• 한국임상수의학회지
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• 제34권4호
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• pp.234-240
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• 2017

Use of ketamine and propofol combination (so-called Ketofol) anesthesiain a fixed ratio (1:1 mg/ml) was reported in dogs. The use of ketofol reduced cardiovascular suppression, but respiratory-related side effects was not significantly different from propofol alone. In this study, we evaluated the quality of ketofol anesthesia and changes in cardiopulmonary function according to the ratio of ketamine to propofol. The experimental groups were divided into three groups: propofol alone (P group), 3:7 ketofol group (PK1 group) and 1:1 ketofol group (PK2). For each group, the dose of 0.8 ml/kgwas administered intravenously at a constant rate until the tracheal intubation was possible and anesthesia was maintained with isoflurane for 120 minutes after induction of anesthesia. There was no significant difference in the anesthetic quality among three groups. Also, there was no difference in respiratory rate, tidal volume, end-tidal carbondioxide, and oxygen saturation. In group P, heart rate was not changed significantly during anesthesia, but arterial blood pressure decreased, while heart rate and arterial blood pressure increased significantly in group PK2. In the PK1 group, heart rate and arterial blood pressure during anesthesia remained similar to pre-anesthetic values. In conclusion, ketofol might be used as induction agent, and 3:7 ratioof ketofol showed more safe and effective anesthetic effect in dogs. Additionally, 1:1 ketofol may be used in patients with severe bradycardia orhypotension with close monitoring during anesthesia.

• Journal of Chest Surgery
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• 제22권2호
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• pp.256-264
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• 1989

Modified Blalock-Taussig operation remains the standard technique of systemic-to-pulmonary artery shunt in patients of congenital heart disease with decreased pulmonary blood flow. We reviewed the 41 patients who had been performed modified Blalock-Taussig operation from March 1985 to Feb. 1988, and angiographically measured pulmonary artery size before and after shunt, and calculated pulmonary artery index [PAI] and ratio of left and right pulmonary artery to descending aorta[[LPA+RPA]/dAo]. The mean duration of palliation after shunt operation was 624 days and mean age of the patient at shunt operation was 3.59 years. Mean PAI increased significantly from 131.15*67.11 mm2/M2 preoperatively to 232.70*84.46 mm2/M2 postoperatively. Mean ratio of right and left pulmonary artery to descending aorta also increased significantly from 1.48*0.40 preoperatively to 1.92*0.50 postoperatively. All patients manifested clinical improvement; there was mean decrease in hematocrit of 8.95%, mean increase in arterial oxygen saturation of 11.08%. Pulmonary arterial growth was not influenced by age at operation, initial pulmonary artery size, or graft size, but significantly influenced by antegrade flow. The patients who have some antegrade flow were in more increase of PAI. There were no linear correlation between change of PAI, change of [[LPA+RPA]/dAo], SaO2, and duration. But, according to Scatterplot between change of PAI and duration, some complex correlation was suggested and mean PAI was decreased after 2-year palliation. We concluded that modified Blalock-Taussig operation is excellent palliative surgery for pulmonary artery growth especially on the patient who have some antegrade flow, and the proper duration of palliation was about 2 years.

• Journal of Korean Biological Nursing Science
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• 제4권2호
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• pp.93-112
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• 2002

Recently, the number of the elderly has increased according to the improvement of socioeconomic status and the efficient medical care system. In spite of the development of medicine, the elderly suffers from the various health problems caused by weakness of musculoskeletal system, cardiopulmonary function and immunologic dysfunction. Regular rhythmic exercise program is known to be one of the effective tools to enhance the health condition in the elderly. However, there has been few studies to evaluate the comprehensive effects of rhythmic movement program on the elderly. This study was focused to evaluate the indices of cardiopulmonary function, life satisfaction, calcium, phosphorous, osteocalcin and deoxypyridinoline which are the essential factors of health problems in the elderly women. Twenty six subjects, aged between 68 and 72, who can do the ordinary activities and do not have cardiovascular dysfunction and mental disorder, participated in this study. They were divided into two groups: 13 in the experimental group and 13 in the control group. The experimental group participated in the rhythmic movement program at the welfare center located in G-city. The program were consisted of three sessions a week during 10 weeks. Each session had three parts: warming up(10 minutes), main exercise(40 minutes), finishing(10 minutes). Heart rate, blood pressure and peripheral arterial oxygen saturation were measured for the evaluation of cardiopulmonary function. Serum calcium, phosphorous, osteocalcin and urine deoxypyridinoline were measured as the indices of bony metabolism. Data were analyzed with mean, standard deviation, $x^2$-test, t-test, paired t-test using SPSS PC+ program. The results of this study were as follows. 1) Heart rate of the experimental group showed significant decrease following the rhythmic movement program. Peripheral arterial oxygen saturation of the experimental group showed significant increase following the program. 2) The degree of life satisfaction of the experimental group showed significant increase following the program. 3) Calcium showed significant decrease following the program but remained within normal range. There was no significant difference of phosphorous between two groups. 4) Osteocalcin, the index of bone formation, showed no significant change following the program, but significant increase in the experimental group comparing with the control group. 5) Deoxypyridinoline, the index of bone resorption, in urine of the experimental group showed significant decrease following the program. In conclusion, the rhythmic exercise program in the elderly showed the improvement of physiologic function and favorable effects on life satisfaction and bony metabolism. According to the above results, the regular rhythmic movement program can be strongly recommended for the improvement of health in the elderly women.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.88-94
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• 2009

Background: From November 2006, The national health insurance system in the Republic of Korea began to cover prescribed long-term oxygen therapy (LTOT) in patients with chronic respiratory insufficiency. This study examined the current status of LTOT after national health insurance coverage. Methods: Between November 1, 2006 and June 30, 2008, the medical records of patients who were prescribed LTOT by chest physicians were reviewed. The data was collected from 13 university hospitals. Results: 197 patients (131 male and 66 female) were prescribed LTOT. The mean age was 64.3${\pm}$13.0 years. The most common underlying disease was chronic obstructive pulmonary disease (n=103, 52.3%). Chest physicians prescribed LTOT using arterial blood gas analysis or a pulse oxymeter (74.6%), symptoms (14%), or a pulmonary function test (11.2%). The mean oxygen flow rate was 1.56${\pm}$0.68 L/min at rest, 2.08${\pm}$0.91 L/min during exercise or 1.51${\pm}$0.75 L/min during sleep. Most patients (98.3%) used oxygen concentrators. Only 19% of patients used ambulatory oxygen supplies. The oxygen saturation before and after LTOT was 83.18${\pm}$10.48% and 91.64${\pm}$7.1%, respectively. After LTOT, dyspnea improved in 81.2% of patients. The mean duration of LTOT was 16.85${\pm}$6.71 hours/day. The rental cost for the oxygen concentrator and related electricity charges were 48,414${\pm}$15,618 won/month and 40,352${\pm}$36,815 won/month, respectively. Approximately 75% of patients had a regular visit by the company. 5.8% of patients had personal pulse oxymetry. 54.9% of patients had their oxygen saturation checked on each visit hospital. 8% of patients were current smokers. The most common complaint with LTOT was the limitation of daily activity (53%). The most common complaint with oxygen concentrators was noise (41%). Conclusion: The patients showed good compliance with LTOT. However, only a few patients used an ambulatory oxygen device or had their oxygen saturation measured.

• The Korean Journal of Physiology
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• 제2권2호
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• pp.93-99
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• 1968

The Present study attempted to analyze the fate of CO diffused into the circulating blood through the alveoli. Dogs were induced to CO poisoning by rebreathing CO gas mixture contained in Krog's spirometer, by closed circuit method, for 60 minutes. The spirometer was filled initially with 282 ml of CO and 20 liters of air and oxygen, so the composition of gases were arranged as 1.4% in CO and 50% in $O_2$ at the begining of the rebreathing. Oxygen was added corresponding to the utilization of $O_2$ by the animal in proceeding of the experiment. At 60th minutes of CO rebreathing, the concentration of CO in arterial blood and in mixed venous blood were analysed and compared with each other after the CO contents were corrected with the hematocrit measured in the arterial and mixed venous blood. The distribution of CO gas to other tissues was estimated by the analysis of CO diffused into the cystic bile and into the peritoneal gas pocket which was formed by injection of 300 ml air into the peritoneal cavity prior to the CO gas rebreathing. The blood volume was measured by dilution method using $^{51}Chromium$ tagged red cells. CO amount vanished in the animal body was calculated by subtraction of total CO content in blood stream and the CO remained in closed circuit breathing system from the CO amount given to the breathing system at the begining of the experiment. Results obtained are summarized as follows: 1. The content of CO corrected by the hematocrit value was slightly less in mixed venous blood than in arterial blood. The amount of CO diffused into the cystic bile and into the peritoneal cavity was averaged to 0.1% and 0.4% of the CO amount in 100 ml of blood, respectively. 2. For 60 minutes of CO rebreathing, CO-hemoglobin saturation reached about 77% at the 60th minutes, CO amount vanished in the experimental animal averaged 36.1 ml/dog/hr., or 21% of the total CO volume in the blood stream. The average vanishing rate of CO during 60 minutes of CO rebreathing per kg of body weight was 2.71 ml/hr. Production of CO measured in ten dogs under hypoxic condition averaged 0.023 ml/kg/hr. The major part of the CO vanished in the dogs seemed to be oxidized to $CO_2$ by various tissues of the animal. The conclusion might be delivered as such oxidation of CO to $CO_2$ by animal tissues can play a role in part of the process of recovery and protection of animal from CO-poisoning.

• Journal of Trauma and Injury
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• 제32권3호
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• pp.136-142
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• 2019

Purpose: Near drowning refers to immediate survival after asphyxia due to submersion or immersion in water, which is a crucial public safety problem worldwide. Acute lung injury or acute respiratory distress syndrome (ARDS) is a common complication of near drowning. The purpose of this study was to investigate the feasibility and effectiveness of noninvasive nasal positive pressure ventilation (NINPPV). Methods: This retrospective study was conducted at a tertiary emergency department. NINPPV was administered for moderate ARDS caused by submersion or immersion in patients who were older than 18 years, from January 2015 to December 2018. We collected the demographic (age, sex, length of hospital stay, and outcome), laboratory (arterial blood gas, lactate, oxygen saturation, partial pressure of oxygen divided by the fraction of inspired oxygen, complete blood count, blood urea nitrogen, and creatinine), and clinical data (acute lung injury index and ventilator failure) of the patients. A statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 for Windows. Results: NINPPV treatment was provided to 57 patients for near drowning, 45 of whom (78.9%) were successfully treated without complications; in 12 (21.1%), treatment was changed to invasive mechanical ventilation within 48 hours due to ARDS or acute kidney injury. NINPPV treatment was successful in 31 (75.6%) out of 41 sea-water near drowning patients. They were more difficult to treat with NINPPV compared with the fresh-water near drowning patients (p<0.05). Conclusions: NINPPV would be useful and feasible as the initial treatment of moderate ARDS caused by near drowning.

• Tuberculosis and Respiratory Diseases
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• 제41권2호
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• pp.103-110
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• 1994

연구배경 : 심한 만성 폐색성 폐질환(COPD) 환자들에서 수면중에 심한 동맥혈 산소 탈포화 상태가 일어날 수 있으며, 그 결과 반복적인 폐동맥압의 상승, 폐성심, 수면 장애를 초래하고 심장의 부정맥으로 급사할 수도 있다. 또한 저산소혈증이 있는 COPD 환자들에게 지속적으로 산소를 투여하였을 때 신경정신적 상태의 호전으로 삶의 질이 향상될 수 있고 생존율을 높일 수 있다고 알려져 있다. 이에 저자들을 COPD 환자들에서 수면중 야간 동맥혈 산소 포화도를 감시하여 산소 탈포화 상태의 빈도 및 심한 정도를 알아보고, 수면중 심한 동맥혈 산소 탈포화 상태가 일어나는 것을 예측할 수 있는 인자를 찾아보고자 본 연구를 시행하였다. 방법 : 폐질환으로 입원중인 환자들에서 맥박 산소측정기(Pulse oxymeter)를 이용하여 수면중 동맥혈 산소포화도를 감시하였고, 이들의 성적과 기초폐기능검사 성적, 깨어있는 동안의 동맥혈 산소 상태등과의 연관성을 검토하였다. 결과: 1) 20명의 대상 환자들 중 18예(90%)에서 야간 동맥혈 산소포화도($StcO_2$)가 4%이상 저하되었으며, 10%이상 심하게 저하된 경우(탈포화군)도 8예(40%)였다. 2) 깨어있을 때의 $PaO_2$가 60 mmHg 미만으로 저산소혈증이 있었던 7예중 5예(71.4%), 그 이상이었던 13예중에서는 3예(23.1%)에서 10% 이상의 심한 탈포화를 일으켰다. 3) 탈포화군의 야간 수면중 최저 $StcO_2$는 평균 $73.8{\pm}20.7%$로 깨어있을 시의 $93.4{\pm}1.9$ 보다 크게 저하되었으며, 이때 최대 분당 맥박수는 $149.3{\pm}46.0$으로 깨어있을 시의 $91.9{\pm}15.4$보다 크게 증가되었다. 4) 탈포화군과 비탈포화군을 비교해 보았을 때 연령, 신장, 흡연력, 혈색소치, 폐환기기능에 양군간에 유의한 차이는 없었고, $PaO_2/FIO_2,\;PaO_2/PAO_2$ 값은 탈포화군에서 각각 $274.0{\pm}83.7,\;0.60{\pm}0.29$로 비탈포화군의 $373.1{\pm}83.5,\;0.78{\pm}0.17$에 비해 유의하게 낮았다($PaO_2/FIO_2$: p<0.01, $PaO_2/PAO_2$: p<0.05). 또한 4%이상 산소포화도가 저하된 탈포화 시간과 빈도가 탈포화군에서 각각 $67.9{\pm}56.4$분, $7.3{\pm}6.3$회로 비탈포화군의 $8.4{\pm}12.1$분, $1.8{\pm}1.7$회에 비해 유의하게 많았다(각각 p<0.01). 5) $PaO_2/FIO_2$ 값은 산소포화도의 저하 정도(${\Delta}StcO_2$) 및 기초산소포화도에 대한 ${\Delta}StcO_2$의 비율과 높은 역상관관계(각각 r=-0.78, r=-0.79, p<0.01)를 보였다. 결론 : 이상의 결과로 탈포화군을 감별할 수 있는 인자로서 깨어있을 동안의 $PaO_2/FIO_2,\;PaO_2/PAO_2$만이 의의가 있었고 기초 $PaO_2,\;SaO_2$는 의의가 없어서 기초 $PaO_2$를 낮게 만드는 폐병변의 심한 정도가 산소 탈포화 정도를 결정하는 더 중요한 요소일 가능성을 시사하였다. 또한 기초 $PaO_2$가 60mmHg 이상으로 높은 경우에서도 약 1/4에서 심한 탈포화를 일으켜서 COPD 환자에서 폐환기기능 및 기초 $PaO_2$ 정도에 관계없이 수면중 야간 $StcO_2$를 감시해 볼 필요가 있는것으로 생각되었다.

• Journal of Chest Surgery
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• 제35권10호
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• pp.712-723
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• 2002

체외순환은 뇌 혈류의 변화를 유도하며 이러한 변화가 수술 후 직 간접적인 뇌 손상의 원인이 될 수도 있다. 최근 체외순환 중 뇌 혈류 변화는 동맥혈액의 이산화탄소 분압과 밀접한 관련이 있는 것으로 보고되고 있다. 본 연구는 체외순환을 이용한 심장수술시 뇌 대사에 대한 정상 탄산분압과 고 탄산분압의 임상적 영향을 비교 조사하기 위해 전향적으로 계획되었다. 대상 및 방법: 심장수술이 계획된 36명의 성인 환자들을 연구목적에 따라 무작위적으로 정상탄산분압군(Pa$CO_2$35~40 mmHg, n＝18) 혹은 고탄산분압군(Pa$CO_2$45~55 mmHg, n＝18)으로 나눈 뒤 중등도 저체온(비인두 온도 29~3$0^{\circ}C$)의 비박동성 체외순환을 실시하였다. 수술 중, 각 환자들의 중대뇌동맥 혈류속도(뇌혈류 속도), 뇌동정맥 산소함량 차, 뇌산소 추출률, 뇌산소 대사율, 뇌산소 운반율, 뇌산소운반/뇌산소대사 비율, 뇌정맥 산소 불포화도(내경 정맥구 혈액 산소 포화도$\leq$50%), 동맥혈액 및 내경정맥 혈액 가스분석 등을 평가하였고, 수술 후 신경학적 합병증(섬망증세) 발생 정도 역시 관찰하여 양 그룹간에 비교하였다. 결과 : 체외순환 동안 고탄산분압군이 정상탄산분압군에 비해 뇌혈류 속도(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), 뇌산소 운반율(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), 뇌산소운반/뇌산소대사 비율(287.38$\pm$28.051 vs 246.77$\pm$25.84), 내경 정맥구 산소분압(41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), 그리고 내경 정맥구 산소포화도(68.97$\pm$10.96 vs 58.12$\pm$12.11%) 등이 유의하게 더 높았으나 (p＝0.03), 뇌동정맥 산소함량차(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), 뇌산소 추출률(0.3$\pm$0.03 vs 0.4$\pm$0.03), 뇌산소 대사율(5.8 $\pm$0.5 vs 6.8$\pm$0.6), 동맥혈 pH는 고탄산분압군이 더 낮았다(7.36$\pm$0.09 vs 7.46$\pm$0.07, p＝0.04). 체외순환 동안 뇌정맥혈 불포화를 보인 환자 수는 고탄산분압군이 정상탄산분압군 보다 유의하게 더 적었다(3명 vs 9명, p＝0.03). 수술 후 신경학적 합병증(섬망)의 지속시간 역시 고탄산분압군이 정상탄산분압군 보다 더팔았다(36시간 vs 60시간, p=0.009). 결론: 이상의 연구결과들은 심장수술 동안 고탄산분압 체외순환이 뇌대사 및 수술 후 신경학적 결과에 보다 유익한 효과를 제공해 줄 수 있음을 시사하고 있다.

• Journal of Chest Surgery
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• 제13권3호
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• pp.243-249
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• 1980

Truncus ateriosus is one of the cyanotic congenital heart disease. The incidence is relatively uncommon, as 0.4% of totoal congenital heart disease. Embryologically the defect is due to a lack of partitioning of the embryonic truncus and conus during the first few weeks of fetal life. The ventricular septal defect is invariable present. A single arterial vessel arises from the heart and supplies blood to the aorta, the lung, and the coronary arteries. In 1949, collett and Edwards classified this defect according to anatomic variation to four major types, such as type I, II, III, and IV. Type IV is defined that pulmonary arteries are absent, and the pulmonary arterial supply arises from the descending thoracic aorta. This patients often have a continuous murmur head particularly well in the interscapular area. No effective surgical treatment is available. We have experienced one case of truncus arteriosus, type IV of Collett and Edwards in the Department of Thoracic and Cardiovascular Surgery, Kyungbook National University Hospital. This patient was 10 year-old girl. The chief complaints were cyanosis and dyspnea on exertion since birth. She was admitted at this hospital on April 16, 1980. The continous machinery murmur was heard loudest at the interscapular area. The chest X-ray films revealed cardiomegaly with an increase in pulmonaryvascular markings. The pulmonary secotr was significantly concave. No filling of pulmonary arteries noticed by the right ventriculogram. There was possible biventricular hypertrophy in EKG. The echocardiogram showed that the demension of the aortic root was larger than normal and minimal increase of the left ventricular internal dimension. The cardiac catheterization data was obtained by use of the great saphenus vein approach. The systolic pressure of the right ventricular outflow tract was 80 mmHg and was similar to that of the aorta. The oxygen saturation data revealed the evidence of the left to right shunt at the level of ventricular septum. The patient was operated and the diagnosis was confirmed as trucus arteriosus, type IV. No effective surgical interventins were performed.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.243-249
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• 2010

Background: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disability and mortality worldwide. The aim of this study was to evaluate the risk factors associated with recurrent hospital admissions for exacerbation of COPD in Korea. Methods: A retrospective study of 77 consecutive patients hospitalized for exacerbation of COPD at Pusan National University Hospital during the time period January 2005 to May 2008 was performed. The information was collected from the hospitalization period: clinical information, spirometric measures, and laboratory variables. In addition, socioeconomic characteristics, co-morbidity, anxiety, and depression were reviewed. Frequent readmission was defined as 2 or more hospitalizations in the year following discharge. Results: During the 1-year period after discharge, 42 patients (54.6%) reported one hospital admission and 35 patients (45.4%) reported 2 or more hospital readmissions. Among the 35 frequent readmission patients, 4 had more than 10 readmissions. Univariate analysis showed that a body mass index (BMI) <$18.5kg/m^2$, duration >36 months, forced expiratory volume in 1 second ($FEV_1$) <50% predicted, arterial $CO_2$ partial pressure ($PaCO_2$) >40 mm Hg, and arterial oxygen saturation ($SaO_2$) <95% at discharge were associated significantly with frequent readmissions. The multivariate analysis revealed that BMI <$18.5kg/m^2$, $PaCO_2$ >40 mm Hg at discharge were independently associated with frequent readmissions for exacerbation of COPD. Conclusion: Frequent readmissions for exacerbation of COPD were associated with low BMI and hypercapnia at discharge.