• Journal of Chest Surgery
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• 제19권1호
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• pp.35-42
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• 1986

Prevention of thrombombolism after rosthetic cardiac valve replacement is essential for the patients. About 90% of patients are free of major and minor thromboembolic complications 5 year after replacement of cardiac valves with prosthetic devices when they are under control of anticoagulant therapy. Ticlopidine is a drug that alter platelet function to have an antithrombotic effect. It is an antiaggregating agent which inhibits primary platelet function to have an antithrombotic effect. It is an antiaggregating agent which inhibits primary platelet aggregation induced by ADP and increases the production of prostaglandin $D_{2}$. Aspirin in small doses inhibits platelet synthesis of prostaglandins by irreversibly blocking the enzyme cyclo-oxygenase. Platelet secretion and aggregation are impaired with Ticlopidine and Aspirin. the thromboembolic event sof 54 patient s who were treated with Ticlopidine and Aspirin after cardiac valve replacement were evaluated and compared with that of 79 patients who were treated with Wafarin and Aspirin after the same type of operation. The follow-up period ranged from 4 to 110 months (mean of 48 months). there were 11 major thromboembolic episodes including three deaths in the warfarin goup during mean follow-up period of 56 months. two cases of CVA and one hemoarthrosis were noted due to overdose of Warfarin. Inticlopidine group, there was only one fatal thromboembolic epdisode three month after mitral valve replacement during mean follow-up period of 18 months. Two episodes of hypermenorrhea resulting anemia ere noted in the ticlopidine group. We measured the parameters of platelet function in aggreagation curve of platelet with platelet aggregometer (chrono-log Aggregometer, Model No. 430) Aggregation test was performed with three final concentrations of epinephrine in 10 uM/L, ADP in 5uM/L. 28 patients with prosthetic cardiac valves and 35 healthy volunteers were subgrouped as follows to analyze the effect of antithrombotic drugs used. Group I ; 11 patients treated with 250-500 mg of ticlopidine and 0.5gm of Aspirin as a daily single dose after cardiac valve replacement (14 St. Jude Medical and 1 Carpentier-Edwards, 9 patients with atrial fibrillation among them) Group II ; 10 patients treated with 3-5 mg of Warfarin and 0.75 gm of Aspirin daily to prolong prothrombin time around 20 seconds for more than 6 months and single Aspirin dose was maintained afterward as a life-long regimes(3 St. Jude Medical, 1 Hall-Kaster and 7 Carpentier-Edwards valve, 9 patients in atrial fibrilation). Group III ; 7 patients who quit anticoagulant treatment (Warfarin + Aspirin) 6-12 months after the regime as group II (3 St. Jude Medical. 1 bjork-Shiley, 1 Hall-Kaster, 3 Carpentier-Edwards valve, 2 of them are with atrial fibrillation). Group IV ; 35 healthy vounteers (28 males and 7 females). The following results were obtained. 1. The mean maximal platelet aggregability in Group I induced by 10uM/L epinephrine was 15.6%, and 17.5 and 18.7% in BM in proportion to the induction by 5 and 10 uM/L ADP. 2. The mean maximal platelet aggregability in Group II induced by 10uM/L epinephrine was 16.5%, and 27.4 and 44.7% in BM in proportion to the induction by 5 and 10uM/L ADP. 3. The mean maximal platelet aggregability in group III induced by 10uM/L epinephrine was 65%, and 56.5 and 51.8% in BM in proportion to the induction by 5 and 10 uM/L ADP. 4. The mean maximal platelet aggregability in the normal subjects induced by 10 uM/L epinephrine was 64%, and 65 and 69% in Bm inproportion to the induction by 5 and 10 uM/L ADP. 5. Reversible change of platelet aggregation curve induced by 5 and 10uM/L was noted all of the patients in Group I. conclusion : Ticlopidine is an antiaggregating agent which inhibits primary platelet aggregation induced by ADP, and increases the production of prostaglandin $D_{2}$. Ticlopidine and Aspirin produced a significant inhibition of platelet in the presence of ADP and epinephrine in our study. Acccording to our brief experience, 250 mg of ticlopidine and low dose of Aspirin resulted synergistic superior effect to each drug alone in prevention of thromboembolism after prosthetic cardiac valve replacement.

• 한국철학논집
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• 제43호
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• pp.9-32
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• 2014

조선 도가사상 연구는 지금까지 조선후기를 중심으로 다루어져 왔다. 조선시대 5권의 "노자" 주석서와 2권의 "장자" 주석서가 모두 임진왜란 이후의 작품이기 때문이다. 따라서 본 논문은 조선전기의 도가사상 전개를 고찰하기 위한 1차 작업으로 개국초기의 사상적 기반이 되었던 정도전의 "심기리편"과 "조선왕조실록"의 "태종실록"에서 임란 이전까지 200여년 간의 사료 안에서 도가 사상에 대한 언급을 발췌하고 이를 분석하였다. 이를 통해 다음과 같은 연구결과를 도출하였다. 정도전과 권근은 도가를 '도덕이 없는 양생술의 추구'로 비판하였다. 도교와 불교의 비판 위에서 성리학의 정체성을 확립하고자 한 것이다. 이후 "조선왕조실록"에서 도가는 세 가지 단계로 변용(變容)된다. 첫째는 '노자'를 장생의 사술, 신선의 방술, 도교의 최고 신으로 환치시켜 이단시하고 배척하는 단계이다. 둘째는 1차적인 배척의 논의에서 벗어나 도가사상의 핵심으로서의 "노자"와 '신선술' 및 기복신앙의 대상이 되는 '도교 신'인 '노자'와 분리해서 보려는 단계이다. 셋째 3차 논의는 "노자"의 정치술과 처세술에 대한 존숭으로 드러난다. 즉 조선 전기 도가 사상은 건국초기에서 15~16세기에 이르기까지 초기의 강력한 벽도불에서 벗어나 다양한 스펙트럼을 가지고 전개된다. 이러한 점은 조선 전기의 도가를 단순히 성리학의 도통관에 따른 이단논리로 해석할 수 없는 지점이다. 건국 초기의 벽이단론에서 도가에 대한 온정적 태도를 취하게 되고, 유학과 사상적으로 융합되는 처세술과 정치술을 수용하는 변화를 보인다. 즉 '노자(老子)'는 비도덕적인 장생불사(長生不死)의 탐욕을 가진 이단(異端)에서 유교국가의 처세술과 정치술로 수용되는 것이다. 이러한 수용은 조선 후기로 가면 도가서(道家書)에 대한 적극적 해석의 모습으로 드러난다.