O2 enema group was not recovered until the 90 minutes of the recovery period. Paco2 was slightly decreased after CO poisoning. During the recovery Period, it was markedly increased in the first 15 minutes and maintained the level above that before CO Poisoning in all groups. Furthermore Paco2 of the H2O2 enema group was 102 to 107 mmHg and it was about 10 mmHg higher than that of the room air group during the recovery period. The saturation percentage of HbCO was increased up to the range of 54 to 72 percents after CO poisoning and in general it was generally diminished during the recovery period. However in the H2O2 enema group the diminution of the saturation percentage of HbCO was generally faster than that of the 100% O2 inhalation group and the room air group, and its diminution in the 100% O2 inhalation group was also slightly faster than that of the room air group at the relatively later time of the recovery period. In conclusion, the enema of 0.5% H2O2 solution is seems to facilitate the elimination of CO from the HbCO in the blood and increase PaO2 simultaneously during the recovery period of the acute CO poisoning.

과산화수소 (H2O2) 가 급성 일산화탄소(CO)중독의 회복에 미치는 영향을 알아보기 위하여 가토를 1% Corktm에 30분간 노출시킨후 자연회복군, 100%산소 흡입군 및 H2O2 관장군(10ml/kg의 0.5% H2O2 용액을 2ml내외의 사람혈액과 함께 관장)으로 나누어, 회복기 15,30,60 및 90분에 동맥혈의 pH,PCO2,CO2 및 HbCO 포화도를 측정하여 다음과 같은 결론을 얻었다. pH는 급성 CO중독시 3개군 모두에서 감소하였고, 회복기에는 서서히 증가하여 자연회복군과 100%산소 흡입군은 회복기 90분에 거의 회복되나, H2O2 관장군에서는 pH의 회복이 다른군보다 늦었다. PaCO2 는 급성 Co중독시 3개군 모두에서 감소하였고, 회복기에는 서서히 증가하였으나, 자연회복군의 PaCO2 는 회복기 90분에 거의 회복하는데 반하여 100%산소흡입군과 H2O2 관장군의 PaCO2 는 회복이 늦었고 회복기 90분에도 완전히 회복되지 못하였다. PaO2 는 급성 Co중독시 약간 감소하였다가 회복기에는 회복기 15분부터 급격히 증가하였고 회복기 90분까지 대조치보다 높은 PaO2 를 유지하였다. 회복기동안 H2O2 관장군의 PaO2 는 102∼107mmhg 로 자연회복군보다 약 10 mmhg 높은 수준을 보였다. HbCO 포화도는 급성 CO중독시 54∼72 까지 증가하였다. 회복기에는 H2O2 관장군의 HbCO 포화도의 회복이 자연회복군이나 100%산소 흡입군보다 빨랐으며, 100%산소 흡입군은 회복기 30분에서 60분사이에 자연회복군보다 더 빠른 회복을 보였다. 이상의 결과에서 0.5% H2O2 관장은 CO중독시 혈액의 산소분압을 어느정도 증가시킬 뿐 아니라 혈색소와 결합된 CO의 해리를 촉진시켜, 단독요법 또는 산소요법과 병행하여 사용할 때 급성CO중독에 효과적인 치료법이 될 수 있을 것으로 사료된다.