Tuberculosis and Respiratory Diseases
- Volume 46 Issue 5
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- Pages.645-653
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- 1999
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
Factors Related to the Development of Myocardial Ischemia During Mechanical Ventilation
인공 호흡기 적용에 따른 심근 허혈의 발생에 관한 연구
- Kim, Tae-Hyung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Kim, You-Ho (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Lim, Chae-Man (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Shim, Tae-Sun (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Lee, Sang-Do (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Kim, Woo-Sung (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Kim, Dong-Soon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Kim, Won-Dong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
- Koh, Youn-Suck (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
- 김태형 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 김유호 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 임채만 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 김원 (울산대학교 의과대학 서울중앙병원 응급의학과교실) ;
- 심태선 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 이상도 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 김우성 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 김동순 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 김원동 (울산대학교 의과대학 서울중앙병원 내과학교실) ;
- 고윤석 (울산대학교 의과대학 서울중앙병원 내과학교실)
- Published : 1999.05.30
Abstract
Introduction : Although myocardial ischemia tends to occur more frequently than can he documented in ventilated patients, it has not been well studied on the factors related to the occurrence of the ischemia. Methods : To investigate the related factors to ischemia development, a prospective study was done in 95 cases with consecutive 73 patients who had received mechanical ventilation(MV) in MICU. In addition to 24 h holter monitoring, echocardiogram, electrolytes, cardiac enzymes, hemodynamic, and gas exchange measurements were done within 24 h after initiation of MV in 69 cases. The measurements were repeated at weaning period in 26 cases. The ischemia was defined by the ST segment changes; up-sloping depression more than 1.5 mm or down-sloping or horizontal depression more than 1.0 mm from isoelectric baseline for 80 ms following J point. Results : Twelve patients(12.6% in 95 cases) developed ischemia in total. The incidence of ischemia development showed an increased tendency in the initial 24 hr after MV (15.9%) and in patients with left-sided heart failure found by echocardiogram (18.2%) compared with that of the weaning period (3.8%) and patients without heart failure (10.9%) (P=0.12, P=0.09, in each). There were no differences in APACHE III score, baseline ECG findings, electrolytes abnormalities, use of inotropics or bronchodilators, presence of sepsis or shock, mode of ventilation, and survival rate according to the development of ischemia. Maximal heart rates and mean arterial pressure also were not different between patients with (
연구배경 및 목적 : 급성 호흡 부전으로 인공 호흡 치료를 받는 환자들에서 인공 호흡기 적용 및 이탈 시에 혈역학적 변화에 의해 심근 허혈이 발생될 수 있으나, 이에 연관된 연구는 많지 않다. 본 연구는 급성 호흡 부전으로 인공 호흡 치료를 받는 환자들에서 혈역학적 변화가 가장 심하게 초래될 수 있는 치료 시작 시와 이탈 시에 발생하는 심근 허혈의 빈도 및 그 발생과 관련된 인자들을 알아보고자 하였다. 대상 및 방법 : 급성 호흡 부전으로 서울 중앙 병원 내과계 중환자실에 입원하여 인공 호흡 치료를 받은 73명, 95예(남 : 여=35 : 38, 연령=