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Project of Improving Good Agriculture Practice and Income by Intergrated Agricultural Farming (미얀마 우수농산물 재배기술 전수사업)

  • Lee, Young-Cheul;Choi, Dong-Yong
    • Journal of Practical Agriculture & Fisheries Research
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    • v.16 no.1
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    • pp.193-206
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    • 2014
  • The objectives of the project are to increase farmers' income through GAP and to reduce the loss of agricultural produce, for which the Korean partner takes a role of transferring needed technologies to the project site. To accomplish the project plan, it is set to implement the project with six components: construction of buildings, installation of agricultural facilities, establishment of demonstration farms, dispatching experts, conducting training program in Korea and provision of equipments. The Project Management Committee and the Project Implementation Team are consisted of Korean experts and senior officials from Department of Agriculture, Myanmar that managed the project systematically to ensure the success of the project. The process of the project are; the ceremony of laying the foundation and commencing the construction of training center in April, 2012. The Ribbon Cutting Ceremony for the completion of GAP Training Center was successfully held under PMC (MOAI, GAPI/ARDC) arrangement in SAl, Naypyitaw on June 17, 2012. The Chairman of GAPI, Dr. Sang Mu Lee, Director General U Kyaw Win of DOA, officials and staff members from Korea and Myanmar, teachers and students from SAl attended the ceremony. The team carried out an inspection and fixing donors' plates on donated project machineries, agro-equipments, vehicles, computers and printer, furniture, tools and so forth. Demonstration farm for paddy rice, fruits and vegetables was laid out in April, 2012. Twenty nine Korean rice varieties and many Korean vegetable varieties were introduced into GAP Project farm to check the suitability of the varieties under Myanmar growing conditions. Paddy was cultivated three times in DAR and twice in SAl. In June 2012, vinyl houses were started to be constructed for raising seedlings and finished in December 2012. Fruit orchard for mango, longan and dragon fruit was established in June, 2012. Vegetables were grown until successful harvest and the harvested produce was used for panel testing and distribution in January 2013. Machineries for postharvest handling systems were imported in November 2012. Setting the washing line for vegetables were finished and the system as run for testing in June 2013. New water tanks, pine lines, pump house and electricity were set up in October 2013.

Two Faces of Entrepreneurial Leadership: The Paradoxical Effect Reflecting Followers' Regulatory Focus (기업가적 리더십의 양면성: 구성원의 조절 초점 성향에 따른 패러독스 효과)

  • Sang-Jib Kwon
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.4
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    • pp.165-175
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    • 2023
  • In venture creation research, studying 'entrepreneurial leadership' is important for uncovering and comprehending the underlying causal process in innovative behavior performance. Although previous studies provide that entrepreneurial leadership enhances followers' innovative behavior, there is few research on entrepreneurial leadership and followers' characteristics interaction. The present study's focus is paradoxical effects of entrepreneurial leadership on self-efficacy and innovative behavior. On the basis of individual regulatory focus, this study suggests that interaction effects of entrepreneurial leadership and followers' regulatory focus differed in promotion view and prevention view followers' innovative behavior. To strengthen the casual mechanism, this study conducted in priming experiment method using employees in SMEs. This study used a 2(entrepreneurial leadership vs. control) x 2 (regulatory focus: promotion vs. prevention) between-participants design. The results of this study provide that (1) Individuals in promotion focus especially benefited from entrepreneurial leadership in terms of its effect on their self-efficacy and innovative behavior; (2) whereas entrepreneurial leadership was negatively related to self-efficacy and innovative behavior of followers' prevention focus. In sum, results of the present study supporting evidence for hypotheses, combined effect of entrepreneurial leadership and regulatory focus on innovative behavior through self-efficacy. Experimental results confirmed hypotheses of this study, revealing that promotion focus show more innovative behavior than prevention focus when their leaders' leadership style is entrepreneurial leadership. Also, the paradoxical effect of entrepreneurial leadership and regulatory focus of followers on innovative behavior was mediated by followers' self-efficacy. This study helps explain how leaders' entrepreneurial leadership boost followers' innovative behavior, particularly for those employees who have promotion focus. The current study contributes to the theory of entrepreneurial leadership and regulatory focus and innovation literature. Findings of this study shed light on the organizational processes that shape innovative behavior in venture/startup corporations and provide contributions for venture business field.

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The Study on the Effect to the Yields with the Intermediate Cutting Periods of Mulberry Branch and at the Picking Levels of Leaf Remains in Autumn (추잠기 중간벌채시기 및 잔조에서의 적엽정도가 뽕의 수량에 미치는 영향에 관한 연구)

  • 김문협;김호락;최하자
    • Journal of Sericultural and Entomological Science
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    • v.13 no.2
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    • pp.81-94
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    • 1971
  • This research is conducted to study the effect to rebbuding, death atop, yielding and occurrence of twig blight disease with the interemediate cutting periods of mulberry branch and at the picking levels of leaf remains in autumn. The results obtained are as follows: 1. Re-budding branches are decreased with delaying of interval cutting period, and that more leaves remained lesser both re-budding branches and buds are observed. Therefore, it is better that leaves remained are placed on the upper part of branch, practically with 3-5 leaf remains. It has decreased re-budding branches, in case cutting is conducted in Sept. 20 with picking leaving 3-5 leaf on. 2. With regard that all picking increases the percentage of death atop of the branch and upper half part picking increases slightly over the other treats. Although it seems unlikely to be different in the other treats with cutting period, exception of all picking, it is elucidated better that the all picking after cutting in Sept. 15 represents unusually high, seemingly effected by the temperature contition preferable to the life of twig blight disease along with the lack of branch nutrition caused by the all picking. 3. In view of yielding, it has no difference in autumn yielding with cutting period, but more picking levels of leaf remains, more yielding. In spring yield, both no picking and all picking is the lowest, in spite of cutting period. Each treat produces high yielding except the no picking if rutting is done in Sept. 15 and Sept. 20, respectively; otherwise it is done earlier or later, each treat produces low yielding. It is suggested that yielding ability in following spring affected by the autumn picking because all picking treats represent lower yielding ability than no picking ones except of cutting in Sept. 15 and Sept. 20. With respect to total yield in spring and autumn, it is represented that other treats, among which cutting in Sept. 15 and Sept. 20 is especially high, produce higher yielding than both no picking and all picking. But no difference seemed in leaf remained treats. In these respects, it may be concluded that 3-5 leaf remains after the interval cutting in Sept. 15 to Sept. 20 increases the yielding throughout two seasons and it is suggested that 3-5 leaf remains after cutting in Sept. 5 to Sept. 10 has no difference with no picking and cutting after that day. 4. Diseases in the branch remained are twig blight, massaria-bye, and Die-back, of which twig blight attacks tremendously and slight ouurence in messaria-byo and Die-back. In ouurence of twig blight, it is appeared much in all picking and seasonal occurence high in Sept. 15 with 92.9, and in Sept. 30 with 100 as index, respectively. Also it occurs ,considerably in upper part picking but little occurrence in no picing. 5. It is considered that negative correlation among re-budding percentage. No. of re-budding leaf, and spring yielding is found, seemingly without heavy correlation at -0.42, and -0.27, respectively. However, death atop of branch and occurence of twig blight has little correlation with spring yield. On the other hand, positive correlation highly appeared with the correlation coefficient at 0.8 between occurence of twig blight and death atop of branch.

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A Study on aspect of development and the ideological backgrounds of a pond a place of Korea (한국(韓國) 고대(古代) 궁원지(宮苑池)의 전개양상(展開樣相)과 사상적(思想的) 배경(背景)에 관한 연구(硏究))

  • Oh, Seung-Youn
    • Korean Journal of Heritage: History & Science
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    • v.37
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    • pp.65-89
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    • 2004
  • Up to now, the studies for a pond of ancient palace of Korea are mainly achieved in a landscape architectural field. In fact, we can't grasp the general aspects but we are only heard about the fragmentary ruins and remains by the people who are in charge of an archaeological excavation. In this thesis, therefore, I attempt to grasp the relational categories of the ponds of an ancient palace of Korea, and find out the ideological backgrounds of the ponds of a palace construction through classify them excavated so far. The ancient ponds of Korea are divided to the class of square ponds(I) and curved ponds(II) according a shapes of planes. The class of square ponds(I) are subdivided to the form IA of the class of square ponds and form IB of the class of square ponds by whether it has an island, artificial hill and ornamental stone or not. And the class of the curved ponds(II) are divided to the form IIC that is only composed of curves in shore and the form IID that is composed of curves and straight lines. According the size, it is divided to a small size that is below the maximal diameter, 20m, and a large size that is more than 45m, after all, the ponds of the ancient palaces are devided to IAa, IAb, IBa, II Ca, IICb, IIDa. The square ponds and the curved ponds are co-exist from the initial stage when a pond of a place was found in our country and are succeeded or changed after Silla unified the three Kingdoms. In other words, we can infer a continuity from the earlier stage from the fact that there is a flat figure ground mainly constituted by the ponds of a palace mixed up of a straight line and a curved line in United Silla Kingdom while it succeeds the ponds of a palace that has a square form of Goguryo in Balhai. Different from the successional relation of the flat figure grounds, in an aspect of the elements of the construction, the site of the arbor at the top of the island and the bridge facilities in a field of a palace those are not exist in three Kingdoms period are appeared in United Silla Kingdom. The point that this aspect is simultaneously appeared in a neighboring country, or Japan, allows us to infer that there may be some motivations cause the changes in a construction of the ponds of a palace of Korea, China and Japan from the latter half of the 7th century to the first half of the 8th century. The ideological backgrounds of the ponds of a palace construction are divided roughly into Taoism and Buddhism. We can recognize that the ponds of a palace made up of the islands, the artificial hills and the garden rocks reflect Taiosm, considering the records of the ponds a palace of Korea and China are all use the term, Taoism, or the concrete statement represents that the islands, the artificial hills and the garden rocks are used in the description of the ponds of a palace of Korea. Both two are, therefore, obviously differentiated from the ponds of a palace that doesn't include them. We can conclude that the ponds of a palace that doesn't include them are colored by Buddhism since they are overtly distinguished from the class of curved ponds that reflect Taoism at the same period and they are identical with the site of an ancient temples in an aspect of their type and construction.

Eurasian Naval Power on Display: Sino-Russian Naval Exercises under Presidents Xi and Putin (유라시아 지역의 해군 전력 과시: 시진핑 주석과 푸틴 대통령 체제 하에 펼쳐지는 중러 해상합동훈련)

  • Richard Weitz
    • Maritime Security
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    • v.5 no.1
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    • pp.1-53
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    • 2022
  • One manifestation of the contemporary era of renewed great power competition has been the deepening relationship between China and Russia. Their strengthening military ties, notwithstanding their lack of a formal defense alliance, have been especially striking. Since China and Russia deploy two of the world's most powerful navies, their growing maritime cooperation has been one of the most significant international security developments of recent years. The Sino-Russian naval exercises, involving varying platforms and locations, have built on years of high-level personnel exchanges, large Russian weapons sales to China, the Sino-Russia Treaty of Friendship, and other forms of cooperation. Though the joint Sino-Russian naval drills began soon after Beijing and Moscow ended their Cold War confrontation, these exercises have become much more important during the last decade, essentially becoming a core pillar of their expanding defense partnership. China and Russia now conduct more naval exercises in more places and with more types of weapons systems than ever before. In the future, Chinese and Russian maritime drills will likely encompass new locations, capabilities, and partners-including possibly the Arctic, hypersonic delivery systems, and novel African, Asian, and Middle East partners-as well as continue such recent innovations as conducting joint naval patrols and combined arms maritime drills. China and Russia pursue several objectives through their bilateral naval cooperation. The Treaty of Good-Neighborliness and Friendly Cooperation Between the People's Republic of China and the Russian Federation lacks a mutual defense clause, but does provide for consultations about common threats. The naval exercises, which rehearse non-traditional along with traditional missions (e.g., counter-piracy and humanitarian relief as well as with high-end warfighting), provide a means to enhance their response to such mutual challenges through coordinated military activities. Though the exercises may not realize substantial interoperability gains regarding combat capabilities, the drills do highlight to foreign audiences the Sino-Russian capacity to project coordinated naval power globally. This messaging is important given the reliance of China and Russia on the world's oceans for trade and the two countries' maritime territorial disputes with other countries. The exercises can also improve their national military capabilities as well as help them learn more about the tactics, techniques, and procedures of each other. The rising Chinese Navy especially benefits from working with the Russian armed forces, which have more experience conducting maritime missions, particularly in combat operations involving multiple combat arms, than the People's Liberation Army (PLA). On the negative side, these exercises, by enhancing their combat capabilities, may make Chinese and Russian policymakers more willing to employ military force or run escalatory risks in confrontations with other states. All these impacts are amplified in Northeast Asia, where the Chinese and Russian navies conduct most of their joint exercises. Northeast Asia has become an area of intensifying maritime confrontations involving China and Russia against the United States and Japan, with South Korea situated uneasily between them. The growing ties between the Chinese and Russian navies have complicated South Korean-U.S. military planning, diverted resources from concentrating against North Korea, and worsened the regional security environment. Naval planners in the United States, South Korea, and Japan will increasingly need to consider scenarios involving both the Chinese and Russian navies. For example, South Korean and U.S. policymakers need to prepare for situations in which coordinated Chinese and Russian military aggression overtaxes the Pentagon, obligating the South Korean Navy to rapidly backfill for any U.S.-allied security gaps that arise on the Korean Peninsula. Potentially reinforcing Chinese and Russian naval support to North Korea in a maritime confrontation with South Korea and its allies would present another serious challenge. Building on the commitment of Japan and South Korea to strengthen security ties, future exercises involving Japan, South Korea, and the United States should expand to consider these potential contingencies.

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An Exploratory Study on Customers' Individual Factors on Waiting Experience (고객의 개인적 요소가 대기시간 경험에 미치는 영향에 대한 탐색적 연구)

  • Kim, Juyoung;Yoo, Bomi
    • Asia Marketing Journal
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    • v.12 no.1
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    • pp.1-30
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    • 2010
  • Customers often experience waiting for buying service. Managing customers' waiting time is important for service providers since customers who are dissatisfied with waiting, secede from a service place at last. Not a few studies have been done to solve waiting time problem and improve customers' waiting experience. Hui & Tse(1996) identify evaluation factors in customers' behavioral mechanism as customers wait. That is, customers experience perceived waiting time, waiting acceptability and emotional response to the wait when they wait. Since customers evaluate the wait using these factors, service provider should manage these factors in order to minimize customers' dissatisfaction. Therefore, this study explores that evaluation factors of waiting are influenced by customers' situational and experiential characteristics, which include customer loyalty, transaction importance for customer and waiting expectation level. Those situational and experiential characteristics are usually given to service providers so they can't control these at waiting point. The major findings derived from two exploratory studies can be summarized as follows. First, according to the result from the study 1 (restaurant setting), customers' transaction importance has the greatest positive influence on waiting experience. The results show restaurant service provider could prevent customers' separation effectively through strategies which raise customers' transaction importance, like giving special coupons for important events. Second, in study 2 (amusement part setting) customer loyalty has large positive impact on waiting experience as well as transaction importance. This results show that service provider could minimize customers' dissatisfaction using strategies which raise customer loyalty continuously. This results show customer perceives waiting experience differently according to characteristics of service place and service itself. Therefore, service provider should grasp the unique customers' situational and experiential characters for each service and service place. It could provide an effective strategy for waiting time management. Third, the study finds transaction importance and waiting expectation level have direct influence customers' waiting experience as independent variables, while existing studies treated them as moderators. Customer loyalty which has not been incorporated in previous waiting time research is known to affect waiting experience. It suggests that marketing strategy which builds up customer loyalty for long period of time is also quite effective, compared to short term tactics to help customers endure waiting time. Fourth, this study reveals the importance of actual waiting time along with perceived waiting time. So far most studies only focus on customers' perceived waiting time. Especially, this study incorporates the concept of patient limit on waiting time to investigate effect of actual waiting time. The results show that there were various responses to the wait depending on how actual waiting time exceeds individual's patent limit on waiting time or not, even though customers wait about the same period of time. Finally, using structural equation model, conceptual path between behavioral responses is verified. As customer perceives waiting time, then she decides whether she can endure it or not, and then her emotional response occurs. This result are somewhat different from Hui & Tse(1996)'s study. The study also includes theoretical contributions as well as practical implications.

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Comparision of Medical Care Utilization Patterns between Beneficiaries of Medical Aid and Medical Insurance (의료보호대상자의 의료이용양상)

  • Kim, Bok-Youn;Kim, Seok-Beom;Kim, Chang-Yoon;Kang, Pock-Soo;Chung, Jong-Hak
    • Journal of Yeungnam Medical Science
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    • v.8 no.2
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    • pp.185-201
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    • 1991
  • A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance benficiaries selected by simple random sampling from a Dong(Township) in Taegu. Well-trained surveyers mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical aid beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease. In medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferrable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was afford ability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.

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Bladder Preserving Treatment in Patients with Muscle Invasive Bladder Cancer (근침윤성 방광암 환자의 방광 보존적 치료 결과)

  • Yu, Jeong-Il;Oh, Dong-Ryol;Huh, Seung-Jae;Choi, Han-Yong;Lee, Hyon-Moo;Jeon, Seong-Soo;Yim, Ho-Young;Kim, Won-Suk;Lim, Do-Hoon;Ahn, Yong-Chan;Park, Won
    • Radiation Oncology Journal
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    • v.25 no.2
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    • pp.70-78
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    • 2007
  • [ $\underline{Purpose}$ ]: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. $\underline{Materials\;and\;Methods}$: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range $38{\sim}86\;years$). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range $55.8{\sim}67\;Gy$). The survival rate was calculated by the Kaplan-Meier method. $\underline{Results}$: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range $3{\sim}91$ months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. $\underline{Conclusion}$: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.

The Effect of Glucocorticoid on the Change of Nitric Oxide and Cytokine Levels in Induced Sputum from Patients with Bronchial Asthma (기관지 천식 환자에서 부신피질 스테로이드 투여 전후 유도객담내 Nitric Oxide 및 Cytokine의 변화)

  • Kim, Tae-Yon;Yoon, Hyeong-Kyu;Choi, Young-Mee;Lee, Sook-Young;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Park, Sung-Hak;Song, Jeong-Sup
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.6
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    • pp.922-931
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    • 2000
  • Background : It has been well known that bronchia1 asthma is a chronic airway inflammatory disorder. Recently, sputum induced with hypertonic saline was introduced as a simple and useful nonivasive medium to investigate airway inflammation and symptom severity in patients with asthma. We examined the eosinophil, eosinophil cationic protein (ECP), interleukin(IL)-3, IL-5, granulocyte-macrophage colony-stimulating facta (GM-CSF), and nitric oxide (NO) derivatives in induced sputum from patients with bronchia1 asthma in order to determine the role of NO and various inflammatory cytokines as a useful markers of airway inflammation or changes in pulmonary function tests and symptoms. Methods : A total 30 patients with bronchia1 asthma received oral prednisolone 30 mg daily for 2 weeks. Forced expiratory volume in one second ($FEV_1$), total blood eosinophil count and induced sputum eosinophil count, ECP, IL-3, IL-5, GM-CSF, and NO derivatives were determined before and after the administration of prednisolone. Results : Of the 30 patients, 13 (43.3%) were male and 17 (56.7%) were female. The mean age of patients was 41.8 years (range 19-64 years). Two patients could not produce sputum at the second study and 3 could not be followed up after their first visit. Two weeks after the prednisolone administration, there was a significant increase in $FEV_1$ (% of predicted value) from 78.1$\pm$20.6 % to 90.3$\pm$ 18.3 % (P<0.001). The eosinophil percentages in induced sputum were significantly decreased after treatment with prednisolone, with values of 56.1$\pm$27.2 % versus 29.6$\pm$21.3 % (P<0.001), and ECP were $134.5\pm68.1\;{\mu}g/L$ versus $41.5\pm42.4\;{\mu}g/L$ (P<0.001) respectively. After the prednisolone treatments, the eotaxin concentration also showed a decreasing tendency from 26.7$\pm$12.8 pg/ml to 21.7$\pm$8.7 pg/ml. There was a decreasing tendency but no significant differences in total blood eosinophil count (425.7$\pm$265.9 vs 287.7$\pm$294.7) and in the concentration of NO derivatives ($70.4\pm44.6{\mu}mol/L$ vs $91.5\pm48.3\;{\mu}mol/L$) after the prednisolone treatments. IL-3, IL-5, GM-CSF were undetectable in the sputum of most subjects either before the prednisolone treatments or after the treatments. Before the prednisolone treatments, a significant inverse correlation was observed between FEV1 and sputum ECP (r=-D.364, P<0.05) and there was a significant correlation between sputum eosinophils and eotaxin (r=0.369, P<0.05) Conclusion : The eotaxin and ECP concentration in induced sputum may be used as markers of airway inflammation after treatments in bronchia1 asthma. In addition, the measurement of sputum eosinophil percent ages is believed to be a simple method displaying the degree of airway inflammation and airway obstruction before and after the prednisolone treatment in bronchia1 asthma. However, unlike exhaled NO, the examination of NO derivatives with Griess reaction in induced sputum is considered an ineffective marker of changing airway inflammation and obstructing symptoms.

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The Influences of Maintenance Hemodialysis on Sleep Architecture and Sleep Apnea in the Patients with Chronic Renal Failure (만성신부전 환자에서 혈액투석 유지요법이 수면구조 및 수면 무호흡에 미치는 영향)

  • Park, Yong-Geun;Lee, Sang-Haak;Choi, Young-Mee;Ahn, Seok-Joo;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyoung;Song, Jeong-Sup;Park, Sung-Hak;Moon, Hwa-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.6
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    • pp.824-835
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    • 1999
  • Background: Sleep-related breathing disorders are commonly found in patients with chronic renal failure and particularly, sleep apnea may have an influence on the long-term mortality rates in these patients. Maintenance hemodialysis is the mainstay of medical measures for correcting the metabolic derangements of chronic renal failure but it is uncertain whether it may alleviate sleep disorders including sleep apnea. Methods: Forty seven patients on maintenance hemodialysis were surveyed with the sleep questionnaire about their clinical symptoms related to sleep disorders. Among them, 15 patients underwent the polysomnography and their blood levels of urea nitrogen, creatinine, electrolytes and the arterial blood gases in the nights before and following hemodialysis were measured. Results: Forty(85.1%) of the 47 patients complained of the symptoms associated with sleep-wake cycle disturbances, 55.3% experienced snoring and 27.7% reported witnessed apneas. The duration of REM sleep increased significantly in the nights after hemodialysis compared to the nights without hemodialysis(p<0.05) and the percentage of total sleep time comprising NREM sleep decreased significantly in the nights following hemodialysis compared to the nights before hemodialysis(p<0.05). The percentage of total sleep time consisting of the stage 1 and 2 NREM sleep showed the trend for a decrease in the nights after hemodialysis(p=0.051), while the percentage of total sleep time comprising the stage 3 and 4 NREM sleep did not change between nights. The obstructive sleep apnea was more predominant type than the central one in both nights and there were no differences in the apnea index and the apnea-hypopnea index between the nights. The decrease in the blood level of urea nitrogen, creatinine, potassium and phosphorus was observed after hemodialysis(p<0.05), but the differences of parameters measured during polysomnography between the nights did not correlate with the changes of biochemical factors obtained on the two nights. Arterial blood gas analysis showed that pH was significantly greater in the nights after hemodialysis than in the nights before hemodialysis(p<0.05), but there were no correlations between the parameters examined during polysomnography and the parameters of arterial blood gas analysis(p<0.05). Conclusion: These results suggest that chronic renal failure is an important systemic disorder which is strongly associated with sleep disorders. Maintenance hemodialysis, although it is a widely accepted measure to treat chronic renal failure, did not significantly modulate the sleep architecture and the severity of sleep apnea. Thus, taking the patients with chronic renal failure into account, it is advisable to try not only to find a substantial way for correcting metabolic derangements but also to consider the institution of more effective treatments for sleep disorders.

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