急性 Barbiturate中毒症의 臨床的硏究 : 第2編 Electrocardiogram 所見에 대한 觀察 (Ⅱ) Observations Electrocardiograms with Reference to the Alteration in Serum Transaminase, Serum Amylase, Coma & Liver function Tests = Clinical Studies on Acute Barbiturate Poisoning

다국어 초록 (Multilingual Abstract)

In cases of acute barbiturate poisoning, studies on the ECG changes with references to the alteration in serum transarninase and serum amylase are absent in the literatures, though a few studies have been reported on the ECG changes.
So the author investigated ECG findings in 30 cases of acute barbiturate poisoning selected at random, with reference to the change of serum transaninase, serum amylase, grade and duration of coma and liver fution tests.
Of the 30 patients, there were 9 males and 21 females ranging in age from 16 to 59 years. The degree of unconsciousness were graded I-V according to Reed, et al. There were 3 cases in grade I, 4 in grade Ⅱ, 10 in grade Ⅲ, 6 in grade Ⅳ and 7 in grade Ⅴ. The duration of coma was 6 to 181 hr. with the average being 37 hr.
The serum transaminase (SGOT, SGPT) was determined by the Sigma-Frankel method and the serum amylase by the Somogyi's method.
Six liver function tests were performed; serum total protein, A/G ratio, C.C.F., T.T.T., alkaline phosphatase and serum total bilirubin.
The results were as follows:
1) Six varieties of ECG changes were regarded abnormal: sinus tachycardia, arrhythmia, prolongation of QT interval, depression of ST segment and T wave changes (flattening, biphasic and inversion).
2)Sinus tachycardia was observed in 43.3% of the cases and the majority were associated with depression of ST segment or T wave changes.
They usually lasted for a day or so, but occasionally for 2 to 5 days. In some cases the appearance of depressed S-T segment and T wave changes was heralded by sinus tachycardia. 3) Arrhythmia was seen in 6.6% of the cases. In one case tachycardia developed into auricular fibrillation and in another case intraventricular conduction defect was suspected.
4) Prolongation of QT interval was noted in 13.3% of the cases. It appeared earlier than other ECG abnormalities and returned to normal 1∼2 days later. All cases were with abnormalities of S-T segment (2 of elevation and 2 of depression).
5) In 10% of the cases, elevation of ST segment, more than 1 mm. in L₁-L₃ and V₁-V_(6) was observed. Usually they appeared on the 1st day and returned to normal on the following day.
6) Depression of S-T segment, more than 1 mm. in L₁-L₃ and V₁-V_(6) was noted in 36.3%, lasting for 1 to 3 days. In all cases such depression appeared in combination with T wave changes or some of the other ECG abnormalities such as sinus tachycardia, prolongation of QT interval or arrhythmia.
7) In 33.3% of the cases, T wave changes (flattening, biphasic or inversion) were encountered in L₁,L₂ and V₃-V_(6)They appeared with depressed S-T segment in most cases. In only one case T wave change only occured.
8) Combined depressed S-T segment and T wave changes were observed in 30% of the patients, usually coma of higher grade.
9 ) Among the ECG changes, the elevation of the ST segment was the earliest in onset. It was encountered on the first hospital day in all cases. Prolongation of QT interval and sinus tachycardia were observed exclusively on the first or 2nd hospital day, while the depressed S-T segment and T wave changes appeared later on the 3rd day in some cases of coma of longer duration. The ECG changes found in later period of the poisoning were mostIy depression of S-T segment or T wave changes.
10) The incidence of the ECG changes, particularly, depression of the S-T segment, T wave changes or arrhythmia, were higher in the group of grade IV-V than in the group of grade Ⅰ-Ⅲ. While the ECG changes in former group were as much as 53.8% in sinus tachycardia, 61.5% in depression of S-T segment, 53.8% in T wave changes, 53.8% in depression of S-T segment plus T wave change and 23% in prolongation of QT interval, it was only 35% in sinus tachycardia, 17.6% in depression of S-T segment, 17.6% in T wave changes, 11.7% in depression of S-T segment plus T wave changes, and 5.8% in prolongation of QT interval in latter group. There was no relationship between elevation of S-T segment and grade of coma in the author's series.
11) Among the average duration of coma in each group of the ECG changes, the group of depressed S-T segment was the longest. The group of depressed S-T segment plus T wave changes and the group of T wave changes were the next in duration in average. In the group of sinus tachycardia, elevated S-T segment and prolongation of QT interval, the average duration was much shorter but stilI longer than the normal ECG group. Thus some relationship seemed to be indicated between the ECG abnormalities and the duration of coma.
12) Among the average value of SGOT and SGPT in each group of the abnormal ECG cases, the highest value was noted in the group of T wave changes. Another three groups, sinus tachycardia, depression of S-T segment plus T wave changes and depression of S-T segment, were lower than the group of T wave changes with similar abnormal levels. The average value of serum amylase was highest in the group of S-T segment depression plus T wave changes.
13) Cases of ECG abnormalities, particularly of depressed S-T segment and T wave changes, were tend to b e associated with abnormalities in many type of liver function tests.
14) As the causes of the ECG changes in acute barbiturate poisoning not only the myocardial anoxia, possibly of importance, but a direct barbiturate effects on cardiae muscels as well, possibly minor in role, are suggested.

목차 (Table of Contents)

• Ⅰ. 緖論
• Ⅱ. 觀察對象 및 方法
• Ⅲ. 成績
• 1] 洞性頻脈에 대한 觀察
• 2] 不整脈에 대한 觀察
• 3] Q-T 延長에 대한 觀察
• 4] S-T節上昇에 대한 觀察
• 5] S-T節 降下에 관한 觀察
• 6] T波形의 變化에 관한 觀察
• 7] S-T節에 降下 및 T 波異常이 同時觀察된 例에 관한 觀察
• 8] ECC 變化例群에 관한 觀察
• Ⅳ. 考按 및 總括
• Ⅴ. 結論
• 參考文獻