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심한 만성기류폐쇄 환자의 Impairment/Disability 측정에 있어 폐기능검사 및 운동부하검사의 역할 (The role of the pulmonary function test and the exercise test for assessing impairment/disability in patients with chronic airflow obstruction)

  • 천선희
    • Tuberculosis and Respiratory Diseases
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    • 제43권3호
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    • pp.377-387
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    • 1996
  • 연구배경 : 폐기능의 경한 저하는 운동능력이나 작업능력을 제한 시키지 않지만 심한 폐기능 저하는 중요한 제한 요인이 된다. 1980년 세계보건기구(WHO)에서는 폐기능의 감소를 impairment, 운동기능의 감소를 disability로 구분하였으며, 1986년 ATS에서 FVC가 50% 이하로 감소, FEV1이 40% 이하로 감소, FEV1/FVC가 40% 이하로 감소, 혹은 DLCO가 40% 이하로 감소된 경우, 또는 운동부하 검사에서 VO2max가 15 ml/Kg/min 이하이면 거의 모든 작업기능을 수행할 수 없는 심한 장애상태로 평가하였다. 이에 심한 기류폐쇄환자를 대상으로 impairment/disability를 평가하는데 있어 안정시 폐기능 검사와 운동부하검사의 역할 및 상관관계를 살펴보고자 하였다. 방법 : 성한 만성기류폐쇄(CAO; chronic airflow obstruction) 환자 19예를 대상으로 안정시 spirometry와 body plethysmograph를 시행하였으며, cycle ergometer를 이용하여 증상제한적 최대 운동검사(symptom limited maximal exercise test)를 분당 5 - 10 watt 씩 증가시키면서 시행하였다. 환자를 안정시 폐기능검사 결과에 따라 FEV1이 40% 이하인 경우 severe impairment군, 이상인 경우 non-severe impairment 군으로 구분하여 비교하였다. 결과 : 1. Severe impairment 군은 non-severe impairment 군에 비하여 기도폐쇄 및 저산소증이 유의하게 심하였고, VO2max가 유의하게 감소되어 운동수행상태가 현저하게 감소되어 있었다. 2. Severe impairment 군은 운동부하검사에서 환기제한장애(ventilatory limitation)를 보였으며, 운동제한 증상은 10예중 9예가 호흡곤란이었다. 3. 만성기류폐쇄 환자중에서 결핵 파괴성 폐질환 환자의 장애가 가장 심하였다. 4. 안정시 폐기능검사 결과 중에서 FEV1이 심한 장애를 결정하는 가장 유용한 지표였으며, VO2max와의 상관관계도 가장 컷다(r = 0.81, p < 0.001). 5. 안정시 폐기능검사에 의한 심한 폐기능장애(impairment by WHO)는 sensitivity 80%, specificity 89%로 심한 운동장애(disability by WHO)를 예측할 수 있었다. 결론 : 심한 기류폐쇄환자에서는 안정시 폐기능검사 특히 FEV1으로 운동수행상태를 잘 예측할 수 있어, 운동부하검사를 시행하지 않고서도 안정시 폐기능검사인 폐기능 장애(impairment by WHO)에 따라 운동기능 장애(disability by WHO)를 충분히 판단할 수 있을 것으로 생각된다.

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청소년의 의복행동과 교복만족도 및 교복변형행동 (The Clothing Behavior, School Uniform Satisfactions and School Uniform Modification Behavior of Adolescent)

  • 이애경;한영숙;이혜자
    • 한국가정과교육학회지
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    • 제18권3호
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    • pp.133-148
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    • 2006
  • 청소년들이 보다 만족할 수 있는 교복에 관한 자료를 얻고자 경기도 안양시 소재 중 고등학교 남녀 472명을 대상으로 의복행동, 교복만족도 그리고 교복변형행동을 설문 조사하였으며 SPSS/WIN (ver.11.0) program으로 통계 처리한 결과 다음과 같은 결론을 얻었다. 청소년들은 용돈의 대부분을 의복구입비로 사용하고 있으며 외모관심도, 동조성, 개성, 상표지향성에 대한 의복행동이 높았다. 청소년의 교복만족도는 낮으며. 특히 교복의 신분상징성, 유행성, 세탁관리성, 신체적 안락감, 경제성에 대한 만족도가 낮았다. 청소년의 약 74.8%가 개성과 유행추구를 이유로 교복변형을 찬성하였고 약 58.1%가 교복의 일부 혹은 여러부분을 변형하였으며 교복을 부위별로 줄여서 몸에 밀착된 형태로 변형시키는 경향이 나타났다. 외모관심도, 동조성, 정숙성, 상표지향성에 대한 의복행동이 높은 청소년일수록 교복의 신분상징성, 세탁관리성 둥에 대한 만족도가 높았다. 외모관심도, 유행, 상표지향성에 대한 의복행동이 높을수록 교복변형행동에 영향을 미쳤으나 교복만족도와 교복변형행동과는 유의한 상관관계가 없었다. 앞으로 교복 연구는 외모, 개성, 유행 등의 의복행동을 표현하려는 청소년들의 의복 욕구와 학생다운 이미지, 정숙성, 경제성을 추구하는 기성 세대 간의 요구를 절충할 수 있도록 지속적으로 수행되어야하며 그 결과는 청소년들의 교복 선택과 결정에 실질적으로 반영되며 학교와 교복제작업체는 이를 반영한 교복디자인과 제작을 시행해야 한다고 제언한다.

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직업적 망간 폭로에 있어서 뇌자기공명영상의 의의 (Significance of brain magnetic resonance imaging(MRI) in the assessment of occupational manganese exposure)

  • 정해관
    • Investigative Magnetic Resonance Imaging
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    • 제2권1호
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    • pp.14-30
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    • 1998
  • 망간은 체내 필수원소의 하나이며 주로 간과 뇌의 기저핵게 축적되며 간을 통하여 배설된다. 망간은 체내 대사가 매우 빠르기 때문에 직업적 망간 폭로를 측정하는데 어려움이 있다. 특히 용접공과 같이 망간 폭로가 간헐적이거나 불규칙한 경우에는 혈중 및 요중 망간과 같은 기존 생체폭로지표로는 장기간에 걸친 폭로량을 정확하게 반영하기 힘들다. 뇌자기공명영상이 대두됨에 따랄 뇌내에 축적된 망간을 영상으로 확인하는 것이 가능하게 되었다. 초기에는 만성간부전 및 장기간에 걸친 정맥영양주입환자 등에서 뇌기저부의 고신호간도 소견이 보고되었다. 망간은 상자성 물질로 뇌자기공명영상에서 T1 이완시간을 단축시켜 T1 강조영상에서 고신호강도를 나타난다. 망간축적에 따른 고신호강도는 주로 담창구, 흑질, 피간 및 뇌하수체 등에서 나타난다. 저자들은 최근까지 국내 및 국외에서 직업적 및 비직업적으로 망간에 폭로된 사람에서 보고된 뇌자기공명영상소견을 수집하여 분석하였다. 우선 T1강조영상에서 관찰되는 고신호 강도와 연령, 성별, 직업적 망간 폭로 및 신경학적 이상 유무간의 관계를 분석하였다. 생물학적 폭로지표와 고신호강도간의 관계도 분석하였다. 고신호강도와 뇌내 망간축적, 신경세포손상 및 신경학적 이상간의 관계에 대한 문헌들을 분석하였다. T1강조영상에서 나타나는 고신호강도는 뇌내 망간축적 정도를 반영한다. 이러한 관계를 이용하여 신호강도를 분석하므로써 뇌내 망간축적 정도를 추정할수 있다. 뇌내 망간축적은 기저핵의 신경세포손상을 초래한다. 그러나 신경학적 이상은 비교적 단기간에 걸친 망간 축적과는 무관하게 보인다. 이는 신경학적 이상소견은 마간의 누적축적량과 관련되어 있기 때문인것으로 추정된다. 뇌자기 공명영사에서 관찰되는 고신호강도 소견은 표적 장기의 망간적 축적량을 반영하는데는 충분하지 못한 것으로 보인다. 따라서이러한 놔자기공명영상의 특성 및 비용-효과적인 측면을 고려할 대 망간폭로집안에서의 망간폭로정도를 추정하기 위하여 놔자기공명영상을 사용하는 것은 바람직하지 않다고 보인다. 그러나 망간과 관련된 건강장해가 의심되는 파킨슨증 환자에서 망간폭로를 확인 및 추정하는 데에는 매우 유용하게 활용할 수 있다.

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고등학생의 채소.과일류 섭취습관과 식이섬유소 섭취실태에 관한 연구 - 대구 일부지역 고등학생을 중심으로 - (A Study on Vegetable & Fruit Eating Habits and Dietary Fiber Intake of High School Students - focusing on high school students in Daegu -)

  • 정혜경;조현주;최미자
    • 한국학교ㆍ지역보건교육학회지
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    • 제12권3호
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    • pp.43-64
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    • 2011
  • Objectives: The purpose of this study was to provide the nutritional education data of the fruit and vegetable eating habits and dietary fiber intake of male and female high school students in the Daegu area. Methods: A survey was conducted on 300 male/female students from four general high schools in the City of Daegu, and the survey included questions ongeneral characteristics, dietary habits, eating behavior patterns and dietary intake. A 24-hour recall method was used for the dietary intake, and the surveyed dietary intake information was analyzed using the Computer Aided Nutritional analysis program (CAN 3.0)--dietary fiber intake, in particular. The data was analyzed using the SPSS window 12.0 program. Results: The average ages of boys and girls were 16.8- and 15.6-years old, respectively. A classification based on BMI showed the following: the low-weight student group was comprised of 10.3% boys and 31.6% girls; the normal-weight group 68.4% boys and 67.5% girls; and the overweight group 21.3% boys and 0.9% girls, whereby showing a significant difference between boys and girls. Vegetable intake showed the following: the ratio of the response of 'taking it once a day' was more than 70%, which showed the low frequency of fruit intake; the ratio of 'taking it more than five times a week' was 53.0% for boys and 68.4% for girls, which showed a higher intake frequency for girls over boys; and the daily dietary fiber per 1,000kcal was 7.1g for boys and 8.2g for girls, whereby showing a significant difference between boys and girls. The meals that contributed most to dietary fiber intake were the school meals, whereas the dietary fiber intake rate through breakfast was the lowest among the three daily meals. The food groups that contributed to dietary fiber intake were vegetable, grains and flavoring matters for boys and vegetable, grains and fruits for girls. Conclusions: In order to increase the daily dietary intake for growing adolescents, who are in an important stage for building the foundation of health, it's recommended that, in addition to the supplement for insufficient dietary fiber through a regular breakfast consisting of high dietary fiber content foods, nutrition-related education about the effects of dietary fiber on the human body be conducted.

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한국산장지뱀과의 성적이형 (Sexual Size Dimorphism of Lacertid Lizards from Korea)

  • 장민호;오홍식
    • 한국환경생태학회지
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    • 제26권5호
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    • pp.668-674
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    • 2012
  • 본 연구는 한국에 서식하는 장지뱀과 3종인 표범장지뱀(Eremias argus), 아무르장지뱀(T. amurensis), 줄장지뱀(T. wolteri)의 외부 형질에 대한 성적 크기 차이(SSD)를 알아보기 위하여 수행되었다. 외부 형질 중 주둥이-항문 길이, 꼬리 길이, 머리 길이, 머리 폭, 앞다리 길이, 뒷다리 길이와 같은 6개 부위를 중심으로 수컷과 암컷을 비교하였다. 머리-항문 길이는 student's t 검정을, 나머지 부위는 머리-항문 길이를 공변량으로 이용하여 공분산 검정을 수행하였다. 머리 길이와 꼬리길이는 일반적인 장지뱀과의 특성과 마찬가지로 한국산 장지뱀과 3종 모두 수컷이 암컷보다 긴 것으로 나타났다. 추가적으로 표범장지뱀은 머리 넓이, 앞다리 길이, 뒷다리 길이, 줄장지뱀은 머리 넓이에서 수컷이 암컷보다 길었다. 머리-항문 길이는 한국산 장지뱀과 3종 모두 암 수 사이에서 유의한 차이가 없었다. 머리-항문 길이의 SSD의 원인을 파악하기 위해서는 수컷간의 싸움과 암컷 머리-항문 길이와 한 배 산란수의 관계와 같은 생태학적 정보가 필요하다. 한국산 장지뱀과 3종에 대한 생태학적 연구가 계속 진행된다면 SVL에서 SSD가 일어나지 않은 이유를 설명할 수 있을 것이다.

팔체질침 전문 한의사의 체질침 효과에 대한 인식조사 (A Research on the Recognition of the Effect of Constitution-Acupuncture Based on the Expert Constitution-Acupuncture Oriental Medical Doctors)

  • 민재영;박영재;박재성;신용섭;박영배;이상철;김민용
    • 대한한의진단학회지
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    • 제11권1호
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    • pp.105-129
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    • 2007
  • Objectives: The purpose of this research is to obtain basic data about the effects of Constitution-Acupuncture (CA) based on Eight-Constitution Medicine (ECM) by the expert CA Oriental Medical Doctors. Methods: The resources were collected from the internet survey method. 35 samples were collected. The SPSS 13.0 for windows and Answer Tree 3.0 was used for statistical analysis. Results: The results from this research are as follow. 1. The motivation that apply ECM to clinic are 'Because ECM is effective for diagnosis, treatment and prevention against disease' 48.6% and 'Because CA therapy is effective' 25.7%. 2. The advantage that CA therapy compare to the other acupuncture therapy are 'Management and prevention against disease are available by ECM theory to a person who exact constitution is confirmed' 82.9%, 'CA therapy is superior in treatment of hard symptoms to treat by the other acupuncture therapy' 80%, 'Treatment effect is good' 77.1%, 'Needle manipulation of CA is simple comparatively' 57.1%, 'It is definite whether treatment effect is good or not' 54.3% and CA therapy is superior all in diseases of twelve category. 3. When the effects of CA is good, patients expressed much 'Eyesight lightened', 'Took deep sleep at night', 'Fatigue decreased', 'Body is light', 'Feelings became refreshing' as well as 'Symptoms were improved' and also physicians confirmed as those reactions whether treatment is effective. Conclusions: The research suggest that CA is effective therapy in clinic, and so further study is needed for CA therapy.

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수분 섭취 및 배설량의 측정방법에 관한 연구 (A Study on Fluid Intake and Output Measurements)

  • 최스미;양영희;정연
    • 대한간호학회지
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    • 제25권1호
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    • pp.88-98
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    • 1995
  • The Fluid and electrolytes balance in the body is of critical importance in maintaining good health. When the fluid and electrolyte imbalance is present, patients are in great danger. They must be assessed immediately by a nurse so that appropriate treatment can be started as soon as possible. Patients' fluid intake and output records contain highly important information for the diagnosis and treatment of fluid imbalance, but, these records are often inaccurate and the method of recording the fluid intake is not universal for every hospital. Be-cause they are few quantitative measurements of a patient's hydration, the need to improve the accuracy of fluid intake records is very important. However, very few studies have been done to investigate the accuracy of measurements of patients' fluid intake and output. The purpose of this study was to investigate the methods used for calculation of fluid intake which is most similar to fluid output in normal adults and hospitalized patients. This study focused on three different calculation methods for fluid intake and compared these to fluid output and developed suggestions as to the ideal way to record fluid in-take. Data for 43 hospitalized patients and 37 normal adults were analyzed. The findings of this study are as follows ; 1) In normal adults, the daily intake of water which enteres by the oral route was 2415m1 (the first method of calculation). The daily intake of water in the form of pure water or some other beverage was 1365m1 (the third method of calculation) The daily intake of water including fresh fruits and vegetables, rice, porridges, and Me m which have water content more than 80% were 2186m1 (the second method of calculation). 2) The urine output of the normal adults was 1350m1. This apprroximates the amount of fluid an adult takes in the form of pure water. 3) In patient group, the total intake of water was 2550m1 (the first method of calculation). The in-take of water in the form of pure water or as some other beverage and IV fluid was 1661m1 (the third method of calculation). The daily in-take of water including foods which have high water content was 2356m1 (the second method of calculation). 4) The urine output of the patient's group was 1728m1. This approximates the amount of fluid an adult takes in the form of pure water. 5) Investigation of the method of calculation of the patient fluid intake showed that among the 31 hospitals studied, only eight use the third method of calculation which reflects the most close value to urine output. From the results obtained in this study, it was indicated that the amount of fluid taken in the form of pure water reflects the most close value to urine output. Therefore, it can be suggested that the third method of calculation which includes water in-take only in the form of pure water or beverage should be used as patients' fluid intake record.

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여성건강을 위한 개념적 모형 (Conceptual Model for Women s Health)

  • 이경혜
    • 대한간호학회지
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    • 제27권4호
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    • pp.933-942
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    • 1997
  • There has recently been an increased interest in women's health from, various disciplines, with different perspectives presented according to each profession's academic background. This has led to many instances of incorrectly defining, or misinterpretation, of the issues even among professionals. Nurse scholars as well as practitioners who work in women's health care need to have a clear conceptual understanding of women's health in order to build a body of knowledge, delineate curricular activities, and set directions for professional nursing interventions. In addition, a conceptual model that may be directly utilized in practice is needed to maintain and promote women's health issues. The purpose of this study was to apply a Hybrid model, analyzing conceptual definitions and discussions related to women's health gathered from review of the literature. Further to compare analyticals the concepts and properties observed from field work, so as to present a final definition of women's health and, build a conceptual framework for a united comprehensive perspective on the concept as well as on nursing practice. Data collection and analysis consisted of a theoretical stage, field work stage, and final analysis. A heterogeneous group of professionals and lay persons, 39 in all, participated in the field work. Study findings Include several subconcepts under the concept of women's health : a woman's whole life, holistic health, quality of life, awareness of being a woman, individual nursing, self care ability, reproductive health, and family health. Thus, a comprehensive definition was built, 1. e., "Women's health care be defined as improvement in the quality of life of women through attainment of holistic health throughout the life span. With reproductive health at the core, the concept is directly related to family and national health, and includes taking care of one's own health based on awareness of being a woman and utilizing self care activities. Women's health care issues are unique and allow various responses, therefore women's health professionals need to apply individual approaches to reach solutions in attaining holistic health and improving quality of life." The constructual factors of women's health were found to be reproductive functions, diseases more common in woman, self actualization, mental health, women's health policies, sexuality, midlife changes, and marital relations, with each factor having more than three properties. Positive factors affecting women's health were found to be a normal childbearing process, a healthy lifestyle, active health management, health information, support, and resources, and interpersonal relationships. Negative factors were found to be overwhelming role stress, cultural oppression, gender inequality, distorted sexual identity, economic difficulties, misuse and/or abuse of substances, and stress. The model of women's health may be visualized as a balance scale set upon a woman's life, supporting 4 concentric circles. The innermost circle and second circle incorporate conceptual definitions of women's health, and the outer two circles represent the constructional factors and properties of women's health. Each circle has its own color that symbolizes the conceptual meaning. Positive and negative factors are represented as weights at either end of the scale, and are affected by nursing intervention, i. e., health and wellness increase when positive factors are stronger, whereas disease and illness increase when negative factors are stronger. This model is only a preliminary effort and requires much discussion and testing to be further developed. Continuous research is also required.

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환자 및 간호사가 지각하는 치료적인 병실분위기 조성의 저해요인에 대한 조사 연구 (A Study on the Disturbing Factors which Work against Therapeutic Atmosphere & Environment on Hospital Wards as Perceived by Patients and Nurses)

  • 김영혜;한명은
    • 대한간호학회지
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    • 제27권1호
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    • pp.178-188
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    • 1997
  • As a descriptive survey, this study was attempted to get basic data necessary to recognize the factors that disturb the therapeutic atmosphere of hospital wards as perceived by nurses and hospitalized patients, to identify differences between the perceptions of the nurses and of patients. The subjects, 159 patients in Pusan National Hospital and 68 nurses working there were sampled between March 18 and April 13, 1996. The tool used to measure the disturbing factors was an amended form of the one developed by Kim, Mae Ja(1983). The differences between each subject's score for each factor were analyzed using means & SD. and the highest 3 items above the mean score for each factor were collected and compared. The results are described below : 1. Subject's perception of main disturbing factors : patients reported that the main factors were 'loss of role & economic trouble', 'the prognosis of disease', 'the change of daily life' but nurses replied that the main factors were' the prognosis of disease', 'the communication trouble with the medical team & interpersonal relationships'. 'The change of daily life' was not a perceved factor by nurses, but ranked third by the patients. 2. Subject's perception degree of each disturbing factor : (1) among the items related to interpersonal relationship. the patient group reported that the worst disturbance was dur to severely ill patients in the same room' but the nurse group regarded 'greed to monopolize wheelchairs or other supplies' as the worst disturbance. (2) among the items related to physical factors. the patient group regarded 'limitations to wash their body, physical pain and limitations in physical activity' as the worst disturbance, but the nurse group regarded' physical pain', and 'limitations to activity or change of appearance' as the worst disturbance. (3) among the items related to the change of daily activity, the patient group regarded 'the boredom of hospitalization or infavorable diet' as the worst disturbance, but the nurse group regarded 'too much noise or unclean room' as the worst disturbance. (4) among the items related to the communication trouble with medical team, the patient group regarded 'the ignorance of their disease due to poor information. the inability to understand the language of the medical team or the difficulty in seeing physician in time' as the worst disturbance, but the nurse group regarded 'the inability to trust physicians and physician's poor attention to patients' as the worst disturbance.

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입원초기 영양불량 환자의 TPN 지침에 따른 영양개선 평가 (Evaluation of Nutritional Improvement by Total Parenteral Nutrition Guideline in Early Malnourished Inpatients)

  • 차윤영;김정태;임성실
    • 한국임상약학회지
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    • 제23권4호
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    • pp.365-372
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    • 2013
  • Background: Malnutrition of inpatients has been associated with higher morbidity, mortality, cost, and longer hospital stay. Total parenteral nutrition (TPN) therapy plays an important role in decreasing morbidity and mortality among critical inpatients in hospitals, and has been commonly used to improve clinical outcomes. However, only a few studies were conducted regarding patients' nutritional improvement by TPN. Method: This study therefore evaluated the changes in nutritional parameters by TPN therapy for early malnourished inpatients. Data from early malnourished inpatients who were treated with TPN therapy between January 2012 and June 2013 at the ${\bigcirc}{\bigcirc}$ university Hospital were studied retrospectively. Information regarding sex, age, underlying diseases, division, TPN (peripheral and central), and changes in nutritional parameters were collected by reviewing electronic medical records. The criteria for evaluation of the changes in nutritional parameters were included physical marker, body mass index (BMI), and biochemical markers, including albumin (Alb), total lymphocyte count (TLC), and cholesterol. Nutritional parameters were collected three times: pre-TPN, mid-TPN and end-TPN. A total of 149 patients (peripheral, 97; central, 52) was evaluated. Results: In all patients, the malnutrition number was significantly decreased following the complete TPN therapy (peripheral patients, pre-TPN: $3.33{\pm}0.12$, mid-TPN : $3.06{\pm}0.17$, and end-TPN: $2.85{\pm}0.21$ (p < 0.05); central patients, pre-TPN: $3.38{\pm}0.11$, mid-TPN: $3.06{\pm}0.13$, and end-TPN: $2.75{\pm}0.21$ (p < 0.05). The malnutrition number means number of nutrition parameters below normal range of malnutrition. In addition, all of the four nutritional parameters (BMI, Alb, TLC and cholesterol) were increased with duration of TPN periods for all patients, and the changes in the early stage were larger than in the late stage (p < 0.05). The nutritional parameters of non-cancer patients were increased to a greater extent compared to cancer patients with longer TPN therapy, but it was not significant. The nutritional parameters of younger patients (50-60 years) were also increased more than of older patients (70-80 years), but it was not significant. Conclusion: In conclusion, the TPN therapy decreases malnutritional status and improves nutritional parameters in malnourished patients, thereby decreasing morbidity and mortality. The combined evaluation of all four nutritional parameters is more accurate for nutritional assessment than a single one.