• 제목/요약/키워드: Mean Reaction Rate

검색결과 181건 처리시간 0.034초

Isofourane으로 마취된 개에 medetomidine, medetomidine-buprenorphine, medetomidine-fentanyl의 경막외 투여 시 심혈관계 반응과 진통효과의 비교 (Comparision of cardiovascular and analgesic effects of epidural administration of medetomidine, medetomidine-buprenorphine and medetomidine-fentanyl in dogs anesthetized with isoflurane)

  • 장화석;김혜진;최치봉;이정선;김휘율
    • 대한수의학회지
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    • 제47권1호
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    • pp.103-115
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    • 2007
  • The aim of this study was to compare the reaction of the cardiovascular system, and the anesthetic effect among 3 experimental groups, epidural administration of medetomidine as a single agent, the combination of buprenorphine and medetomidine, and the combination of fentanyl and medetomidine. Twenty one dogs were anesthetized with isoflurane and allowed to breathe spontaneously. Epidural, arterial, and venous catheters were inserted. The tip of epidural catheter was positioned at the level of the space between the sixth and seventh lumbar vertebra. After a stable plane of anesthesia was achieved, these dogs were each administered one of the following treatments epidurally : medetomidine $10{\mu}g/kg$ (Group M), a combination of medetomidine $5{\mu}g/kg$ and buprenorphine $10{\mu}g/kg$ (Group M/B), and a combination of medetomidine $5{\mu}g/kg$ and fentanyl $10{\mu}g/kg$ (Group M/F). Heart rate (HR), Respiratory rate (RR), End-tidal carbon dioxide (EtCO2), and arterial blood pressure were measured before drug administration (base line) and 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, and 60 min postinjection. Blood gas analysis was performed before injection and 5, 15, 25, 35, 45, 60 min postinjection. Isoflurane was discontinued 80 min postinjection and pain/motor function were evaluated up to 260 min postinjection every 15 min. At the early stage of drug introduction (until 5 min), the HR was decreased significantly in all 3 groups compared with base line. In Group M, HR was significantly decreased compared with the other 2 groups. With time (starting 20 min after drug introduction), the HR was decreased significantly in Group M/B in respect to base line. However, no significant difference was seen number-wise in all 3 groups. During 60 min after drug introduction, the systolic, diastolic and mean arterial pressures were highest in Group M and lowest in Group M/F. Among 3 groups, drug action and motor loss duration were longest in Group M/F. Analgesic effect observed in the M/F group was the most prominent and long-lasting, compared to those seen in the other 2 groups. Given the fact that the recovery of motor function takes place in a short period of time after analgesic effects disappeared, additional use of M/F depending on the patient's condition would be a good way to achieve effective pain management. However, proper care should be taken to ensure the function of cardiovascular system in the patient because the administration of M/F under isoflurane anesthesia results in a significant decline in arterial blood pressure ($65{\pm}10mmHg$).

단일맹검시험을 통한 대황(大黃) 상용량(常用量)의 독성작용 평가 (Evaluation on Toxicity of Habitual dose of Extract of Rheum Palmatum through Single Blinded Pilot Study)

  • 권혁;지규용;엄현섭
    • 동의생리병리학회지
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    • 제24권3호
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    • pp.390-400
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    • 2010
  • This study is aimed to test physiological and hematological actions of Rheum palmatum through clinical pilot study optimized for usual oriental medicine prescription. Thirty-one cases were finally collected and the sample extract 100 $m{\ell}$ of Rheum palmatum (ERP) was administered two times in a day during 3 days and checked with blood CBC test, urinalysis, liver function test, abdominal X-ray as well as general diagnostic process of oriental medicine; pattern identification, assessment of shapes and constitution. The total toxic effective rate of ERP was 9.68% in 3 cases of the whole in case of consistent uneasy state in the subjective symptomatic assessment and aggravation of blood and urine examination. The relevant diagnostic factors were so-eum constitution and essence type subject, carapaces species, lung type in the aspect of Jisan shape theory. On the other hand, the positive effective rate of ERP was 29.03% manifesting improvement of vital signs or present illness and no abnormal changes of blood chemistry and urinalysis and simple abdomen radiology. The relevant diagnostic factors were tae-eum constitution, energy type subject, aves species, heart and liver type in Jisan's shape theory. And the other cases were manifesting no specific change through the administration of ERP. The ratio of the numbers of decrease and increase was 44:5 in the tenderness and hardness of abdominal palpation. But if the pattern identification doesn't comply with the aim of rhubarb application despite of constipation and abdominal pain, the tendeness and biochemical report was shown in abnormal change. The mean number of diarrhea by ERP was $16.77{\pm}6.95$ during 3 days after administration, and the frequent areas of abdominal pain were lower>middle>upper in order, and it meant the target site of ERP too. Besides, the toxic reaction against ERP was expressed highly in case of decrease in blood cell count and hemoglobin, hematocrit having blood deficiency syndrome. Likewise, the toxicity of ERP was influenced by pattern identification manifesting present disease condition and diagnostic factors of four constitutions, Jisan's shape theory collaterally. In conclusion, evaluation of herbal toxicity in order for using as a clinical guideline, various diagnostic pattern information and shape features like the above should be studied together with other pharmacologic toxicology test for the future.

Pandemic Novel Influenza A (H1N1) Virus in Korea: The Experience from August to September 2009

  • Lee, Kyung-Ok;Park, Min-Young;Kim, Lyoung-Hyo;Seong, Hye-Soon;Park, Bo-Hyun;Jeong, Su-Jin
    • 대한임상검사과학회지
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    • 제41권4호
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    • pp.145-152
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    • 2009
  • Novel influenza A virus, subtype H1N1 of swine-lineage, has been transmitted rapidly to many regions of the world. Rapid detection of the virus is essential to instigate appropriate patient care and public health management and for disease surveillance. The aim of this study is to determine the prevalence of novel influenza A (H1N1) virus in Korea using reverse-transcription real time polymerase chain reaction (rRT-PCR). Novel H1N1 virus was detected in a total of 8,948 nasopharyngeal samples from patients with influenza-like illness throughout Korea from August to September 2009. RNA was extracted from $300{\mu}l$of sample using an RNA extraction kit (Zymo Research, CA, USA). In the present study, Genekam kit (Genekam, Duisburg, Germany) was used to detect novel H1N1 virus. Novel H1N1 virus was found in 1,130 samples from a total of 8,948 samples (12.6%). The highest frequency was found in 10- to 19-year-olds (M: 29.3% vs. F: 16.4%), followed by 20- to 29-year-olds (M: 17.9% vs. F: 15.4%), 40- to 49-year-olds (M: 6.5% vs. F: 8.1%), 50- to 59-year-olds (M: 6.0% vs. F: 5.5%), and 30- to 39-year-olds (M: 4.6% vs. F: 3.8%). The mean positive rate was higher in men than in women (M: 14.7% vs. F: 7.4%). Novel H1N1 virus showed the lowest prevalence in patients over 60 years old. The positive rate increased daily and showed a significant high peak in mid-September 2009. In 19 provinces of Korea, Cheonan (41.1%), Busan (37.3%), Gangneung (33.3%), Jinju (32.1%), Ulsan (24.6%), Deajeon (23.7%) areas showed high frequencies and other provinces were found less than 10% of novel H1N1 virus. Since reverse-transcription real time PCR assay is rapid, accurate, and convenient, it may assist public health laboratories in detecting novel H1N1 virus. Moreover, these data could be useful for the management of patients with influenza-like illness.

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딸기 인공 수분시 화분 활력 및 암술의 수정 능력이 결실률에 미치는 영향 (Effects of Pollen Viability and Pistil Receptivity on Seed Set for Artificial Pollination in Strawberry)

  • 김대영;윤무경;도경란;김태일
    • 한국육종학회지
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    • 제41권4호
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    • pp.496-501
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    • 2009
  • 저장조건을 달리한 딸기 화분을 FCR Test와 결실률을 바탕으로 하여 화분 활력을 조사하고 암술 주두 활력을 인공수분을 통하여 구명함으로서 딸기 교배 육종시 효율성을 높이고자 하였다. '설향'을 대상으로 화분 활력을 조사하였으며 암술 주두의 수정 능력은 '매향' 등 4품종을 공시하고 화분친은 '설향'을 사용하였다. 딸기 화분은 상대습도 33%이하의 건조한 조건에서는 처리 온도($18^{\circ}C$$22^{\circ}C$)와 관계없이 수일 동안 높은 활력을 유지하였다. 반면 상대습도가 높을수록 화분 활력의 감소가 컸으며 저장한지 7일차에 대부분의 화분이 활력을 상실하여 결실률이 급격히 감소하였고 이러한 경향은 $18^{\circ}C$보다 $22^{\circ}C$저장 조건에서 결실률이 더욱 불량하였다. 즉, 상대습도가 낮은 경우 화분 활력은 크게 감소하지 않았으며, 온도보다는 습도가 화분 활력을 결정하는 중요한 요인으로 작용하는 것으로 판단된다. 암술의 수정 능력은 품종간의 차이가 있었으나 시설 내부 일평균온도가 $15^{\circ}C$내외일때, 제웅 후 2일차부터 8일차까지 평균 77.2%이상으로 높게 유지되었다. 그러나 결실률은 제웅 후 10일차부터 점차 감소하기 시작하여 12일차 이후에는 일부 품종을 제외하고 급격히 감소하였다. 적산온도를 기준으로 하였을 때, 제웅 후 $45{\sim}140^{\circ}C$내외 범위에서 인공수분을 하는 것이 딸기 결실률을 향상 시킬 수 있을 것으로 판단된다.

반응셀 유도결합플라스마 질량분석분석기를 이용한 칼슘 동위원소비율의 측정과 동위원소희석법의 적용 (Application of Dynamic Reaction Cell - Inductively Coupled Plasma Mass Spectrometry for the Determination of Calcium by Isotope Dilution Method)

  • 서정기;임용현;황의진;이상학
    • 분석과학
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    • 제15권5호
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    • pp.417-426
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    • 2002
  • 반응셀이 장치된 유도결합플라스마 사중극자 질량분석기를 이용하여 자연적으로 존재하는 6개의 칼슘 동위원소의 검출특성에 관한 연구를 수행하였다. 동적반응셀 (dynamic reaction cell, DRC)장치를 이용한 실험에서 최적의 신호 대 잡음비를 얻기 위한 실험조건을 조사하였다. 본 실험을 통해서 반응기체로서 0.7 mL/min의 $NH_3$를 사용하고 rejection parameter (RPq)값을 0.6으로 사용함으로써, Ca의 질량위치인 m/z 40, 42, 43, 44, 46 그리고 m/z 48의 위치에서 잠재적인 간섭이온인 $Ar^+$, ${CO_2}^+$, ${NO_2}^+$, $CNO^+$ 등이 효과적으로 제거됨을 확인하였다. 검출한계는 동위원소 $^{40}Ca$, $^{42}Ca$, $^{43}Ca$, $^{44}Ca$, 및 $^{48}Ca$에 대해서 각각 1, 29, 169, 34, and 15 pg/g으로 얻을 수 있었다. 이러한 실험조건 하에서 국제비교분석을 위해서 영국의 LGC (Laboratory of the Government Chemistry, Queens Road, Teddington, England)로부터 공급된 합성식품분해물질 중의 Ca을 동위원소희석법을 적용하여 분석하였다. 동위원소희석법에 의한 측정의 불확도는 ISO/GUM과 EURACHEM지침서에 따라 평가하였다. 측정된 시료중의 Ca의 농도와 불확도는 ($66.4{\pm}1.2$) mg/kg이었다. 또한 본 실험방법의 유효성을 확인하기 위해 농도가 인증된 표준시료 NRCC (National Research Council of Canada)의 SLRS-3 (riverine water CRM)과 NIST (National Institute of Science and Technology)의 SRM1643d (trace element in water)를 분석하였다.

구충증(鉤蟲症)에 관(關)한 연구(硏究) 제1편(第1篇) 구충(鉤蟲)의 감염(感染) 및 구충성빈혈(鉤蟲性貧血)에 관(關)한 고찰(考奈) (Studies on Ancylostomiasis I. An Experimental Study on Hookworm Infection and Anemia)

  • 이문호;김동집;이장규;서병설;이순형
    • 대한핵의학회지
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    • 제1권1호
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    • pp.55-66
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    • 1967
  • In view of its prevalence in the Far East area, a more detailed knowledge on the hookworm infection is one of the very important medical problems. The present study was aimed to; determine the infectivity of the artificially hatched ancylostoma duodenale larvae in man after its oral administration, evaluate the clinical symptomatology of such infection, determine the date of first appearance of the ova in the stool, calculate the blood loss per worm per day, assess the relation-ships between the ova count, infectivity(worm load), blood loss and severity of anemia. An erythrokinetic study was also done to analyse the characteristics of hookworm anemia by means of $^{59}Fe\;and\;^{51}Cr$. Materials and Methods Ten healthy male volunteers(doctors, medical students and laboratory technicians) with the ages ranging from 21 to 40 years were selected as the experimental materials. They had no history of hookworm infection for preceding several years, and care was taken not to be exposed to reinfection. A baseline study including a through physical examinations and laboratory investigations such as complete blood counts, stool examination and estimation of the serum iron levels was done, and a vermifuge, bephenium hydroxynaphoate, was given 10 days prior to the main experiment. The ancylostoma duodenale filariform larvae were obtained in the following manner; The pure ancylostoma duodenale ova were obtained from the hookworm anemia patients and a modified filter paper method was adopted to harvest larger number of infective larvae, which were washed several times with saline. The actively moving mature larvae were put into the gelatine capsules, 150 in each, and were given to the volunteers in the fasting state with 300ml. of water. The volunteers were previously treated with intramuscular injection of 15mg. of chlorpromazine in order to prevent the eventual nausea and vomiting after the larvae intake. The clinical symptoms and signs mainly of the respiratory and gastrointestinal tracts, appearance of the ova and occult blood in the stool etc. were checked every day for the first 20 days and then twice weekly until the end of the experiment, which usually lasted for about 3 months. Roentgenological survey of the lungs was also done. The hematological changes such as the red blood cell, white blood cell and eosinophil cell counts, hemoglobin content and serum iron levels were studied. The appearance of the ova in the stool was examined by the formalin ether method and the ova were counted in triplicate on two successive days using the Stoll's dilution method. The ferrokinetic data were calculated by the modified Huff's method and the apparent half survival time of the red blood cells by the modified Gray's method. The isotopes were simultaneously tagged and injected intravenously, and then the stool and blood samples were collected as was described by Roche et al., namely, three separate 4-day stool samples with the blood sample drawing before each 4-day stool collection. The radio-activities of the stools ashfied and the blood were separately measured by the pulse-height analyser. The daily blood loss was calculated with the following formula; daily blood loss in $ml.=\frac{cpm/g\;stool{\times}weight\;in\;g\;of\;4-day\;stool}{cpm/ml\;blood{\times}4}$ The average of these three 4-day periods was given as the daily blood loss in each patient. The blood loss per day per worm was calculated by simply dividing the daily blood loss by the number of the hookworm recovered after the vermifuge given twice a week at the termination of the experiment. The iron loss in mg. through the gastrointestinal tract was estimated with the daily iron loss in $mg=\frac{g\;Hgb/100ml{\times}ml\;daily\;blood\;loss{\times}3.40}{100}$ 3.40=mg of iron per g Hgb following formula; Results 1. The respiratory symptoms such as cough and sputum were noted in almost all cases within a week after the infection, which lasted about 2 weeks. The roentgenological findings of the chest were essentially normal. A moderate degree of febril reaction appeared within 2 weeks with a duration of 3 or 4 days. 2. The gastrointestinal symptoms such as nausea, epigastric fullness, abdominal pain and loose bowel appeared in all cases immediately after the larvae intake. 3. The reduction of the red blood cell count was not remarkable, however, the hemoglobin content and especially the serum iron level showed the steady decreases until the end of the experiment. 4. The white blood cells and eosinophil cells, on the contrary, showed increases in parallel and reached peaks in 20 to 30 days after the infection. A small secondary rise was noted in 2 months. 5. The ova first appeared in the stool in 40. 1 days after the infection, ranging from 29 to 51 days, during which the occult blood reaction of the stool became also positive in almost cases. 6. The number of ova recovered per day was 164, 320 on the average, ranging from 89,500 to 253,800. The number of the worm evacuated by vermifuge was in rough correlation with the number of ova recovered. 7. The infectivity of ancylostoma duodenale was 14% on the average, ranging from 7.3 to 20.0%, which is relatively lower than those reported by other workers. 8. The mean fecal blood loss was 5.78ml. per day, with a range of from 2.6 to 11.7ml., and the mean blood loss per worm per day was 0.30ml., with a range of from 0.13 to 0.73ml., which is in rough coincidence with those reported by other authors. There appeared to exist, however, no correlation between the blood loss and the number of ova recovered. 9. The mean fecal iron loss was 2.02mg. per day, with a range of from 1.20 to 3.89mg., which is less than those appeared in the literature. 10. The mean plasma iron disappearance rate was 0.80hr., with a range of from 0.62 to 0.95hr., namely, a slight accerelation. 11. The hookworm anemia appeared to be iron deficiency in origin caused by continuous intestinal blood loss.

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Catecholamines에 관(關)하여 -제4편(第四編) : 심실전동발생(心室顫動發生)에 있어서의 catecholamines의 의의(意義)- (Role of Catecholamines in Ventricular Fibrillation)

  • 이우주
    • 대한약리학회지
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    • 제19권1호
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    • pp.15-35
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    • 1983
  • Although it has been well known that ventricular fibrillation is the most important complication during hypothermia, much investigation has failed to show the exact nature of the etiology of ventricular fibrillation. Recently, there has been considerable research on the relationship between sympathetic activity and ventricular fibrillation under hypothermia. Cardiac muscle normally contains a certain amount of norepinephrine and the dramatic effect of this catecholamines on the cardiac muscle is well documented. It is, therefore, conceivable that cardiac catecholamines might exert an influence on the susceptibility of heart muscle to tachycardia, ventricular fibrillation and arrhythmia, under hypothermia. Hypothermia itself is stress enough to increase tonus of sympatheticoadrenal system. The normal heart is supplied by an autonomic innervation and is subjected to action of circulating catecholamines which may be released from the heart. If the reaction of the heart associated with a variable amount of cardiac catecholamines is. permitted to occur in the induction of hypothermia, the action of this agent on the heart has not to be differentiated from the direct effects of cooling. The studies presented in this paper were designed to provide further information about the cardio-physiological effects of reduced body temperature, with special reference to the role of catecholamines in ventricular fibrillation. Healthy cats, weighing about 3 kg, were anesthetized with pentobarbital(30 mg/kg) intraperitoneally. The trachea was intubated and the endotracheal tube was connected to a C.F. Palmer type A.C. respirator. Hypothermia was induced by immersing the cat into a ice water tub and the rate of body temperature lowering was $1^{\circ}C$ per 5 to 8 min. Esophageal temperature and ECG (Lead II) were simultaneously monitored. In some cases the blood pH and serum sodium and potassium were estimated before the experiment. After the experiment the animals were killed and the hearts were excised. The catecholamines content of the cardiac muscle was measured by the method of Shore and Olin (1958). The results obtained are summarized as follows. 1) In control animal the heart rate was slowed as the temperature fell and the average pulse rates of eight animals were read 94/min at $31^{\circ}C$, 70/min at $27^{\circ}C$ and 43/min at $23^{\circ}C$ if esophageal temperature. Ventricular fibrillation was occurred with no exception at a mean temperature of $20.3^{\circ}C(21-l9^{\circ}C)$. The electrocardiogram revealed abnormal P waves in each progressive cooling of the heart. there was, ultimately, a marked delay in the P-R interval, QRS complex and Q-T interval. Inversion of the T waves was characteristic of all animals. The catecholamines content of the heart muscle excised immediately after the occurrence of ventricular fibrillation was about thirty percent lower than that of the pre-hypothermic heart, that is, $1.0\;{\mu}g/g$ wet weight compared to the prehypothermic value of $1.41\;{\mu}g/g$ wet weight. The changes of blood pH, serum sodium and potassium concentration were not remarkable. 2) By the adrenergic receptor blocking agent, DCI(2-3 mg/kg), given intramuscularly thirty minutes before hypothermia, ventricular fibrillation did not occur in one of five animals when their body temperature was reduced even to $16^{\circ}C$. These animals succumbed at that low temperature, and the changes of heart rate and loss of myocardial catecholamines after hypothermia were similar to those of normal animals. The actual effect of DCI preventing the ventricular fibrillation is not predictable. 3) Administration of reserpine(1 mg/kg, i.m.) 24 hours Prior to hypothermia disclosed reduced incidence of ventricular fibrillation, that is, six of the nine animals went into fibrillation at an average temperature of $19.6^{\circ}C$. By reserpine myocardial catecholamines content dropped to $0.045\;{\mu}g/g$ wet weight. 4) Bretylium pretreatment(20 mg/kg, i.m.), which blocks the release of catecholamines, Prevented the ventricular fibrillation under hypothermia in four of the eight cats. The pulse rate, however, was approximately the same as control and in some cases was rather slower. 5) Six cats treated with norepinephrine(2 mg/kg, i.m.) or DOPA(50 mg/kg) and tranylcypromine(10 mg/kg), which tab teen proved to cause significant increase in the catecholamines content of the heart muscle, showed ventricular fibrillation in all animals under hypothermia at average temperature of $21.6^{\circ}C$ and the pulse rate increased remarkably as compared with that of normal. Catecholamines content of cardiac muscle of these animals markedly decreased after hypothermia but higher than control animals. 6) The functional refractory periods of isolated rabbit atria, determined by the paired stimulus technique, was markedly shortened by administration of epinephrine, norepinephrine and isoproterenol. 7) Adrenergic beta-blocking agents, such as pronethalol, propranolol and sotalol(MJ-1999), inhibited completely the shortening of refractory period induced by norepinephrine. 8) Pretreatment with either phenoxftenbamine or phentolamine, an adrenergic alphatlocking agent, did not modify the decrease in refractory period induced by norepinephrine. From the above experiment it is possible to conclude that catecholamines play an important role in producing ventricular fibrillation under hypothermia. The shortening of the refractorf period of cardiac muscle induced by catecholamines mar be considered as a partial factor in producing ventriculr fibrillaton and to be mediated by beta-adrenergic receptor.

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천연색소 추출공정 최적화를 위한 반응표면분석법의 적용 (Application of Response Surface Methodology for Optimization of Nature Dye Extraction Process)

  • 이승범;이원재;홍인권
    • 공업화학
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    • 제29권3호
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    • pp.283-288
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    • 2018
  • 환경 친화적이고 질병을 유발시키지 않는 천연색소의 사용이 증가함에 따라 천연색소를 추출하는 다양한 방법이 연구되고 있다. 본 연구에서는 천연염료인 chlorophyll을 포함하고 있는 식물성 원료인 파슬리를 대상으로 천연색소를 추출하였다. 추출용매의 pH와 추출온도를 변수로 추출된 천연염료의 녹색계열의 목표색 코드 #50932C (L = 55.0, a = -40.0, b = 46.0)을 설정하고, 추출된 천연염료의 명도와 색좌표(L, a, b)의 정량적 수치로부터 색도분석을 수행하였다. 반응표면분석법에 의해 예측된 색도분석 중 색좌표 분석은 최적조건인 pH 8.0, 추출온도 $60.9^{\circ}C$에서의 이론적 수치 L (55.0), a (-36.3), b (36.8)를 나타냈고, 실제 실험으로 확인한 결과 L (69.0), a (-35.9), b (31.4)를 나타내, 이론 정확도 73.0%, 실제오차율은 13.8%로 확인되었으며, 색차분석의 ${\Delta}E$의 이론 최적화 값은 pH = 9.2 추출온도 $55.2^{\circ}C$에서 ${\Delta}E$ (12.4)이었고, 실제 실험의 경우 ${\Delta}E$ (13.0)로 나타났다. 색차 분석의 이론정확도 97.5% 및 실제 오차율은 4.5%를 나타냈다. 하지만, 색좌표의 조합이 목표색에 근사한 색을 나타내지 않았고, 단지 산술기하 평균적으로서 목표색에 근사함을 나타냈다. 따라서 천연염료 추출공정에 반응표면분석법을 적용시킬 경우 반응치로 색차 ${\Delta}E$에 비해 색좌표(L, a, b)를 이용하는 것이 색소추출공정의 최적화에 더 우수한 방법인 것으로 사료된다.

자궁적출술 환자를 위한 critical pathway 개발과 적용효과 (Critical Pathway Development for the Hysterectomy Patients and its applied Effect)

  • 노기옥;박경숙
    • 여성건강간호학회지
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    • 제6권2호
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    • pp.234-257
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    • 2000
  • At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

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Fibricola seoulensis와 요꼬가와흡충에 혼합 감염된 흰쥐에서 충체 회수율과 소장 병변 (Worm recovery rate and small intestinal lesions of albino rats coinlected with Fibricola seoulensis and Metaqonimus yokogawai)

  • 홍성종;우호춘
    • Parasites, Hosts and Diseases
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    • 제31권2호
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    • pp.109-116
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    • 1993
  • Fibriuraseouensis와 요꼬가와흡충을 흰쥐에 혼합감염시키고 충체 회수율과 소장 병 변을 각 충체를 단독 감염시켰을 때와 비교하였다. 동시 감염군은 흰쥐 한 마리에 두 흡충의 피낭유충을 각각 1,000개씩 감염시키고 20일 후에 도살하였다. 도전 감염군은 F. seoulensis 피낭유충을 1,000개씩 감염시키고 10일 후에 요꼬가와흡충 피낭유층 1,000개씩으로 도전 감염 시켰으며 그 10일 후에 도살하였다. 동시 감염 군에서 F. seoulensis와 요꼬가와흡충은 각각 평균 250마리와 118 마리가 회수되어 단독 감염군과 아주 비슷하였지만 F.seoulensis의 경우 십이지장에서 평균 223마리로 단독 감염 군보다 높았으며 공장에서는 26마리로 낮았다. 도전 감염군에서 F. seoulensis의 총 충체 회수율은 단독 감염군과 비슷하였으며 부위별로는 동시 감염군과 같았으나 요꼬가와흡충은 평 균 69마리가 회수되어 단독 감염 군보다 현저히 낮았으며 십이지장에서 평균 7마리, 공장에서 평균 45마리, 회장에서 평균 17마리가 회수되어 기생부위가 넓어겼고 공장보다 회장에서 더 많은 충체가 회수된 단독 감염군과 달랐다. 동시 감염군에서 십이지장의 융모는 비후, 융합, 단축이 흑 seodenis 단독 감염군에 비하여 매우 심하였으며 선와 상피세포가 과증식되었으나 기질층의 염증 세포 침윤은 덜했다. 공장과 회장의 융모 위축은 요꼬가와흡충 단독 감염 군보다 가벼웠다. 도전 감 염군은 동시 감염군과 유사하였으나 십이지장의 선와 상피세포 증식은 심하지 않았으며 공장과 회장의 접막하조직에 염증반응이 있었다. 이상의 결과로 미루어 볼 때 소장 상부에 먼저 기생하고 있는 F. seoulensis는 소장응모의 위축과 염증을 일으켜 나중에 감염되는 요꼬가와흡충에게 불리한 환경을 조성함으로써 이 흡충이 소장 하부에 정착하는데 영향을 미친다고 생각된다.

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