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Analysis of Perception of School Foodservice Facilities and Utilities in Gyeongnam Area by School Nutrition Teachers (Dietitians) -Comparison of School Foodservice Facilities and Improvement of Utilities in Schools- (경남지역 영양(교)사의 급식시설 설비에 대한 인지도 분석 -학교급식시설 현대화 사업 완료 학교와 미완료 학교의 비교를 중심으로-)

  • Jeon, Young;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.9
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    • pp.1447-1456
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    • 2014
  • The purpose of this study was to compare perception of school foodservice facilities and utilities in dietitians and school nutrition teachers in the Gyeongnam area between schools that improved foodservice facilities and utilities versus those who did not. From July 23 to Aug 31, 2012, 391 questionnaires were distributed, and 289 questionnaires were obtained. A total of 275 questionnaires were used for the final analysis, excluding improper ones. The results of this study were as follows. First, among 275 schools, 90 schools (32.7%) improved school foodservice facilities and utilities while 175 schools (67.3%) did not. Second, schools with improved facilities had a more well-equipped receiving room (P<0.01), preparation room (P<0.001), dishwashing room (P<0.001), storage room for supplies (P<0.001), rest-room for school foodservice employees (P<0.05), locker room (P<0.01), shower room (P<0.001), laundry room (P<0.001), boiler room (P<0.05), and room for serving cart (P<0.05) than schools with no improvement. Third, total perception score of school foodservice facilities area from schools with improved facilities (1.71) was significantly higher than that (1.60) of school without improvement (P<0.001). Fourth, total satisfaction (3.32) of school foodservice facilities and utilities in school with improved facilities was significantly higher than that (2.62) of schools without improvement (P<0.01). Fifth, schools with improved facilities had a better equipped of floor (P<0.05), entrance (P<0.001), drain (P<0.001), water supply (P<0.01), lighting (P<0.001), hand washing (P<0.001), foodservice management room (P<0.001), locker room (P<0.001), rest-room and shower room (P<0.001), and preparation room (P<0.001) than schools without improvement. However, there was no significant difference in terms of walls and ceilings, windows, ventilation, and storage. In conclusion, school foodservice facilities and utilities improvement should conducted as soon as possible.

The Early Experience with a Laparoscopy-assisted Pylorus-preserving Gastrectomy: A Comparison with a Laparoscopy-assisted Distal Gastrectomy with Billroth-I Reconstruction (복강경 보조 유문부보존 위절제술의 초기 경험: 복강경 보조 원위부 위절제술 후 Billroth-I 재건술과의 비교)

  • Park, Jong-Ik;Jin, Sung-Ho;Bang, Ho-Yoon;Chae, Gi-Bong;Paik, Nam-Sun;Moon, Nan-Mo;Lee, Jong-Inn
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.20-26
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    • 2008
  • Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+$\beta$ lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a $2.5{\sim}3.0\;cm$ pyloric cuff and maintaining a $3.0{\sim}4.0\;cm$ distal margin for the resection. Results: The mean age for patients who underwent LAPPG and LADGBI were $59.9{\pm}9.4$ year-old and $64.1{\pm}10.0$ year-old, respectively. The sex ratio was 1.3 : 1.0 (male 5, female 4) in the LAPPG group and 2.6 : 1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes ($28.3{\pm}11.9$ versus $28.1{\pm}8.9$), operation time ($269.0{\pm}34.4$ versus $236.3{\pm}39.6$ minutes), estimated blood loss ($191.1{\pm}85.7$ versus $218.3{\pm}150.6\;ml$), time to first flatus ($3.6{\pm}0.9$ versus $3.5{\pm}0.8$ days), time to start of diet ($5.1{\pm}0.9$ versus $5.1{\pm}1.7$ days), and postoperative hospital stay ($10.1{\pm}4.0$ versus $9.2{\pm}3.0$ days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. Conclusion: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

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The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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Change of Green Space Arrangement and Planting Structure of Apartment Complexes in Seoul (서울시 아파트단지의 녹지배치 및 식재구조 변화 연구)

  • Lee, Dong-Wook;Lee, Kyong-Jae;Han, Bong-Ho;Jang, Jae-Hoon;Kim, Jong-Yup
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.4
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    • pp.1-17
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    • 2012
  • This study was carried out to propose the improved method by analyzing the change of green space arrangement and planting structure of apartment complexes in Seoul. 12 survey sites, which have obvious differences, were selected by reflecting the change of floor area ratio, underground parking place, and green space ratio. We divided the survey sites into four types that high green ratio(over 40%) apartment on natural ground, low green ratio(under 40%) apartment on natural ground, low green ratio(under 40%) apartment on artificial ground, and high green ratio(over 40%) apartment on artificial ground each period based on green space ratio and ground structure, plant crown volume, planting density, and planting pattern. The main factors of change of green space arrangement were green space ratio and ground structure. The Green space ratio was changed by the floor area ratio with constructing underground parking place and floor area ratio was adjusted by government policy and economic status. Average width of front green area has been changed from 10.0m in high green ratio apartment on natural ground for 3.5m, 2.7m, and 4.5m each period. The average width of the buffer green area has been changed from 15.0m in high green ratio apartment on natural ground of 7.7m, and 2.7m by extending parking place in the low green ratio apartment of artificial ground, so buffer green areas have been reduced and disconnected. So buffer green area in apartment complexes has been extended that the average width of the buffer green area was 3.8m caused by growing recognition of green since 2001. The ratio of native plant in canopy layer was increased from 45.1 % in the case of the high green ratio apartment of natural ground in 1980~1983 to 55.6%. Average plant crown volume increased from $1.27m^3/m^2$ in high green ratio apartment on natural ground for $3.47m^3/m^2$ in a low green ratio apartment on natural ground. But average plant crown volume is $0.27m^3/m^2$ in the high green ratio apartment of the artificial ground plant density of canopy layer was changed from 5 individuals per $100m^2$ to 14.5 individuals per $100m^2$. We should construct the buffer green area with natural ground and get the function of ecological and beautiful environment regarding to garden concept in case of front green area, width 4.5m. We should get the function of increasing green volume by multi-layer planting with shade woody species and flower woody species in case of back-side green area, width over 5.0m. We should get the function of covering the wall and increasing green landscape by planting with high woody species in case of side green area. We should apply the ecological planting technique to buffer green area and connect buffer green area to inner green area in apartment complexes.

Comparison of Health Status and Activities for the Pain and No-pain Groups in the Elderly (노인의 만성동통 유무에 따른 건강상태 및 일상활동장애 비교)

  • Kim, Hyo-Jung;Kim, Myung-Ae;Park, Kyung-Min
    • Journal of agricultural medicine and community health
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    • v.24 no.1
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    • pp.79-89
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    • 1999
  • The purpose of this study is to compare health status and activities for the pain and no-pain groups in the elderly. The study subjects included 189 elderly people(65 years and older) living in an urban area. They were surveyed at their homes through interview using a closed-ended questionnaire from Nov. 6th. to Nov. 16th. 1997. The instrument used in the study was selected after carefully reviewing pain-related articles and records well described the characteristics of the elderly. The data were analysed by using descriptive statistics and chi-square tests. The findings were as follows : Of the 189 subjects, 83.6% reported experiencing the pain for the last year. By the age, there were significant differences between the pain and no-pain group(${\chi}^2$=9.572, p=.023). The percentage of the pain complainers was the highest in 80 years and older(100.0%), followed by 70~74(89.1%), 75~79(81.3%), 65~69(76.8%) which presented crude increase according to age. By sex, men had lower pain prevalence(69.5%) than that of women(90.0%). The number of pain complainers was higher in women than men(${\chi}^2$=12.448, p=.023). There were significant differences between the pain and no-pain groups by spouse distribution(${\chi}^2$=10.736, p=.001), educational state(${\chi}^2$=13.020, p=.000), occupation(${\chi}^2$=18.807, p=.000). Pain prevalence in the subjects having no spouse(59.3%) was higher than those having spouse(40.7%), Illiteracy rate was higher in pain group(49.0%) than no-pain group(13.3%). The number of the subjects having occupation(full time or part time) was fewer in pain group than no-pain group. By health status, there were significant differences between two groups(${\chi}^2$=40.055, p=.000). : the pain group showed poor(61.4%), followed by moderate(22.1%), good(16.5%) while no-pain group showed good(64.5%), moderate(29.0%), poor(6.5%). By activities, there were significant differences between the pain and no-pain groups. The pain group was disturbed more severely than the no-pain group in movement(${\chi}^2$=57.829, p=.000), sleep(${\chi}^2$=12.785, p=.000), usual activities(${\chi}^2$=39.196, p=.000), receiving guests(${\chi}^2$=13.163, p=.000), and hobbies and recreation(${\chi}^2$=28.177, p=.000).

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The Physical and Social Disability of Aged Persons Who Live Alone in Goksung Area (곡성지역(谷城地域) 독거노인(獨居老人)의 신체적(身體的) 사회적(社會的) 능력장애(能力障碍)에 관(關)한 조사(調査))

  • Kim, Shin-Woel;Kim, Young-Lak;Ryu, So-Yeon;Park, Jong;Kim, Ki-Soon;Kim, Yang-Ok
    • Journal of agricultural medicine and community health
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    • v.24 no.2
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    • pp.245-268
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    • 1999
  • It is necessary that the old should have the physical and social ability to perform their daily life. This study is to grasp their degree of disability and problems and suggest their solutions. It surveyed the 87 old people over 65 years old from September 1st until September 30th, in 1997. The findings are as follows. 1) The activities of daily living(ADL) to find their degree of physical disability shows that their average performance ability is 75.9% of all the action while 24.1% of all the old people needs the others' help. As they get older and older, the aged drop off in their physical ability, which is related to a statistical sense (p<0.001). 2) The social disability shows that the aged have their great difference from 9.2% to 85.1% in their instrumental activities of daily living(IADL), intellectual ability and social role. 3) A simple analysis shows that the activities of daily living are, in a statistical sense, related to age(p<0.001), the use of elder's hall(p<0.001), the understanding degree of health(p<0.01) and so forth. 4) A simple analysis shows that the instrumental activities of daily living are, in a statistical sense, related to age(p<0.001), the degree of education(p<0.05), the life of leisure(p<0.001), the understanding degree of health and so forth. 5) A multivariate logistic regression analysis shows that the disability of daily living is related to age, the visit of elder's hall, the period of solitary living, instrumental activities of daily living is age and the visit of elder's hall, and social role is the visit of elder's hall and the decree of education, while intellectual activity has no related variables in a statistical sense.

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Factors associated with Experience of Diagnosis and Utilization of Chronic Diseases among Korean Elderly : Focus on Comparing between Urban and Rural Elderly (한국 노인의 만성질환 진단경험 및 의료이용에 관련된 요인 : 도시와 농촌 간 비교를 중심으로)

  • Lee, Min Ji;Kown, Dong Hyun;Kim, Yong Yook;Kim, Jae Han;Moon, Sung Jun;Park, Keon Woo;Park, Il Woo;Park, Jun Young;Baek, Na Yeon;Son, Gi Seok;Ahn, So Yeon;Yeo, In Uk;Woo, Sang Ah;Yoo, Sung Yun;Lee, Gi Beop;Lim, Soo Beom;Jang, Soo Hyun;Jang, In-Deok;Jeon, Jeong-U;Jeong, Su Jin;Jung, Yeon Ju;Cho, Seong Geon;Cha, Jeong Sik;Hwang, Ki Seok;Lee, Tae-Jun;Lee, Moo-Sik
    • Journal of agricultural medicine and community health
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    • v.44 no.4
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    • pp.165-184
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    • 2019
  • Objectives: The purpose of this study was to identify and compare the difference and related factors with general characteristic and health behaviors, a experience of diagnosis and treatment of chronic diseases between rural and urban among elderly in Korea. Methods: We used the data of Community Health Survey 2017 which were collected by the Korean Center for Disease Control and Prevention. The study population comprised 67,835 elderly peopled aged 65 years or older who participated in the survey. The chi-square test, univariate and multivariate logistic regression analysis were used to analyze data. Results: We identified many significant difference of health behaviors, an experience of diagnosis and treatment with chronic diseases between rural and urban. Compared to urban elderly, the odds ratios (ORs) (95% confidence interval) of rural elderly were 1.136 (1.092-1.183) for diagnosis of diabetes, 1.278 (1.278-1.386) for diagnosis of dyslipidemia, 0.940 (0.904-0.977) for diagnosis of arthritis, 0.785(0.736-0.837) for treatment of arthritis, 1.159 (1.116-1.203) for diagnosis of cataracts, and 1.285(1.200-1.375) for treatment of cataracts. In the experience of diagnosis and treatment of chronic diseases, various variables were derived as contributing factors for each disease. Especially, there were statistically significant difference in the experience of diabetes diagnosis, arthritis diagnosis, cataract diagnosis and dyslipidemia except for hypertension diagnosis (p <0.01) between urban and rural elderly. There were statistically significant differences in the experience of treatment for arthritis and cataract (p <0.01), but there was no significant difference in the experience of treatment for hypertension, diabetes, dyslipidemia between urban and rural elderly. Conclusion: Therefore, it would be necessary to implement a strategic health management project for diseases that showed significant experience of chronic diseases with diagnosis and treatment, reflecting the related factors of the elderly chronic diseases among the urban and rural areas.

COMPARISON OF POLYMERIZATION SHRINKAGE AND STRAIN STRESS OF SEVERAL COMPOSITE RESINS USING STRAIN GUAGE (스트레인 게이지를 이용한 수종의 복합레진의 중합수축 및 수축응력의 비교)

  • Kim, Young-Kwang;Yoo, Seung-Hoon;Kim, Jong-Soo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.3
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    • pp.516-526
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    • 2004
  • Polymerization shrinkage of photoinitiation type composite resin cause several clinical problems. The purpose of this study was to evaluate the shrinkage strain stress, linear polymerization shrinkage, compressive strength and microhardness of recently developed composite resins. The composite resins were divided into four groups according to the contents of matrix and filler type. Group I : $Denfil^{TM}$(Vericom, Korea) with conventional matrix, Group II : $Charmfil^{(R)}$(Dentkist, Korea) with microfiller and nanofller mixture, Group III : $Filtek^{TM}$ Z250(3M-ESPE, USA) TEGDMA replaced by UDMA and Bis-EMA(6) in the matrix, and Group IV : $Filtek^{TM}$ Supreme(3M-ESPE, USA) using pure nanofiller. Preparation of acrylic molds were followed by filling and curing with light gun. Strain gauges were attached to each sample and the leads were connected to a strainmeter. With strainmeter shrinkage strain stress and linear polymerization shrinkage was measured for 10 minutes. The data detected at 1 minute and 10 minutes were analysed statistically with ONE-way ANOVA test. To evaluate the mechanical properties of tested materials, compressive hardness test and microhardness test were also rendered. The results can be summarized as follows : 1. Filling materials in acrylic molds showed initial temporary expansion in the early phase of polymerization. This was followed by contraction with the rapid increase in strain stress during the first 1 minute and gradually decreased during post-gel shrinkage phase. After 1 minute, there's no statistical differences of strain stress between groups. The highest strain stress was found in group IV and followed by group III, I, II at 10 minutes-measurement(p>.05). In regression analysis of strain stress, group III showed minimal inclination and followed by group II, I, IV during 1 minute. 2. In linear polymerization shrinkage test, the composite resins in every group showed initial increase of shrinkage velocity during the first 1 minute, followed by gradually decrease of shrinkage velocity. After 1 minute, group IV and group III showed statistical difference(p<.05). After 10 minutes, there were statistical differences between group IV and group I, III(p<.05) and between group II and group III(p<.05). In regression analysis of linear polymerization shrinkage, group II showed minimal inclination and followed by group IV, III, I during 1 minute. 3. In compressive strength test, group III showed the highest strength and followed by group II, IV, I. There were statistical differences between group III and group IV, I(p<.05). 4. In microhardness test, upper surfaces showed higher value than lower surfaces in every group(p<.05).

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Actual Conditions and Perception of Safety Accidents by School Foodservice Employees in Chungbuk (충북지역 학교급식 조리종사원의 안전사고 실태 및 인식)

  • Cho, Hyun A;Lee, Young Eun;Park, Eun Hye
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.43 no.10
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    • pp.1594-1606
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    • 2014
  • The purpose of this study was to examine safety accidents related to school foodservice, working and operating environments of school foodservice, status and awareness of safety education, educational needs, and information on qualitative improvement of school foodservice. The subjects in this study were 234 cooks in charge of cooking at elementary and secondary schools in Chungbuk. A survey was conducted from July 30 to August 8, 2012, and among 202 questionnaires gathered, 194 completed questionnaires were analyzed. Statistical analyses were performed on data utilizing the SPSS version 19.0. The main results of this study were as follows: 44.3% of workers experienced safety accidents. The most frequent safety accident was 'once' (60.5%), and most safety accidents took place between June and August (31.4%). The time at which most safety accidents happened was between 8 and 11 am. Most safety accidents happened during cooking (52.3%) and while using a soup pot or frying pot (52.4%). The most common accidents were 'burns', 'wrist and arm pain', and 'slips and falls'. Respondents who experienced safety accidents replied that 57.6% of employees dealt with injuries at their own expense, and only 35.3% utilized industrial accident insurance. In terms of the operating environment, the score for 'offering information and application' was highest (3.76 points), whereas that for 'security of budget' was lowest (1.77 points). As for accident education, employees received safety education approximately 3.45 times and 5.10 hours per year. Improving the working environment of school foodservice cooks requires administrative and financial support. Furthermore, educational materials and guidelines based on the working environment and safety accident status of school foodservice cooks are required in order to minimize potential risk factors and control safety accidents in school foodservice.

Relationship of Compliance and Oxygen Transport in Experimental Acute Respiratory Failure during Positive End-Expiratory Pressure Ventilation (실험적 급성호흡부전에서 호기말양압에 의한 폐유순도와 산소운반의 변화 및 상관관계 - 호흡부전의 기전에 따른 차이 -)

  • Lee, Sang-Do;Yoon, Se-Jin;Lee, Bok-Hee;Han, Sung-Koo;Shim, Young-Soo;Kim, Keun-Youl;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.1
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    • pp.6-15
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    • 1993
  • Background: Positive end, expiratory pressure (PEEP) has become one of the standard therapies for adult respiratory distress syndrome (ARDS). Total static compliance has been proposed as a guide to determine the size of PEEP ('best PEEP') which is of unproven clinical benefit and remains controversial. Besides increasing functional residual capacity and thus improving oxygenation, PEEP stimulate prostacyclin secretion and was proposed for the treatment of acute pulmonary embolism. But little is known about the effect of PEEP on hemodynamic and gas exchange disturbances in acute pulmonary embolism. Methods: To study the validity of total static compliance as a predictor of 'best PEEP' in ARDS and acute pulmonary embolism, experimental ARDS was induced in mongrel dog with oleic acid and acute pulmonary embolism with autologous blood clot. Then hemodynamic and gas exchange parameters were measured with serial increment of PEEP. Results:In ARDS group, total static compliance and oxygen transport were maximal at 5 cm$H_2O$, and decreased thereafter (p<0.05). With increment of PEEP, arterial oxygen tension ($PaO_2$) and arterial carbon dioxide tension ($PaCO_2$) increased and cardiac output and physiological shunt decreased. In pulmonary embolism group, total static compliance, oxygen transport, physiological shunt and cardiac output decreased and $PaO_2$ and $PaCO_2$ increased with increment of PEEP (p<0.05). Comparing the change induced by increment of PEEP by 1 cm$H_2O$ in ARDS group with that in pulmonary embolism group, there was no significant difference between two groups except cardiac output which decreased more in pulmonary embolism group (p<0.05). In ARDS group, oxygen transport and total static compliance increased after PEEP application, and total static compliance was maximal at the PEEP level where oxygen transport was maximal. However in pulmonary embolism group, oxygen transport and total static compliance decreased after application of PEEP. There was significant correlation between change of total static compliance and change of oxygen transport in both groups. Conclusion: In both ARDS and acute pulmonary embolism, it can be concluded that total static compliance is useful as a predictor of 'best PEEP'.

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