• 성인간호학회지
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• 제13권1호
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• pp.136-147
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• 2001

Dysphagia is common and serious problem in intracerebral hemorrhage patients. Nasogastric-tube intubation is an important method for dysphagic patients who have an intracerebral hemorrhage. But many discomforts develope in patients with a nasogastric-tube. Therefore, it is necessary to decide when to remove the tube and as early as possible. The purpose of this study is to decide the applying time of training program to facilitate deglution for dysphagic patients who have intracerebral hemorrhage. Among the 343 patients with intracerebral hemorrhage who had been admitted to P-university hospital from April, 1994 to December, 1998, the medical record of the 110 patients with nasogastric tube were reviewed retrospectively. Results from the study were as follows: 1. Nasogastric tube insert duration of improved patients was a mean of 23.2 days 2. When a L-tube was inserted and removed, the L.O.C. of improved patients was $2.6{\pm}0.8$(in the midst of stupor or a semicoma),$1.9{\pm}0.5$(close to drowsy), respectively. This was signifcantly different(P=0.000). 3. When a L-tube was inserted and removed, GCS of improved patients was $9.3{\pm}2.9$, $12.1{\pm}2.2$ respectively. This was significantly different (P=0.000). 4. The duration of nasogastric tube insertion was the longest when in a stupor(L.O.C), 6~8 points(GCS).

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.259-265
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• 2001

Objectives : Spontaneous intracerebral hemorrhage(S-ICH) is generally considered to be a mon-ophasic event. But some patients with ICH continued to bleed even after hospitalization. In order to evaluate the rebleeding and growth factor of hematoma in small volume S-ICH, 125 cases of S-ICH were reviewed retrospectively. Methods : We assesed age, sex, initial mental state, location of hemorrhage, systolic and diastolic blood pressure, blood pressure patterns, hematologic profile, trauma and stroke history, alcohol consumption and smoking history. Two subgroups-rebleeding groups versus no rebleeding groups-were compared, in terms of data analysis, with student T-test and chi-square test. Results : Substantial growth in the volume of S-ICH occurred in 21 cases(16.8%)-putamen(7 cases), thalamus(6 cases), subcortex(5 cases), cerebellum(2 cases), pons(1 case)-of the 125 patients. There was no significant difference in any of the parameters except initial systolic blood pressure(p=0.037) when patients with and without rebleeding were compared. Conclusion : The rebleeding and growth of the small volume S-ICH was related to the markedly elevated initial systolic blood pressure(${\geq}180mmHg$) and labile pattern of blood pressure.

• 성인간호학회지
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• 제17권3호
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• pp.464-473
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• 2005

Purpose: The purpose of this study was to evaluate and compare the predictive ability of three mortality scoring systems; Acute Physiology and Chronic Health Evaluation(APACHE) III, Simplified Acute Physiology Score(SAPS) II, and Mortality Probability Model(MPM) II in discriminating in-hospital mortality for intensive care unit(ICU) patients with spontaneous intracerebral hemorrhage. Methods: Eighty-nine patients admitted to the ICU at a university hospital in Daejeon Korea were recruited for this study. Medical records of the subject were reviewed by a researcher from January 1, 2003 to March 31, 2004, retrospectively. Data were analyzed using SAS 8.1. General characteristic of the subjects were analyzed for frequency and percentage. Results: The results of this study were summarized as follows. The values of the Hosmer-Lemeshow's goodness-of-fit test for the APACHE III, the SAPS II and the MPM II were chi-square H=4.3849 p=0.7345, chi-square H=15.4491 p=0.0307, and chi-square H=0.3356 p=0.8455, respectively. Thus, The calibration of the MPM II found to be the best scoring system, followed by APACHE III. For ROC curve analysis, the areas under the curves of APACHE III, SAPS II, and MPM II were 0.934, 0.918 and 0.813, respectively. Thus, the discrimination of three scoring systems were satisfactory. For two-by-two decision matrices with a decision criterion of 0.5, the correct classification of three scoring systems were good. Conclusion: Both the APACHE III and the MPM II had an excellent power of mortality prediction and discrimination for spontaneous intracerebral hemorrhage patients in ICU.

• Journal of Korean Neurosurgical Society
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• 제30권sup2호
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• pp.294-299
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• 2001

Objectives : CT-guided stereotactic evacuation for spontaneous intracerebral hemorrhage can minimize the brain damage and can be performed safely and simply under local anesthesia. But that procedure is time consuming and has a risk of rebleeding because of the stress during head pin fixation. So authors describe easy and precise guidelines for FHA of putaminal hemorrhage without stereotactic instrument. Methods and Materials : We analyzed the data of 298 patients who underwent CT-guided stereotactic aspiration of putaminal hematoma in our hospital between January 1990 and December 2000. We divided the patients into three groups according to the location of hematoma : anterior portion, middle portion and posterior portion of putamen. Total number of catheters inserted into the hematoma were 345 and there were with regard to the direction and depth of catheters. Results : Proposed guidelines of catheter insertion to putaminal hemorrhage in our institution. 1) hematoma at the anterior portion of putamen ; Direction of catheter was the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between external auditory meatus(EOM) and 1cm posterior to EOM. Depth of catheter was 6-6.5cm. 2) hematoma at the middle portion of putamen ; Direction of catheter was the midpupillary line of the the eye and the point intersecting a line drawn from the burr hole to a point between 1cm and 2cm posterior to EOM. Depth of catheter was 6.5-7cm. 3) hematoma at the posterior portion of putamen ; Direction of catheter was 15 degree laterally from the midpupillary line of the eye and the point intersecting a line drawn from the burr hole to a point between 2cm and 3cm posterior to EOM. Depth of catheter was 7-7.5cm. We have performed FHA of putaminal hemorrhage in 48 cases according to this guideline. All catheter were inserted exactly at the center of hematoma and average operation time was about 30 minutes. Conclusion : Our proposed guidelines for putaminal hemorrhage are considered to be safe and simple method with similar accuracy and rapid decompression compared with traditional stereotactic method. Main advantages of this technique were unnecessity of stereotactic frame application and less time requirement for hematoma removal.