一般外科疾患および心臓疾患における血清コリンエステーラゼの変動
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The author determined the Serum cholinesterase (SChE) activity by the use of Acholest method which may readily be done during the surgical procedures to investigated its clinical significance and arrived at the followihg conclusion.<BR>1. Reduced SChE activity was recognized in 26 (32.5 %) of 80 cases who were operated upon for general surgical diseases. The incidence of the reduction in this esterase activity was found to be higher in cases of gastric cancer and those with impaired liver function, being 56.2 and 61.5 % respectively. As to the relationship between liver function tests and SChE activity, 70 % of cases with normal A/G ratio showed normal SChE activity, while the activity was found normal in a half, decreased in the other half of cases with renuced A/G ratio ; the zinc sulfate test (Kunkel) revealed that the greater the value of this test, the more becomes the number of cases showing decreased SChE activity, a reduced SChE activity was also seen in 17 % of cases of negative CCF test and in more than 50 % of positive cases. Otherwise, no distinct correlatit n was noticeable between liver function tests and SChE level.<BR>2. Halothane and methoxyflurane, at ordinary concentrations used in anesthesia, were found not to affect the SChE activity.<BR>3. Succinylcholine chloride (S. c. c.) as well as d-Tubocurarine (dTc), among muscle relaxants, also was found not to exert any significant influence upon the SChE activity.<BR>Hexafluorenium apparently lowered the SChE activity, its duration of action being prolonged particularly in cases showing reduced SChE activity preoperatively.<BR>4. As the criterion for the evaluation of the duration of the neuromuscular blocking action of S. c. c., the conventionally employed apnea period is not always suited. In contnast to this, a method devised by the author in which the plamter flexion of toes induced by electrical stimulation of the tibial nerve was measured by means of a strain gauge. The method was demonstrated to give much more correct results.<BR>5. In 8 of 33 cases of cardiac surgery, reduced SChE activity was seen, and this incidence is substantially the same as that for general surgical patients with normal liver function.<BR>In cases of general cardiac surgery done without the use of artificial heart & lung, no particular alterations in the SChE activity were noten during and after the operation probably because only young patients about 20 in age were employed, while in those undergoing open-heart surgery by the use of artificial heart & lung there was a declining tendency of the SChE activity noted due to the use of this apparatus.<BR>In cases of heart operation conducted with the use of artificial heart & lung under hypothermia, the SChE activity was found to be lowered by hypothermia of below 34°C, especially below 30°C. This reduction in the esterase activity occurred more frequently and definitely in cases with a low Acholest value preoperatively than in those with nomal Acholest value.<BR>Reduced or greatly reduced SChE activity during a period from 1 to 4 hours following operation may thus be of help in the assessment of prognosis in patients who are oberated upon with the use of artificial heart & lung, whereas such a reduction in this enzymatic activity occurring during and just after the operation is not necessarily indicative of poor prognosis.
- 学校法人 昭和大学・昭和医学会の論文