集中治療を受けている患者の急性メガロブラスティック骨髄変化の発生率と病原性
Lancet (London, England)
|October 16, 1982
まとめ
酸化窒素麻酔は,特に重症患者の場合,メガロブラスティック骨髄変化とDNA合成異常を引き起こす可能性があります. これらの影響からの回復は,心臓外科手術患者の場合よりも遅い,より深刻です.
科学分野:
- 血液学 ヘマトロジ
- アネステシオロジー アネステシオロジー
- クリティカルケア・メディシン
背景:
- 酸化窒素 (N2O) は一般的な麻酔剤です.
- N2Oは,メチオニン合成酵素を非活性化することによって,DNA合成に干渉することが知られている.
- N2Oが重症で,既にある疾患を患っている患者に与える影響は,十分に理解されていません.
研究 の 目的:
- 重症患者のメガロブラスティック骨髄変化とDNA合成異常の発生率と病原性を調査する.
- これらの変化における酸化窒素麻酔の役割を評価する.
- 集中治療室 (ICU) の患者と心臓バイパス手術を受ける患者とのN2Oの効果を比較する.
主な方法:
- ICUに入院した70人の重病患者を対象とした前向きな研究.
- デオキシウリジン (dU) 抑制試験を使用して,メガロブラスティック骨髄変化とDNA合成異常を評価しました.
- 窒素酸化窒素麻酔曝露の記録された歴史.
主要な成果:
- メガロブラスティック骨髄の変化は,入院時に22人の患者に存在し,そのうち18人はN2O麻酔を受けた.
- 死亡率は,ノルモブラスティック大髄 (7/22) の患者と比較して,メガロブラスティック変化 (16/18) の患者で高かった.
- 異常なdU抑制テストは,N2Oにさらされた39/42人の患者で発見され,心臓手術患者よりも回復が遅かった.
結論:
- 酸化窒素麻酔は,重症患者のメガロブラスティック骨髄変化とDNA合成異常の重要な原因である.
- これらの効果はより深刻で,ICU患者では心臓手術患者と比較して回復が遅い.
- 回復中に,dU抑制テストのパターンは,ビタミンB12欠乏症を示唆するから,葉酸欠乏症にシフトし,複雑な代謝障害を示した.
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