• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.57-62
• /
• 2010

Purpose: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. Methods: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. Results: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. Conclusion: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

• Journal of Korean Biological Nursing Science
• /
• 제19권3호
• /
• pp.123-130
• /
• 2017

Purpose: This study aimed to identify factors influencing intra-operative core body temperature (CBT), and to develop a predictive model for intra-operative CBT in laparoscopic abdominal surgery. Methods: The prospective observational study involved 161 subjects, whose age, weight, and height were collected. The basal pre-operative CBT, pre-operative blood pressure, and heartbeat were measured. CBT was measured 1 hour and 2 hours after pneumoperitoneum. Results: Explanatory factors of intra-operative hypothermia (< $36^{\circ}C$) were weight (${\beta}=.361$, p< .001) and pre-operative CBT (${\beta}=.280$, p= .001) 1 hour after pneumoperitoneum (Adjusted $R^2=.198$, F= 7.56, p< .001). Weight was (${\beta}=.423$, p< .001) and pre-operative CBT was (${\beta}=.206$, p= .011) 2 hours after pneumoperitoneum (Adjusted $R^2=.177$, F= 5.93, p< .001). The researchers developed a predictive model for intra-operative CBT ($^{\circ}C$) by observing intra-operative CBT, body weight, and pre-operative CBT. The predictive model revealed that intra-operative CBT was positively correlated with body weight and pre-operative CBT. Conclusion: Influence of weight on intra-operative hypothermia increased over time from 1 hour to 2 hours after pneumoperitoneum, whereas influence of pre-operative CBT on intraoperative hypothermia decreased over time from 1 hour to 2 hours after pneumoperitoneum. The research recommends pre-warming for laparoscopic surgical patients to guard against intra-operative hypothermia.

• Journal of Korean Neurosurgical Society
• /
• 제51권2호
• /
• pp.81-85
• /
• 2012

Objective : The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. Methods : Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;$18.5-22.9kg/m^2$), an overweight group (Group 2, BMI; $23-24.9kg/m^2$), and an obese group (Group 3, BMI; $25.0-29.9kg/m^2$) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. Results : IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) ($p$=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 ($p$=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position ($p$=0.022) and BMI ($p$<0.05). Conclusion : These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.

• Journal of Trauma and Injury
• /
• 제25권1호
• /
• pp.1-6
• /
• 2012

Purpose: This study analyzed the characteristics of unstable pelvic bone fractures associated with intra-abdominal solid organ injury. Methods: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. Results: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. Conclusion: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

• The Journal of Korean Physical Therapy
• /
• 제17권3호
• /
• pp.311-327
• /
• 2005

The purpose of this study was to investigate the effects of diaphragmatic breathing on activation of trunk muscles of patients with low back pain. Diaphragmatic breathing may affect activation of trunk muscles. The assumptions are as follows: the crural diaphragm attatches to the lumbar vertebrae from L1 to L3, the voluntary downward pressurization of the diaphragm increases intra-abdominal pressure, and this increases the stiffness of the spine. Diaphragmatic breathing increases intra-abdominal pressure and the increased intra-abdominal pressure may contribute to the lumbar stability. Sixty patients with low back pain were randomly divided into two groups. Experimental group performed diaphragmatic breathing exercise with six breathing positions and control group performed only the breathing positions for five times per week during six weeks. % maximal voluntary contraction(% MVC) of trunk muscles on six breathing positions of experimental and control group was measured according to testing period of pre test, three weeks, and six weeks. The repeated measures of one-way ANOVA were used to analyze % MVC on trunk muscles of experimental and control group according to testing period. The results of this study were as follows: First, % MVC of right and left erector spinae in the right leg extension position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Second, % MVC of right and left erector spinae in all-four positions indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Third, % MVC of right and left erector spinae, external oblique in the sitting position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Fourth, % MVC of right and left erector spinae, external oblique in the standing position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Fifth, % MVC of right and left erector spinae, external oblique in the supine position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). Sixth, % MVC of right and left erector spinae, external oblique in the lying on prone position indicated the statistically significant difference in experimental group which performed diaphragmatic breathing exercise rather than control group (p<0.05). In conclusion, as experimental group performed diaphragmatic breathing exercise according to the period of pre-test, post three weeks, and post six weeks, experimental group showed the greater significant effect on the activation of right, left erector spinae, and external oblique muscle. Diaphragmatic breathing exercise which resulted in activation of trunk muscles can be effective for managing the patients with back pain and should be utilized as the new therapeutic intervention.

• 한국엔터테인먼트산업학회논문지
• /
• 제14권3호
• /
• pp.475-482
• /
• 2020

허리 안정화 근육들을 강화하기 위해 실시하는 복부 드로우인 기법(ADIM)은 복부내압을 상승시켜 배가로근(TrA)과 배속빗근(IO)을 선택적으로 수축시키는 운동법이다. 본 연구는 일상생활에서 많이 사용하는 자세인 앉은 자세에서 ADIM을 실시했을 때 파악력에 어떠한 영향을 미치는지 확인하고자 하였다. 정상 성인 30명을 대상으로 앉은 자세에서 ADIM을 실시하도록 한 후 실시하지 않은 상태와 실시한 상태에서 각각 파악력을 측정하여 앉은 자세에서 실시한 ADIM이 파악력에 미친 영향과 가장 많은 영향을 발휘하는 근육이 있는지 알아보았다. 측정에 동원된 근육은 RA, EO, IO/TrA, 그리고 ES로 ADIM 적용 시 가장 활성화된다고 알려진 허리 안정화 근육들이다. 연구 결과 앉은 자세에서 실시한 ADIM이 실시하지 않은 자세 보다 모든 근육들의 활성도가 유의하게 증가하였으며 파악력 또한 유의하게 증가하였다. 측정된 각 근육의 차이값을 비교해 어떤 근육이 파악력에 더 큰 영향을 알아보았으나 유의한 상관관계를 나타낸 근육은 보이지 않았다. 이는 특정 근육이 파악력에 영향을 미친 것이 아니라 복부내압의 증가가 파악력에 영향을 미친 것으로 사료된다. 따라서 앉아서 오랜 시간 생활하는 일반인들의 일상생활에 파악력 증가와 허리 안정성 향상을 위한 치료적 중재방법에 활용할 수 있을 것으로 제안할 수 있겠다.

• Tuberculosis and Respiratory Diseases
• /
• 제61권1호
• /
• pp.46-53
• /
• 2006

연구배경: IAP의 증가는 혈류량을 감소시켜 여러 장기에 영향을 준다. IAH는 IAP가 12 mmHg 이상 또는 APP가 60 mmHg 이하로, ACS는 IAP가 20 mmHg 이상이면서 동시에 하나 이상의 장기 손상이 있는 경우로 각각 정의한다. 저자들은 중환자에서 IAH 및 ACS의 유병률과 이들이 환자의 예후에 미치는 영향을 고찰하고자 하였다. 방 법: 고려대학교 의료원 중환자실에 입원하는 내과계 환자를 대상으로 하여, APACHE II 및 III 점수, SAPS II 점수를 기록하였다. IAP는 삼중관 요도관을 통하여, 입원 7일째까지 매일 3회 측정하였고, 환자가 사망하거나 일반 병실로 전실 또는 요도관을 제거할 때까지 계속하였다. 환자의 예후는 28일을 기준으로 판단하였다. 결 과: 총 111명 대상 환자들의 입원 1일 IAH 및 ACS의 유병률은 각각 47.7%, 15.3%였다. 사망군과 생존군 사이에 IAH의 유병률은 유의한 차이가 없었으나, ACS는 사망군에서 더 높았다 (p=0.004). 사망군에서 IAP는 더 높았고 (p=0.012), APP는 유의하게 낮았다 (p<0.001). 결 론: 중환자에서 입원 1일에 측정한 IAP의 증가, APP의 감소 및 ACS 발생은 환자의 사망과 연관이 있을 것으로 판단된다.

• 한국전문물리치료학회지
• /
• 제22권1호
• /
• pp.37-48
• /
• 2015

This study aimed to investigate the effect of the abdominal drawing-in maneuver (ADIM) and abdominal expansion maneuver (AEM) on trunk stabilization, as well as trunk muscle activities and differences in quadruple visual analogue scale, Korean Oswestry Disability Index, and Fear Avoidance Beliefs Questionnaire scores, in patients with chronic low back pain and lumbar spine instability. To increase intra-abdominal pressure during the trunk stabilization exercise, the technique of pushing the abdomen out using diaphragmatic abdominal breathing suggested by Pavel Koral was used, which we termed the AEM. Fifty patients who tested positive on more than three of the five lumbar spine instability tests were separated from 138 patients with chronic low back pain of these patients, 16 were placed in the control group (trunk stabilization exercise), 17 were placed in the ADIM group (trunk stabilization exercise with ADIM), and 17 were placed in the AEM group (trunk stabilization exercise with AEM). Each group participated in the study for 30 minutes three times weekly for 4 weeks. Surface electromyography was used to measure the trunk muscle activities during the kneeling forward and supine bridging positions, and one-way repeated analysis of variance was used to determine the statistical significance of the trunk muscle activities in the rectus abdominis, internal oblique (IO), erector spinae, and multifidus (MF) muscles. The ADIM and AEM groups showed relatively larger improvements in psychosocial and functional disability level than control group. There were significant changes among the three groups, those from the measured values of the AEM group was significantly higher than the other two groups in changes in IO and MF trunk muscle activities (p<.05). This finding demonstrates that trunk stabilization exercises with AEM is more effective than ADIM for increasing trunk deep muscle activity of chronic low back pain patients with lumbar spine instability.

• 한국전문물리치료학회지
• /
• 제26권1호
• /
• pp.51-59
• /
• 2019

Background: Chronic low back pain (CLBP) causes morphological changes in muscles, reduces muscle strength, endurance and flexibility, negatively affects lumbar stability, and limits functional activity. Plank exercise strengthens core muscles, activates abdominal muscles, and improves intra-abdominal pressure to stabilize the trunk in patients with CLBP. Objects: We investigated the effect of plank exercise on abdominal muscle thickness and disability in patients with CLBP. Methods: We classified 33 subjects into 2 groups: An experimental (n1=17) and a control group (n2=16). Patients in the experimental group participated in plank exercise and those in the control group participated in stretching exercise. Patients in both groups attended 20-minute exercise sessions thrice a week for 4 weeks. Abdominal muscle thickness in each subject was evaluated ultrasonographically, and disabilities were assessed using the Oswestry disability index (ODI). Results: Four weeks later, abdominal muscle thickness showed a significant increase over baseline values in both groups (p<.05). Patients in the experimental group reported a more significant increase in the thickness of the external oblique muscle than that in the control group (p<.05). ODI scores in the experimental group were significantly lower after intervention than before intervention (p<.05). Conclusion: Plank exercise increases the thickness of the external oblique muscle and reduces disability secondary to mild CLBP. Therefore, plank exercise is needed to improve lumbar stability and functional activity in patients with mild CLBP.

• Journal of Yeungnam Medical Science
• /
• 제33권2호
• /
• pp.90-97
• /
• 2016

Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.