• Child Health Nursing Research
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• 제4권1호
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• pp.17-30
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• 1998

In order to investigate the effects of a decreased activity on skinfold thickness, circumference and muscle strength of the extremities during the recovery period following heart surgery, skinfold thickness, circumference and muscle strength of the extremities were measured on days 0, 3, 6, and 9 following the surgery, and compared with those on the arrival day of intensive care unit. Skinfold thickness was measured using a skinfold caliper(Saehan Cor., Korea), circumference of the limbs were measured with a tape measure, upper extremity strength was determined using the Takei grip dynamometer and lower extremity strength was measured by pressing the flatfoot on an electronic digital health meter while tying on a bed. Results from this study were thus : 1. Skinfold thickness of triceps, quadriceps and gastrocnemius muscle on days 3, 6, 9 following the heart surgery was not significantly different from that of on the day of operation. 2. Circumference of midupperarm and midthigh on days 3, 6, 9 following the heart surgery was not significantly different from that of on the day of operation. Circumference of midcalf on days 3, 6 following the heart surgery was not significantly different from that of on the day of operation, while that of midcalf on day 9 following the surgery decreased significantly compared with that of on the day of operation. 3. Muscle strength of the upper extremity was not significantly different from that of on the day of operation, while that of the lower extremity on day 9 following the surgery decreased significantly compared with that of on the day of operation. From these results, it may be concluded that circumference and muscle strength of lower extremity can be decreased due to the postoperative inactivity following heart surgery in congenital heart disease children.

• 성인간호학회지
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• 제19권3호
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• pp.459-469
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• 2007

Purpose: The purpose of this study was to identify the effect of supportive nursing intervention on the anxiety and nursing satisfaction of mothers with children undergoing open-heart surgery. Methods: The research design involved a non-equivalent control group pretest-posttest non synchronized design. The subjects consisted of 43 mothers of children who were expected to undergo open heart surgery, and were divided into two groups; an experimental group of 22 and a control group of 21. The experiment was administered to the experimental group a total of four times, following supportive nursing intervention protocols. The research tools used were Spielberger's State Anxiety Inventory for anxiety and Park Jung-Eun's nursing satisfaction. The data were analyzed using the $x^2$-test, and t-test with SPSS/WIN 12.0 program. Results: Hypothes 1, 'The experimental group who are given supportive nursing intervention will have a lower anxiety score than the control group' was supported(t=5.658, p=.000). Hypothesis 2, 'The experimental group who are given supportive nursing intervention will have a higher nursing satisfaction score than the control gropu wasl supported(t=-9.549, p=.000). Conclusion: The supportive nursing intervention protocol was effective in reducing anxiety and increasing the nursing satisfaction of mothers with children undergoing open-heart surgery.

• Korean Circulation Journal
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• 제52권12호
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• pp.865-875
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• 2022

Background and Objectives: Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure. However, in pediatric and congenital heart disease (CHD) patients, current adult indications cannot be directly applied because of heterogeneity in anatomy and diagnosis. Therefore, CRT responses and clinical outcomes in these patients were investigated to derive possible candidates for CRT. Methods: This study retrospectively analyzed 16 pediatric and CHD patients who underwent CRT implantation at a single center in early (0.7±0.2 year) and late (4.7±0.3 years) follow-up period after CRT. Results: The median age at CRT implantation was 2.5 (0.3-37.2) years, and median follow-up duration was 6.3 (0.1-13.6) years. Thirteen had non-transvenous CRT. Two had congenital complete atrioventricular (AV) block with previous right ventricular pacing, 5 had dilated cardiomyopathy (DCM) with left bundle branch block, and 9 had CHD. The mean ejection fraction of the systemic ventricle increased from 28.1±10.0% to 44.3±21.0% (p=0.003) in early and 51.8±16.3% (p=0.012) in late outcome. The mean functional class improved from 3.1±0.9 to 1.8±1.1 after CRT (p=0.003). Twelve patients (75%) showed improvement in ventricular function or functional class after CRT. Proportion of responders differed between patients without CHD (2/2 patients with complete AV block and 5/5 with DCM, 100%) and those with CHD (5/9, 56%), although statistical significance was not reached (p=0.088). Conclusions: CRT improved ventricular function and functional status according to the underlying condition in pediatric and CHD patients. However, further large and longer-term studies are needed to establish the guideline for the patient selection of CRT in these patients.

• Journal of Chest Surgery
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• 제56권6호
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• pp.394-402
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• 2023

Background: The optimal choice of valve substitute for aortic valve replacement (AVR) in pediatric patients remains a matter of debate. This study investigated the outcomes following AVR using mechanical prostheses in children. Methods: Forty-four patients younger than 15 years who underwent mechanical AVR from March 1990 through March 2023 were included. The outcomes of interest were death or transplantation, hemorrhagic or thromboembolic events, and reoperation after mechanical AVR. Adverse events included any death, transplant, aortic valve reoperation, and major thromboembolic or hemorrhagic event. Results: The median age and weight at AVR were 139 months and 32 kg, respectively. The median follow-up duration was 56 months. The most commonly used valve size was 21 mm (14 [31.8%]). There were 2 in-hospital deaths, 1 in-hospital transplant, and 1 late death. The overall survival rates at 1 and 10 years post-AVR were 92.9% and 90.0%, respectively. Aortic valve reoperation was required in 4 patients at a median of 70 months post-AVR. No major hemorrhagic or thromboembolic events occurred. The 5- and 10-year adverse event-free survival rates were 81.8% and 72.2%, respectively. In univariable analysis, younger age, longer cardiopulmonary bypass time, and smaller valve size were associated with adverse events. The cut-off values for age and prosthetic valve size to minimize the risk of adverse events were 71 months and 20 mm, respectively. Conclusion: Mechanical AVR could be performed safely in children. Younger age, longer cardiopulmonary bypass time and smaller valve size were associated with adverse events. Thromboembolic or hemorrhagic complications might rarely occur.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1167-1174
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• 1997

저자들은 1991년부터 1996년까지 5년간 지연 흉골 폐쇄를 시행한 20명의 환자를 분석하고 추적 조사 하였다. 남녀비는 11:9였고 평균연령은 6.4개월(범위 7일-5년)이었다. 적응증으로는 개심술후 심근부종에 기인한장치한 불안정한 혈역학적 상태로 인한 것이 15례로 가장 많았고, 심폐기 이탈 불가로 심실 보조 장치를 경우에서가 3례, 폐동맥 밴딩술 후 저산소증으로 인한 것이 2례 등이었다. 흉골 봉합은 술후 평균 102시간(범위 4-213시간)에 이루어졌으며 시행 후 중심 정맥압의 유의한 상승이 관찰되었다. 종격 동염, 환부 감염 등은 없었으며 2례에서 패혈증이 관찰되었다. 5명이 사망하였고 생존환자 15명중 2명 이 술후 추적관찰 기간 중 사망하였다. 누적 생존률은 1년과 2년에서 각각 65.0%였다. 지연 흉골 봉합 은 혈역학적으로 불안정한 심장을 감압하는 좋은 방법이며 성공적인 결과를 얻기 위해서는 적응증에 대한 신중한 고려가 선행되어야 한다고 생각된다.

• 대한간호학회지
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• 제31권1호
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• pp.31-42
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• 2001

This study was done to evaluate the effect reducing artificial dead space on intubated children. Data were collected from July 1st, 1998 to August 31st, 1999. The subjects were selected from a pediatric intensive care unit of 'S' hospital and intubated with 3.5 mm or 4.5 mm endotracheal tube after open heart surgery. They were composed of 34 patients : 17 patients were assigned to the experimental group and the rest of them were placed in the control group. The artificial airway volume was minimized in the experimental group, and the control group maintained the artificial airway volume. ETCO2, PaCO2, SPO2 were measured as indicators of pulmonary ventilation. The tools of this study were GEM-Premier and Space-Lab patient monitors. The data were analyzed using the SPSS/PC+ program. The $\chi$2 -test was used to find general characteristics. The t-test was used to test the homogenety of the pulmonary ventilation status and mechanical ventilation setting before intervention between the two groups. Also, the paired t-test was used to examine the hypothesis. The results can be summerized as : 1. CO2 can be expelled effectively from the body in case artificial dead space was decreased. 2. As the artificial dead space was reduced, the difference between ETCO2 and PaCO2 was decreased, in other words pulmonary ventilation was improved. 3. If the artificial dead space occupied above 15 percent of tidal volume, the effect of CO2 was retention revealed in the body. 4. If the artificial dead space occupied below effect. Based on the results, the following is suggested to be applied practically : 1. A kind of the ventilator circuit acting artificial dead space should be removed from the intubated children with mechanical ventilaion. 2. The endotracheal tube should not be cut because extra-body space of the endotracheal tube did not have an effect on the dead space of the intubated children. Since the researcher could not cover this aspect in the study, they recommend the following. 1. The study should be extended to the other pulmonary disease patients for the effect of improving pulmonary ventilation. 2. Also, further studying with a more narrow interval in the extra-body space of the artificial airway will be able to explain the point of artificial dead space with proper ventilation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권2호
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• pp.93-97
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• 2014

Purpose: Gastroesophageal reflux in infant is a physiological process. However, surgery is performed in high risk infants with severe gastroesophageal reflux disease (GERD) when medical management fails. This study focuses on efficacy and safety of Nissen fundoplication for GERD in infants under age 12 months. Methods: This study was a retrospective case analysis of 11 neonates and infants under 12 months of age who underwent Nissen fundoplication following a failure of medical treatment between June 2010 and June 2013 at Pusan National University Children's Hospital. The records were reviewed to determine the effect of fundoplication on symptoms and post-operative complications. Results: A total of 11 infants consist of four males and seven females. Mean birth weight was $2,305.5{\pm}558.6g$ (1,390-3,130 g). They had some underlying disease, which are not related with GERD such as congenital heart disease (54.5%), prematurity (45.5%), neurologic disease (18.2%), respiratory disease (18.2%), and other gastrointestinal disease. Mean body weight at surgery was $3,803.6{\pm}1,864.9g$ (1,938.7-5,668.5 g). Mean age at operation was $99.9{\pm}107.6days$ (17-276 days). Duration from operation to full enteral feeding was 10.9 days. Symptoms related GERD disappeared in all patients including one who got reoperation. One infant died of congenital heart disease unrelated to surgery. There were no complications related to fundoplication. Conclusion: Fundoplication is effective and safe treatment in the neonates and infants with severe GERD.

• Advances in pediatric surgery
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• 제1권1호
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• pp.8-17
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• 1995

The clinical experience of 2,340 inguinal hernia repaired by one pediatric surgeon on 2,079 children at Hanyang University Hospital from September 1979 to December 1993 was analyzed. Of 2,046 patients who had primary hernia repairs at Hanyang University Hospital, 1,636 were male and 410 female, and 55.5% of hernias occurred on the right side, 36.0% on the left, and 8.6% were bilateral. The patients presented hernia under the age of 12 months were 45.3% and those performed herniotomy under the age of 12 months were 25.5%. Birth weight was less than 2.5kg in 111 patients(8.7%) of 1,279 data available patients. Ninety(6.6%) of 1,354 data available patients were premature(<37wks gestation). The proportions of bilateral inguinal hernia and the onset age under 12 months of life in low birth weight babies and premature babies were higher than in full-term babies. Incarcerated inguinal hernia occurred in 327 patients(16.0%) of whom 8 patients were strangulated hernias. The occurrence of incarceration inversely related with age of patients. The subsequent contralateral inguinal hernia following unilateral hernia repairs occurred in 80 patients(4.3%) among which 72 were male and 8 were female. The incidence of contralateral inguinal hernia was more frequent in boys(4.8%) than girls (2.2%) and in cases after left herniotomy(6.4%) than after right herniotomy(2.9%). Sixty percent of contralateral inguinal hernia developed within 1 year after primary hernia repair. The recurrence of inguinal hernia occurred in 6 patients(0.27%) treated at our hospital primarily. There were one or more associated congenital anomalies in 83 patients of which congenital heart diseases were the most common. Sliding hernia occurred in 25 patients consisted of 5 boys and 20 girls. Family history was noted in 35 patients and there were 28 sets of monozygotic and 3 sets of dizygotic twins.

• Journal of Chest Surgery
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• 제37권6호
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• pp.504-510
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• 2004

배경: 심장 수술과 관련된 혈관확장성 쇼크는 주로 체외순환 후 바소프레신의 결핍이나 패혈증으로 발생하며, 흔히 사용하는 심근수축제에 잘 반응하지 않는 경우가 많다. 성인에서는 바소프레신의 투여가 효과적인 것으로 알려져 있으나 선천성 심장병 수술을 받은 환자에서 이에 대한 경험이 제한되어 본원의 경험을 보고하고자 한다. 대상 및 방법: 2003년 2월부터 8월까지 선천성 심장병으로 수술후 일반 심근수축제에 반응하지 않는 혈관확장성 쇼크가 발생한 6명에게 바소프레신을 투여하였다. 수술 당시 연령은 생후 2∼41일(중앙값 25일)이었고, 수술 시 체중은 900∼3,530 gm (중앙값 2,870 gm)이었다. 수술 전 진단명은 좌심형성부전증후군 1예, 대동맥 축착증과 심한 승모판막역류을 동반한 완전방실중격결손 l예, 완전대혈관전위증 2예, 활로씨형 양대혈관우심기시증 1예, 총폐정맥환류이상 1예였다. 완전교정술과 고식적 수술이 각각 3명에서 시행되었다. 결과: 일반 심근수축제에 반응하지 않는 저혈압은 대부분의 환자에서 수술 후 24시간 이내에 발생하여 바소프레신의 투여가 필요하였고, 이후 패혈증 쇼크로 바소프레신의 추가 투여가 필요하였다. 바소프레신 투여양은 0.0002∼0.008 unit/kg/min이었고, 총 투여 시간은 26∼140시간(중앙값 59시간)이었다. 바소프레신 투여 직전, 투여 1시간 ,6시간째 수축기 혈압은 각각 42.7$\pm$7.4 mmHg, 53.7$\pm$11.4 mmHg, 56.3$\pm$13.4 mmHg로 의미 있는 혈압 상승이 관찰되었다(투여 직전과 비교하여 투여 1시간 ,6시간 모두 p=0.042). 바소프레신 투여 전과 투여 6시간, 12시간 후의 inotropic index 는 각각 32.3$\pm$7.2 와 21.0$\pm$8.4, 21.2$\pm$8.9)로 바소프레신 투여 전과 비교하여 투여 후 6시간과 12시간 모두 의미 있게 inotropic index의 감소를 보였다(투여 직전과 비교하여 투여 6시간, 12시간 모두 p=0.027). 바소프레신 투여 후 전신 순환의 감소와 관련된 대사성 산증의 악화나 소변량 감소 등의 소견은 관찰되지 않았다. 결론: 선천성 심장병으로 수술받은 환자, 특히 신생아에서 수술 직후 심한 심실 기능 저하의 소견이 없는데도 불구하고 일반 심근수축제에 반응을 하지 않는 심한 저혈압이 발생한 경우, 이로 인한 말단 장기의 비가역적 손상이 발생하기 전 가능한 한 빨리 바소프레신을 정맥 투여함으로써 혈압 상승뿐만 아니라 기존 심근수축제의 사용량을 줄여 이와 관련된 합병증을 감소시킬 수 있어, 바소프레신의 투여는 수술 직후 불안정한 시기에 사용할 수 있는 중요한 치료법의 하나로 생각된다.

• Journal of Chest Surgery
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• 제31권5호
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• pp.456-465
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• 1998

개심술후에 영아나 작은 소아에서는 수분의 체내 저류현상이 더욱 심하게 나타난다. 이에 대한 치료법의 하나로 개심술시 변형 초여과법을 적용함으로써 술후 상태에 미치는 영향을 알아 보고자 하였다. 개심술을 받았던 5세이하의 소아를 대상으로 개심술후 변형 초여과법을 적용하였던 환아(초여과군) 10명과 초여과법을 실시하지 않았던 대조군 10명의 2군으로 나누어서 개심술에 따른 조기 성적을 비교 분석하였다. 환아의 연령, 체중, 심폐기 충진액의 총량과 이에 첨가한 혈액의 양, 그리고 체외순환시간과 대동맥차단시간 등의 값들은 모두 양군간에 유의한 차이가 없었다. 변형 초여과법을 적용함에 있어서 관류속도는 평균 171.4ml/min, 관류시간은 평균 18.9분이 소요되었고, 이 동안에 걸러진 수액의 총량은 평균 38.4ml/kg, 심폐기의 혈액을 환자에게 재수혈한 양은 평균 32.1ml/kg였다. 술후 24시간동안의 출혈량은 초여과군에서 평균 14.5ml/kg/24hr, 대조군에서 13.7ml/kg/24hr였고, 같은 기간에 수혈한 양은 초여과군에서 전혈 6.6ml/kg/24hr, 혈장 65.7ml/kg/24hr, 대조군에서는 전혈 15.2ml/kg/24hr, 혈장 59.6ml/kg/24hr이었다. 이는 임상적으로는 초여과군에서 전혈의 수혈량이 대조군에 비하여 훨씬 적어 보였지만 통계학적으로 유의한 차이는 없었다. 술전후 적혈구용적률의 변화는, 초여과군에서는 체외순환 시작후 10분에 평균값이 26.5%로 떨어졌다가 초여과법 종료 5분후에는 37.1%로 급격히 상승하였고, 대조군에서는 체외순환중의 24.7%에서 체외순환이 끝나고 20분이 경과한 후에도 30.5% 수준으로밖에 상승하지 못하였다. 그러므로 적혈구용적률의 변화를 체외순환중의 수치에 대한 상승률(%)로 나타냈을 때, 초여과군은 40%, 대조군은 23%로써 양군간에 통계학적으로 유의한 차이를 보였다(p=0.002). 초여과법 시행에 따른 수축기 및 이완기동맥압의 변화에 있어서는 양군간에 유의한 차이가 없었으며, 평균동맥압의 변화는 양군간에 통계학적으로 유의한 차이는 없었으나(p=0.086), 임상적으로는 상당한 차이를 보였다. 결론적으로, 소아환자에서 개심술후에 변형 초여과법을 적용했을 때, 거의 일률적으로 적혈구용적률과 동맥혈압이 상승함을 볼 수 있었고, 이는 환아를 중환자실로 옮긴 후에도 지속됨으로써 개심술직후 환아관리에 긍정적인 효과를 발휘하는 것으로 평가된다. 따라서 향후 영아나 작은 소아의 개심술에 있어서 변형 초여과법은 보다 많은 빈도로 이용될 것으로 전망된다.