• Journal of Chest Surgery
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• 제42권2호
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• pp.226-232
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• 2009

배경: 흉부 둔상은 전체 흉부 손상의 90%정도를 차지하며 외상과 관련된 사망률의 20%를 유발시킨다. 흉분 둔상에 의한 손상 후 이환율과 사망률의 주요 원인은 발견되지 못한 손상이 남아있기 때문이다. 그리하여 흉부전산화단층 촬영은 외상환자의 진단적 검사에서 매우 자주 사용되어져 왔다. 그러나 흉부 컴퓨터 촬영은 가격이 비싸고, 방사선 노출을 증가시킬 수 있다. 이번 연구를 통하여 흉부둔상 환자에서 흉부단순촬영과 비교하여 흉부전산화단층촬영을 통하여 얼마나 더 많은 정보를 얻을 수 있는지 조사해 보고 그리고 흉부 컴퓨터 촬영의 진단과 치료에 있어서의 역할을 알아보고자 한다. 대상 및 방법: 2006년 11월부터 2007년 7월까지 응급실로 내원한 환자 100명을 대상으로 하였다. 이 중 74명의 자동차 관련사고 환자와 26명의 낙상 사고 환자가 있었으며 흉부엑스선과 흉부전산화단층 촬영을 동시에 시행한 환자를 전체 응급실 환자 중에 선택하였다. 자료는 차트를 통하여 혈역학적 소견, 중재적 치료 여부, 손상의 중증도(RTS)와 종류를 조사하였으며, 초기 응급실 내원환자 중 흉부단순촬영과 흉부전산화단층촬영을 시행한 환자를 대상으로 발견되지 못한 병적 소견을 각각 질환별로 분석하였다. 결과: 100예의 환자 중 흉부엑스선 검사상 하나 이상의 병적소견을 보인 환자가 79예였으며 21예의 환자에서는 흉부엑스선 검사상 정상 소견을 보였으며, 이 21예의 환자 중 17예에서 흉부전산화단층촬영상 이상소견이 발견되었다. 흉부엑스선 검사상 발견하지 못한 소견으로는 기흉, 혈흉, 폐좌상, 흉골 골절 등이 있었으며 이러한 병적 소견의 진단은 흉부전산화단층촬영이 흉부엑스선 검사보다 통계적으로 유의하게 우수한 것으로 나타났다. 하지만 치료에 있어서는 흉부전산화촬영 시행 후 발견된 병변으로 흉관삽입술등의 치료를 시행한 환자는 31명에 불과했고 흉관삽입술, 개흉술 등의 흉부외과적인 치료 없이 집중관찰을 위하여 입원한 환자가 42명이었으며, 흉부엑스선촬영과 환자의 이학적 소견으로 진단되어 치료를 시행한 환자가 27명이었다. 결론: 흉부전산화단층촬영은 진단에 있어서 흉부엑스선 촬영보다 통계적으로 의미 있게 진단에 도움이 되는 것을 알 수 있었으나 발견되지 못한 병변이 증가할지라도 치료의 변화와 방법의 변화가 있는 경우는 매우 소수에 불과했다. 그리하여 응급실에서의 흉부전산화단층촬영의 오남용을 막기 위하여 선별적인 흉부전산화단층 촬영을 고려해야 할 것이다.

• 정신신체의학
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• 제17권1호
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• pp.8-14
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• 2009

연구목적 : 본 연구의 목적은 만성전립선염 환자들을 대상으로 스트레스의 다양한 측면들을 조사하여 만성전립선염과 스트레스와의 연관성을 알아보고자 함이다. 방법 : 비세균성 만성전립선염으로 진단받은 32명의 환자군과 건강한 성인남자 64명을 대상으로 하여 자기보고식 설문지를 작성하도록 하였다. 스트레스 인자에 대한 지각, 스트레스 반응 및 대응전략은 각각 스트레스 지각척도(Global Assessment of Recent Stress Scale), 스트레스 반응척도(Stress Response Inventory) 및 대처방식 체크리스트(Ways of Coping Checklist)를, 전립선염의 증상 정도는 미국립보건원 만성전립선염 증상지수(NIH-Chronic Prostatitis Symptom Index)를 이용하여 평가하였다. 결과 : 만성전립선염 환자는 대조군에 비하여 대인관계의 변화, 질병 및 상해, 경제적인 문제와 관련된 스트레스인자 지각점수가 높았고, 환자군이 대조군에 비해 스트레스 반응이 전체적으로 높게 나타났으며, 스트레스 대처방식에서는 적극적 대처와 소극적 대처 모두 환자군이 대조군에 비해 전체적으로 스트레스 대처수준이 낮게 관찰되었다. 전립선염 증상 정도가 심한 환자일수록 스트레스에 대한 반응에서 우울의 경향을 더 나타내었고 (p=0.039), 스트레스 대처방식에서는 문제중심적 대처방식(p=0.000)과 사회적 지지의 추구(p=0.017)와 유의한 음의 상관성을 보였다. 결론 : 만성전립선염 환자들은 다양한 영역의 스트레스를 경험하고, 높은 스트레스 반응을 보이며, 이에 대한 대처전략은 부족하였다. 이와 같은 결과는 만성전립선염 환자의 치료에 있어서 동반된 스트레스 인자의 평가 및 조절, 스트레스에 대한 반응과 대처방식의 효율성 증진 등이 효과적일 수 있음을 시사한다.

• 한국산학기술학회논문지
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• 제18권1호
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• pp.336-344
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• 2017

본 연구는 뇌손상 진단을 받고 병원에서 재활치료를 실시하고 있는 환자의 가족 간병인 340명을 대상으로 근골격계증상을 알아보고 그 관련요인을 파악하고자 자기 기입식 설문조사를 실시하였다. 설문조사 내용은 일반적 특성, 간병활동 특성, 근골격계 자각 증상이였다. 본 연구의 조사 기간은 2014년 3월부터 4월이며, 재활병원 및 요양병원에서 수집하였다. 연구결과 독립변수에 따른 자각증상 호소율은 신체부위별로 다르게 나타났다. 요인분석의 결과는 목의 경우 초졸의 학력이 영향을 끼쳤고, 어깨의 경우 여자, 나이 50~59세, 학력 중졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내가 영향을 끼쳤다. 팔/팔꿈치의 경우 나이 40~49세, 학력 대졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 유의한 영향을 끼쳤다. 손/손목/손가락의 경우 나이 50~59세, 간병기간 1년 이내와 1년 7개월 이상 2년 이내 변인이 통증에 유의한 영향을 끼쳤다. 다리/발의 경우 나이 50~59세, 간병기간 6개월 이내 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 허리의 경우 학력 초졸 중졸 고졸, 간병기간 1년 이내와 1년 7개월 이상 2년 이내, 독립보행 불가능 변인이 통증에 유의한 영향을 미치는 것으로 나타났다. 진단명 별 간병활동 특성에서 근골격계 자각증상 호소율은 통계적으로 유의하지 않았다. 근골격계 자각증상 호소에 가장 영향을 미치는 간병활동 동작으로는 이동하기와 보행이었다. 근골격계 자각증상에 영향을 미치는 전체 요인에 대해서는 간병 기간 1년 이내가 전체 통증에 유의한(p<.05) 영향을 미치는 것으로 나타났다. 본 연구의 결론으로는 뇌손상 환자의 가족 간병인은 환자를 간병하는 간병활동 특성에서 근골격계 질환의 위험에 노출되어 생활하는 것을 알 수 있었다. 또한 뇌손상 환자를 돌보는 가족 간병인의 신체부위별 근골격계 증상에 영향을 미치는 요인이 다르므로 이러한 요인에 대한 체계적이며 종합적인 예방 교육과 연구가 마련되어야 할 것이다.

• 대한간호
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• 제35권2호
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• pp.71-91
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• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1992년도 춘계학술대회
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• pp.27-47
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• 1992

Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

• Journal of Chest Surgery
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• 제42권4호
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• pp.441-446
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• 2009

배경: 관상동맥 우회술의 대동맥부 근위부 문합을 위한 상행 대동맥 부분 겸자는 대동맥 내벽에 존재하는 죽상반의 색전에 의한 뇌경색의 위험성을 높일 뿐 아니라, 겸자에 따른 직접적 대동맥 손상의 원인이 될 수 있다. Heartstring proximal sealing system (Guidant Corporation, Santa Clara, Calif)을 이용한 근위부 문합은 대동맥 부분 겸자를 피할 수 있어, 이러한 잠재적 위험을 방지할 수 있는 것으로 제시되어 왔다. 이 연구는 무심폐기 관상동맥 우회술의 근위부 문합에 있어서 대동맥 부분 겸자를 통한 수기 문합과 Heartstring system을 이용한 문합간의 수술 후 신경학적 합병증을 비교하고자 하였다. 대상 및 방법: 2003년 1월부터 2008년 8월까지 499명의 환자가 무심폐기 관상동맥 우회술을 시행받았다. 그 중 182명의 환자가 Heartstring system을 이용한 이식편 대동맥 근위부 문합술을 시행받았고(I군), 317명의 환자가 고식적 수기 문합술을 시행 받았다(II군). 이 두 군간의 수술 후 신경 손상을 비롯한 주요 합병증 및 사망율을 비교하였다. 결과: 나이, 성별, 좌심실 구출율, 신장 기능, 당뇨, 고혈압, 흡연력 등의 수술 전 인자들에 있어서 두 군간에 유의한 차이는 없었다. 수술 전 뇌허혈의 과거력은 환자는 두 그룹간에 유의한 차이가 없었으나(I군 31.3%, II군 34.4%, p=0.48), 뇌혈관 MRI상에서의 내경동맥의 협착이 75%가 넘는 환자는 I군이 81명(44.5%), II군이 95명으로(30.0%) 두 군간의 유의한 차이를 나타냈다(p=0.003). 수술 후 새로 발생한 신경 이상의 경우 I군에서 3명, II군에서 2명으로, 두 군간에 유의한 차이를 보이지 않았으나(p=0.258), I군의 경우 모두 일과성 허혈이었던 것에 반해 II군의 경우 모두 색전에 의한 다발성 뇌경색으로 나타났다. 그 외 수술 후 발생한 주요 합병증(p=0.47)및 사망(p=0.40)에 있어서 두 군간에 유의한 차이를 보이지 않았다. II군에서 한 명의 환자에서 수술 중 근위부 분합에 따른 대동맥 박리증이 발생하여 상행대동맥 치환술을 시행하였다. 결론: 비록 수술 후 신경학적 합병증의 빈도가 낮아 통계학적 유의성에 다다르진 못했으나, Heartstring system을 이용한 근위부 문합술은 고식적 문합에 비해 색전에 의한 수술 후 뇌졸중의 합병 및 대동맥 손상의 위험도를 낮출 것으로 기대해 본다.

• 한국임상약학회지
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• 제13권1호
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• pp.29-39
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• 2003

Neurodegenerative disorders are associated with apoptosis as a causing factor or an inducer. On the other hand, it has been reported that epigallocatechin gallate (EUG), one of antioxidants and flavonoids, and z-VAD-fmk, a nonselective caspase inhibitor, suppress oxidative-radical-stress-induced apoptosis. However, it is not yet known what is the effects of EGCG and z-VAD-fmk on the apoptotic pathway is through phosphoinositide 3-kinase (PI3K), Akt and glycogen synthase kinase-3 (GSK-3) as well as mitochondria, caspase-3 and poly (ADP-ribose) polymerase (PARP). We investigated the effects of EGCG by using $H_2O_2$ treated N18D3 cells, mouse DRG hybrid neurons. Methods: Following 30 min $100\;{\mu}m\;H_2O_2$ exposure, the viability of N18D3 cells (not pretreated vs. EGCG or z-VAD-fmk pretreated) was evaluated by using MTT assay. The effect of EGCG on immunoreactivity (IR) of cytochrome c, caspase-3, PARP, PI3K/Akt and GSK-3 was examined by using Western blot, and was compared with that of z-Y4D-fmk. Results: EGCG or z-VAD-fmk pretreated N18D3 cells showed increased viability. Dose-dependent inhibition of caspase-3 activation accompanied by PARP cleavage were demonstrated by pretreatment of both agents. However, inhibition of cytochrome c release was only detected in EGCG pretreated N18D3 cells. On the pathway through PI3K/Akt and GSK-3, however, the result of Western blot in EGCG pretreated N18D3 cells showed decreased IR of Akt and GSK-3 and increased IR of p85a PI3K, phosphorylated Akt and GSK-3, and contrasted with that in z-VAD-fmk pretreated N18D3 cells showing no changes on each molecule. Conclusion: These data show that EGCG affects apoptotic pathway through upstream signal including PI3K/Akt and GSK-3 pathway as well as downstream signal including cytochrome c and caspase-3 pathway. Therefore, these results suggest that EGCG mediated activation of PI3K/Akt and inhibition GSK-B could be new potential therapeutic strategy for neurodegenerative diseases associated with oxidative injury.

• Child Health Nursing Research
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• 제7권2호
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• pp.245-257
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• 2001

This study analyzed the services as operated by the Child Health Telephone Service Center. The Center is a toll free service operated as part of the community services of the Korean Academic Society of Child Health Nursing. The aim of the study was to describe the concerns of child caregivers regarding child health care as discussed during telephone counseling. Specific objectives were as follows: 1. To analyze the activities of the Center. 2. To describe the characteristics of caregivers who made phone calls for counseling services and also the characteristics of their children. 3. To analyze the content of the counseling sessions. 4. To analyze counseling content according to the characteristics of the caregivers and their children. Data used for the study were obtained from the counseling records for the period from Sept. to Dec. 1999, as kept by the three counselors at the Center. The total number of calls was 8,261 and that consisted of 15,150 questions. The total questions were merged into 13,236 by eliminating those questions which overlapped or were of similar content. The final 13,236 questions were used for the final analyses. Almost of the callers (98.4％) were mothers. Among them 89.6％ were between 25 and 35 years of age. Geographical distribution of the callers covered the whole nation. The largest numbers who made the calls were from the Seoul metropolitan area (36％), followed by 28％ from Kyung Gi Province, and 20％ were from the Kyung Sang area. Among 8,261 callers, 72.8％ were first users. Sex of the babies and children in question for counseling was about even for males and females and ages ranged from one month to six years. The largest group (62.5％) was the less than six month age group. The finalized 13,236 questions/problems were categorized into 11 problem areas. They were in order of frequency, physical problems, feedings and nutrient concerns, information on child rearing, growth and development, guidance on utilization of child care facilities, elimination problems, sleeping concerns, immunization related concerns, behavior problems, injury and accidents, and safety measures. The most frequent problems for counseling were physical signs and symptoms (27.3％), followed by feeding and nutrients, information on child rearing, and growth and development. Of physical problems, abnormal gastrointestinal signs and symptoms were the most frequent concern and skin problems were next at 25％ and 23.3％ respectively. Loose bowels, vomiting and constipation were the most frequent gastrointestinal problems. Atopic dermatitis had the highest frequency at 53.3％ with diaper rash being the second highest among the skin problems. About 80％ of the growth and developmental category were physical development concerns related to physiological, body growth, and motor and sensory development. This study constitutes the activity report for the first year of the Center. The findings correspond with literature reports on child health problems and parents educational needs. One recommendation from this study is that since the services of the Center are carried out only by telephone, the psychology of the counselees and the counselor relationship must be considered for better services.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제7권1호
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• pp.61-73
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• 2004

목 적: 담즙울체를 포함한 간기능 이상은 총정맥영양법을 시행받는 환자에게서 자주 나타나는 합병증 중 하나이며 이를 해소하기 위한 방법의 하나로서 주기성 정맥영양법이 있으나 소아에서는 이에 대한 연구가 미흡한 상태이다. 본 연구에서는 소아에서 총정맥영양법의 합병증으로 생긴 간기능 이상의 발생초기에 주기성 정맥영양법을 시행하여 그 유용성을 평가하고자 하였다. 방 법: 연구대상은 미숙아를 제외한 유소아로 총정맥영양법에 의한 담즙울체 및 간효소치의 증가를 보이고 혈역학적, 대사적으로 안정되었으며 주기성 정맥영양법이 간기능 이상을 보이는 초기에 시도되었던 12례의 환아들이었다. 주기성 정맥영양법의 중단시간은 3개월 미만에서는 2시간 이하, 그 이상에서는 4시간으로 하였다. 환아들의 의무기록지를 후향적으로 검토하였고 진단명, 지속성과 주기성 정맥영양법의 시행기간과 방법, 대사성 혹은 감염성 합병증 유무, 병행된 경관영양유무 및 정맥영양법을 시행하기 전후의 혈청 총 빌리루빈과 간효소치의 변화를 비교하였다. 결 과: 1) 환아들의 정중연령(median age)은 주기성 정맥영양법 시작시 4세(생후 2개월에서 17세)였고 기저질환은 만성가성장폐색증 4례를 비롯하여 다양하였다. 2) 동일 예에서는 대부분에서 투여된 단백과 포도당, 지방의 투여량에 차이가 없었다(p<0.05). 주기성 정맥영양법을 시행하는 동안 1례에서 잘 조절되지 않는 고혈당이 나타나 포도당의 감량이 필요하였으나 다른 대사성 및 정맥관의 감염과 관련된 합병증은 없었다. 3) 혈청 총빌리루빈은 총 5례에서 상승하였고 주기성 정맥영양법 시행 후 전 증례에서 정상화되었다(p<0.05). 주기성으로 전환시 혈청 빌리루빈은 3.6 mg/dL였으며 정상화된 때까지 걸린 기간은 8일이었다. 4) AST/ALT의 상승은 12례에서 모두 관찰되었고 주기성 정맥영양법 시행 후 전례에서 정상화되었다. 주기성으로 전환시 혈청 ALT는 200 IU/L였으며 주기성 정맥영양 시행 후 정상화된 때까지 걸린 기간은 34일이었다. 결 론: 저자들은 장기간의 총정맥영양법으로 인해 발생한 간기능 이상을 보인 유소아에서 주기성 정맥영양법으로의 조기전환이 효과적인 치료적 대안이 될 수 있으며 부작용이 적은 안전한 방법임을 관찰하였다. 향후 주기성 정맥영양법은 총정맥영양을 시행받는 소아들에서 간기능 이상을 방지하고 삶의 질을 높이기 위한 일차적인 방법으로 더욱 연구되어야 할 것으로 생각된다.

• 한국학교ㆍ지역보건교육학회지
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• 제1권2호
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• pp.49-71
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• 2000

The purpose of this study was to serve as a basis for school health care of better quality, by making a comparative analysis of the health care satisfaction and attitude of elementary school students in consideration of their general characteristics and the presence or absence of nurse teacher. The subjects in this study were 919 selected six graders in 16 elementary schools in the city of Tongduchun, Koyang and Euijungbu, Yangju-kun and Yeunchun-kun. A survey was conducted with questionnaire designed for measurement of health care satisfaction and attitude. As a result of analyzing the data collected from June 1 through 15, 2000, the conclusions were as follows. 1) As for the general characteristics of the students investigated, the subjects included 513 boys(55.8%) and 406 girls(44.2%). The schools where 390(42.4%) students attended were located in municipal area, and the schools where 529(57.6%) students attended were located in kun area. 608(66.2%) students had a nurse teacher at their schools, while 311(33.8%) students had no nurse teacher. 498(54.2%) had an experience to use the health room this year, but 421(45.8%) had no such an experience. Their mean school life satisfaction was scored $3.42{\pm}.71$, above the average. And their health condition was rated $3.81{\pm}.87$, which implied they tended to be in good health. 2) The mean satisfaction at the health room operation was scored $3.33{\pm}.71$, above the medium level. What they were most satisfied with($4.02{\pm}1.08$) was, among the health room facilities, that there were beds. But they expressed the least satisfaction($2.83{\pm}1.17$) at the location of health room. The presence or absence of nurse teacher made a significant difference to their satisfactionat health room operation, because the students in schools with nurse teacher showed greater satisfaction($3.42{\pm}.72$) than the others in schools with no nurse teacher did($3.15{\pm}.66$). 3) Concerning their attitude to use the health room in case of disease or accident occurrence, a lot of students in schools with a nurse teacher, who had ever suffered from indigestion, headache or traumatic injury, used the health room. In schools with no nurse teacher, there was a tendency to talk to their class teachers(p<.001). The recognition of the necessity for health counseling was generally on a medium level. The counselor whom they wanted to discuss health problem with was family or friend in the largest cases. Few students discussed with class teachers in case there was a nurse teacher in school. Instead, some of them discussed with friend, family or nurse teacher, and there was a significant difference between them(p<.001). 4) The mean satisfaction at health, sanitation and environmental management was rated $3.20{\pm}.90$, above the average. The classroom lighting gave them the best satisfaction with $3.67{\pm}1.07$, but the satisfaction at toilet cleanness and disinfection was not good with $2.83{\pm}1.19$. By the presence or absence of nurse teacher, those who had a nurse teacher expressed better satisfaction at water supply facilities including hot water than the others who had no nurse teacher did(p<.001). But no significant difference was observed in the other items. 5) The health education satisfaction was rated $3.19{\pm}.99$, which was on a medium level. By item, the mean satisfaction level was $3.36{\pm}1.19$ at nurse teacher's explanation about treatment, $3.13{\pm}1.15$ at the frequency of health education, and $3.08{\pm}1.16$ at the explanation on the cause of disease. By the presence or absence of nurse teacher, the students with nurse teacher showed significantly better satisfaction at every factor0(p<.001). 6) Regarding health education attitude, their recognition of the need for school health education was scored $3.89{\pm}.96$. Those who had a nurse teacher felt it more necessary($3.96{\pm}.92$), yet the others who had no nurse teacher felt its necessity a little less($3.74{\pm}1.01$). The most preferred thing for them to learn in health education was first aid, followed by sex education, obesity prevention, safety accident prevention in school and outdoors, smoking-related health, good use of leisure time, and environmental pollution cause in the order named. According to the presence or absence of nurse teacher, there was a significant difference in sex education(p<.01), but no significant disparities were found in the other factors. The most preferred person who would offer health education was a lecturer from the outside(45.8%) and nurse teacher(45.4%). Their preference for class teacher as a person in charge of health education was just 8.8%. But the presence or absence of nurse teacher didn't produce any differences to their preference for a person in charge of health education.