• 제목/요약/키워드: Fluid Therapy

검색결과 406건 처리시간 0.03초

화상환자의 수술 중 저체온 발생 빈도와 체온변화에 영향을 미치는 요인 (Incidence of Hypothermia and Factors Associated with Body Temperature Changes during Surgery in Burned Patients)

  • 배혜영;김현정
    • Journal of Korean Biological Nursing Science
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    • 제18권4호
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    • pp.231-238
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    • 2016
  • Purpose: The study aimed to evaluate the changes of body temperature and to identify the factors related to changes during surgery in burned patients. Methods: A retrospective study was conducted by reviewing the medical records of 439 adult burned patients who had a surgery under general anesthesia at the Burn Center of a university hospital. Results: After surgery, body temperature of the burned patients declined from $36.6^{\circ}C$ to $35.2^{\circ}C$; 52.2% were hypothermia. There were significant differences in the changes of body temperature according to the participants' characteristics including American society of anesthesiologists physical status, type of burn injury, total burn surface area, range of exposure, operation time, anesthesia time, amount of fluid, blood transfusion, use of tourniquet, and the method of warming therapy. Factors that influence the temperature changes were total burn surface area (${\beta}=0.26$), operation time (${\beta}=0.25$), amount of fluid (0.20), and warming therapy including 'Room temperature setting + Heated circuit + Hot line'(${\beta}=0.09$) and 'Room temperature setting+one of others'(${\beta}=0.08$). Conclusion: Burned patients experienced a decrease of their body temperature during surgery despite of warming therapy. A nursing protocol is needed to provide an appropriate warming therapy based on their characteristics in burned patients.

급성 신손상을 가진 소아의 지속적 신대체 요법 (Overview of Pediatric Continuous Renal Replacement Therapy in Acute Kidney Injury)

  • 박세진;신재일
    • Childhood Kidney Diseases
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    • 제15권2호
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    • pp.107-115
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    • 2011
  • 소아에서 급성 신손상의 흔한 원인들로는 신허혈, 신독성 약물들, 그리고 패혈증 등이 있으며, 신대체요법 시작시의 저혈압, 신대체 요법 동안 승압제의 사용, 그리고 신대체 요법 시작시의 수액 과부하 정도가 환자의 생존(소아 중환자실 퇴원)에 영향을 미치는 요인들로 알려져 있다. 지속적 신대체 요법의 빠른 시작은 급성 신손상을 가진 환자들에게서 사망률과 예후에 나쁜 영향을 미치는 수액 과부하를 감소시키는 것으로 보고되었다. 이에 저자들은 소아 환자에게서 지속적 신대체 요법의 실제 처방과 급성 신손상, 수액 과부하, 그리고 지속적 신대체 요법간의 연관성 및 치료결과를 살펴보고자 한다. 결론적으로, 급성 신손상을 가진 소아의 치료에 있어서 과도한 수액 과부하가 발생하기 전에 빠른 지속적 신대체 요법의 시작이 필요하다고 제시하는 바이다.

중증 화상에서 초기 수액치료 이후 소변량, 혈중젖산, 크레아티닌 수치 변화와 이에 따른 사망률 예측 (Serum Lactate, Creatinine and Urine Output: Early Predictors of Mortality after Initial Fluid Resuscitation in Severe Burn Patients)

  • 오세열;김도헌
    • 대한화상학회지
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    • 제23권1호
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    • pp.1-6
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    • 2020
  • Purpose: PL, creatinine and urine output are biomarkers of the suitability and prognosis of fluid therapy in severe burn patients. The purpose of this study is to evaluate the usefulness of predicting mortality by biomarkers and its change during initial fluid therapy for severe burn patients. Methods: A retrograde review was performed on 733 patients from January 2014 to December 2018 who were admitted as severe burn patients to our burn intensive care unit (BICU). Plasma lactate, serum creatinine and urine output were measured at the time of admission to the BICU and after 48 hours. ABSI score, Hangang score, APACHEII, revised Baux index and TBSA were collected after admission. Results: 733 patients were enrolled. PL was the most useful indicators for predicting mortality in burn patients at the time of admission (AUC: 0.813) and after 48 hours (AUC: 0.698). On the other hand, mortality prediction from initial fluid therapy for 48 hours showed different results. Only creatinine showed statistical differences (P<0.05) in mortality prediction. But there were no statistical differences in mortality prediction with PL and UO (P>0.05). Conclusion: In this study, PL was most useful predictor among biomarkers for predicting mortality. Improvement in creatinine levels during the first 48 hours is associated with improved mortality. Therefore, efforts are needed to improve creatinine levels.

소방이 형성된 흉막질환에서 유로키나제 주입치료의 예후인자 (The Predictors of Effectiveness on Urokinase Instillation Therapy into Loculated Pleural Effusion.)

  • 송기산;방제소;곽승민;조철호;박찬섭
    • Tuberculosis and Respiratory Diseases
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    • 제44권3호
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    • pp.621-628
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    • 1997
  • 연구배경 : 흉막의 염증성 변화가 생기면 흉막의 혈관 및 임파관의 투과성의 증가로 인한 혈장단백질의 유입으로 인해 흉막 비후와 격막의 형성으로 인하여 소방이 형성된다. 이러한 소방이 형성된 흉막질환에 있어 흉막강내 섬유소용해 치료의 하나로 유로키나제 치료가 효과적인 것으로 보고되고 있으나, 이에 대한 치료효과 예측을 위한 지표에 대한 연구는 미미한 실정이다. 이에 저자들은 소방이 형성된 흉막질환에서 일반적으로 시행되는 생화학적 지표들과 초음파검사상의 격막의 정도를 이용하여 유로카나제 치료효과에 대한 예측인자에 대해 알아보고자 하였다. 방 법 : 1993년 4월부터 1996년 4월까지 인하병원에서 소방이 형성된 흉막삼출액 소견을 보인 35명의 환자를 대상으로 흉부 초음파검사와 흉막삼출액에 대한 생화학적 검사를 시행하였고, 1개의 경피적 도관을 삽입하여 배액량이 100ml/day 이하로 감소되면 유로키나제를 주입하였고 배액량이 50ml/day 이하로 측정되면 유로키나제 주입을 중단하였다. 흉부단순촬영 추적검사에서 50% 이상의 폐실질의 확장을 보이면 치료효과군으로, 50% 미만의 확장을 보이면 치료실패군으로 분류하여, 각군들에 대한 초기 흉막 삼출액의 당, 단백질, LDH, ADA, pH, 백혈구 수와 초음파 상의 격막 정도를 무에코형, 선상 격막형, 벌집형으로 구분하여 비교하였다. 결 과 : 1) 대상환자 35명중 치료효과군은 27명 (77.1%)이었고, 치료실패군은 8명(22.9%)였으며, 성과 연령에 있어서의 차이는 없었다. 2) 치료효과군과 치료실패군 사이의 증상발현 기간에 있어서 치료실패군에서 유의하게 길었으며, 유로키나제 주입치료 기간중의 배액량도 적음을 알 수 있었다. 치료효과군에서 $89.7{\pm}35.9mg/dl$, 치료실패군에서 $41.2{\pm}47.1mg/dl$로 치료실패군에서 의미있게 낮은 결과를 보였으며, LDH는 치료효과군에서 $878.7{\pm}654.3IU/L$, 치료실패군에서 $2711.1{\pm}973.1IU/L$로 치료실패군에서 의미있게 높은 결과를 보였고(P<0.05), 단백질, pH, ADA, 백혈구수에 있어서는 의미있는 차이가 없었다. 결 론 : 이상의 결과로 소방이 형성된 흉막질환에서 경피적 도관 삽입을 통한 유로키나제 주입치료의 효과를 판정할 수 있는 지표로 증상발현 기간이 길수록, 흉막삼출액의 당이 낮을수록, LDH 의 수치가 높을수록, 초음파 검사상 격막의 정도가 심할수록 치료가 어려운 것을 나타내는 예측인자임을 추정할수 있었다.

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Biodex System3을 사용한 근력측정과 체조성의 양적조건과의 관련성 (Quantitative Relationship between Body Composition and Muscular Strength Measured with the Biodex System 3)

  • 이상윤;김용권;사토우코우키
    • 대한물리치료과학회지
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    • 제10권2호
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    • pp.208-215
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    • 2003
  • This study measured body composition and muscular strength, to examine their relationship, using the Bioelectrical Impedance (IB) method and biodex system3, respectively, in 44 healthy male(20) and female(24) university students. 1. Muscular strength of the upper extremities correlated significantly with fat-free mass(FFM) with $r=.604{\sim}.630$ and intracellular fluid(ICF) with $r=.672{\sim}.668$ in males and FFM with $r=.416{\sim}.552$, ICF with $r=.432{\sim}.564$ and extracellular fluid(ECF) with $r=.429{\sim}.463$ in females. 2. Muscular strength of the lower extremities correlated significantly with FFM with $r=.522{\sim}.785$, ICF with $r=.501{\sim}.739$ and ECF with $r=.498{\sim}.796$ in males and FFM with $r=.642{\sim}.660$, ICF with $r=.627{\sim}.671$ and ECF with $r=.572{\sim}.623$ in females. 3. Muscular strength of the trunk correlated with FFM with $r=.595$, ICF with $r=.627$, ECF with $r=.448$ in males, but did not correlate significantly with body composition in females. These results suggest that total body water(TBW) and ICF may be factors directly associated with muscular strength as well as physical fitness.

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부인과 암 이후 이차적인 다리 림프 부종 환자에게 적용한 림프흡수 마사지의 효과 (Effects of Manual Lymph Drainage on Patients with Secondary Lymphedema of Legs After Gynecologic Cancer)

  • 정성관;이승병
    • 대한정형도수물리치료학회지
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    • 제22권2호
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    • pp.35-39
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    • 2016
  • Background: The superficial lymphatic system is divided into areas called lymphatic territories which are separated by watersheds. When the lymphatic system fails to remove its load either due to surgery, radiotherapy or some congenital malformation of it then the fluid and the proteins and wastes contained within it accumulates in that territory. Anastomotic connections exist across the watersheds and while they can work unaided manual lymph drainage (MLD) can significantly help drainage across them into unaffected lymphatic territories. The purpose of the study is to examine the effectiveness of a manual technique in moving fluids and softening hardened tissues using a tape measure and Patient-Specific Functional Scale. Methods: We examined the movement of fluids from the affected limbs of lymphedema patients who underwent a standardized 30-min treatment using the Dr. Vodder method of MLD. We chose a typical cross section of patients with secondary leg or secondary arm lymphedema. The lymphedema patient was also measured after the conclusion of treatment and underwent a follow-up control measurement, within 8 weeks. Both evaluation tools indicated a movement of fluid to different and unblocked lymphatic territories as well as a softening of tissues in some of the affected limbs. Results: MLD is an effective means of fluid clearance when it accumulates as a consequence of a failure of the lymphatic system. It seems likely that MLD has a systemic effect on the lymphatic system and that it can improve flow from otherwise normal tissues. Conclusions: It is hypothesized that a series of treatments would result in even more significant improvements.

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부항 시술에 의해 형성된 수포에 관한 고찰 (The Study of Blister Caused by Cupping Therapy)

  • 윤혜연;권선오;김승태;박히준;함대현;이혜정
    • Korean Journal of Acupuncture
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    • 제28권3호
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    • pp.141-150
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    • 2011
  • Objectives : The aims of this study were to evaluate a blister caused by cupping. Methods : We searched relevant case reports, survey, and review articles using databases of online bibliography. Results : 1. The fluid in the blister caused by cupping therapy is normal substance by laboratory analysis. The fluid has no signs of infection in the culture, Gram stain, or tissue biopsy 2. In histological finding, the blister caused by cupping therapy is made by dermo-epidermal seperation at subcellular level. Suction blistering was neither inflammatory nor autolysis activation of lysosomal hydrolases. 3. Blistering times directly, related to suction pressure. Suction blister formation time is accelerated in older subjects compared with younger individuals and higher temperature was more susceptable to the blister compared with lower temperature. The flexor aspect of forearm is a easy site for suction blister formation compared with leg and abdominal site. 4. Blister caused by cupping therapy is treated by regular and judicious changes of sterile dressing over several weeks. The vesicles healed well and left no visible scar. Conclusions : Blister caused by cupping therapy is artificially controlled by doctor's therapeutic purpose. Blister is not histologically injurious to health and the blister is a natural concomitant after cupping therapy.

Tumour Markers in Peritoneal Washing Fluid - Contribution to Cytology

  • Yildirim, Mustafa;Suren, Dinc;Yildiz, Mustafa;Alikanoglu, Arsenal Sezgin;Kaya, Vildan;Doluoglu, Suleyman Gunhan;Aydin, Ozgur;Yilmaz, Necat;Sezer, Cem;Karaca, Mehmet
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권2호
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    • pp.1027-1030
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    • 2013
  • Background: Peritoneal washing cytology (PWC) that shows the microscopic intra-peritoneal spread of gynaecologic cancers is not used in staging but is known as prognostic factor and effective in planning the intensity of the therapy. False negative or false positive results clearly affect the ability to make the best decision for therapy. In this study we assessed levels of tumour markers, carcinoembryonic antigen (CEA), cancer antigen 125 (CA-125) and carbohydrate antigen (CA19-9), in peritoneal washing fluid to establish any possible contribution to the peritoneal washing cytology in patients operated for gynaecologic cancer. Materials and Methods: Preoperative tumour markers were studied in serum of blood samples obtained from the patients for preoperative evaluation of a gynaecologic operation. In the same group peritoneal tumour markers were studied in the washing fluid obtained for intraoperative cytological evaluation. Results: This study included a total of 94 patients, 62 with malignant and 32 with benign histopathology. The sensitivity of the cytological examination was found to be 21% with a specificity of 100%. When evaluated with CEA the sensitivity of the cytological examination has increased to 37%. Conclusions: In addition to examination of PWC, the level of CEA, a tumour marker, in peritoneal washing fluid can make a diagnostic contribution. Determining the level of CEA in peritoneal washing fluid will be useful in the management of gynaecologic cancers.

만성전립선염(慢性前立腺炎)의 관장요법(灌腸療法)에 대한 고찰(考察) (The Analysis of Clinical Report about Rectal Injection Therapy on Chronic Prostatitis)

  • 이구현;조충식;김철중
    • 혜화의학회지
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    • 제14권2호
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    • pp.137-142
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    • 2005
  • Objective : This study was designed to report the clinical effect of Rectal Injection therapy on chronic prostatitis. Methods : We analyzed 20 manuscripts contributed to the Chinese medical journals from 1999 to 2003 that presenting report of Rectal Injection therapy on chronic prostatitis. Results : The results are summarized as follows 1. Operation of rectal injection therapy was treated 2~3 times and one course take time 5~30 days. 2. During therapy, average amount of fluid is 100~150 ml and it takes 1~2 hours. 3. Using medication was 'chung-yol' medicine, 'hwal-hyul-gu-er' medicine, 'bo-yik' medicine, 'lee-soo-sam-sup' medicine. Conclusion : We conclusion that Rectal Injection therapy was clinical effect on chronic prostatitis.

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하법(下法)의 발전 과정에 대한 연구(硏究) -상한론(傷寒論)에서 사상의학(四象醫學) 까지- (The Study on the History of Pugation therapy From -'Treatise on Febrile Diseases' to 'Longevity and Life Presservation In Oriental Medicine'-)

  • 최의권;김경요
    • 대한한방내과학회지
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    • 제19권1호
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    • pp.524-552
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    • 1998
  • Purgation therapy has played an important role as a influential remedy from the begining of the Chinese medicine. Especially purgation therapy is raised as the effective remedy on the acute infectious disease in the book of 'Treatise on Febrile Disease'. But It was inclined to cold-nature and available only in the excess syndrome. Nevertheless it is evident that the book has showed an example of this therapy. During the middle age, purgation therapy is classified into several subtype; hydrogogue therapy, laxation with lubricants, purgation with cold-natured drugs and purgation with warm-natured drugs. Comparing with the ancient times, it must be a progression. It was investigated earnestly by a school leaded by Zhang Congzheng. They were not restricted to several diseases, but applied it to the wide range of diseases. They thought as following. 'One is ill from pathogenic factor so that you should eliminate it from the human body'. Hence, they frequently used three major remedies such as diaphoresis, emesis and purgation. In this process, purgation therapy had showed eye-opening progress. But opposition to it was not little. Li Gao was a representative man on the opposite side. He expressed a critical opinion and placed great importance on the genuine energy, the natural healing force. Under his influence, a large number of doctors evaded purgation and put it under taboo. On account of these trend, purgation therapy had took a backward step and retrograded. Therefore cathartics such as Rhei Radix et Rhizoma, Rharbitidis Semen, cold drugs such as Gypsum Fibrosum, etc. had been excluded for preservation of the genuine energy, and came about an obnoxious custom to value only 'tonity deficiency', or 'warm and tonify'. As it had came into fashion to approach most disease from the point of view, purgation therapy was merely fall into a remedy of constipation. After the eighteenth century purgation therapy encountered the new period of rivival. It was introduced by them who strived for the study of Epidemics to the new current of thought, so called '增水行舟'. It was because 온병 was apt to dissipate one's Yin fluid. Therefore purgation therapy of this period was characterized by establishing nourishment Yin and body fluid with or without use of timely purgation of accumulation of heat. From the time of Zhang Congzheng, it was accomplished by Lee Je-ma to the most epoch-making change. He caused an improvement in the use of purgation therapy by regarding innate constitutional contradiction as importance than representing clinical symptoms. He warned that existing remedies that depend only upon symptoms and signs, not upon individual characteristics including constitutional features didn't bring round to but kill them. And he understood all the pathologic processes in his constitutional theory, investigated specific drugs on four constitution, made indications of each prescriptions clear. For giving to differentiation of constition before differentiation of syndrom, his new slant on the pathologic phenomena overcome the limitations of 변증시치, and revaluate purgation therapy from remedy impaire the genuine energy to that restore it by recover the balance between the internal organ. It is the product of him to fundamentally upset the cause to be in disregard of purgation therapy.

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