• 중환자간호학회지
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• 제11권2호
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• pp.11-20
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• 2018

Purpose : This study aimed to investigate the incidence of intravenous extravasation and the risk factors associated with the use of peripheral intravenous catheters in adults. Method : This prospective observational study included 203 adult patients admitted to the general ward who received non-chemotherapy vesicant drug infusion treatments. Data were analyzed using frequencies, percentage, means, standard deviations, and odds ratios (ORs) from multiple logistic regressions. Results : The incidence of extravasation was 43.3%. Risk factors for intravenous extravasation included continuous injections (OR=5.35, 95% CI [1.38, 20.83]), and parenteral nutrition (OR=3.53, 95% CI [1.43, 8.73]). Conclusion : The present findings revealed that gastrointernal medicine problems, continuous injection, and parenteral nutrition were related to intravenous extravasation. Further research is necessary to reduce the incidence of extravasation related to peripheral intravenous catheterization in adults, and to prevent secondary complications. Finally, patients should be provided appropriate and continuous care based on the type of intravenous infusion.

• Neonatal Medicine
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• 제16권2호
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• pp.121-130
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• 2009

Over the past 20 years, neonatal mortality rates for preterm infants, particularly those born extremely preterm and with a very low birth weight, have decreased steadily. As more very immature preterm infants survive, provision of enteral feeding has become a major focus of concern. According to many experts on neonatal nutrition, the goal for the nutrition of preterm infants should be to achieve a postnatal growth rate approximating that of a normal fetus of the same gestational age. Total parenteral nutrition for maintaining nutritional integrity is mandatory before successful transition to enteral feeding. Early initiation of trophic enteral feeding is vital for postnatal adaptation. Recently published randomized controlled trials provide no evidence to support the practice of postponing enteral feeding to reduce the incidence of necrotizing enterocolitis. Early trophic feeding yields demonstrable benefits and there is currently no evidence of any adverse effects following early feeding. Preterm milk from the infant's own mother is the milk of choice, which can always be supplemented with a human milk fortifier. Here we review over 50 randomized controlled trials and over seven systematic reviews published on neonatal parenteral and enteral feeding of preterm infants. Neonatologists must make use of the evidence from these studies as a reference for feeding protocols for preterm infants in their NICUs are to be based.

• 약학회지
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• 제41권5호
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• pp.607-614
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• 1997

Flurbiprofen- and flurbiprofen axetil-loaded microemulsions composed of soybean oil, poloxamer 407, glycerine and water were prepared by generator-type homgenizer and ultrasoni c probe system. The particle size of microemulsions was measured by the dynamic light scattering method. The pharmacokinetics and organ distribution of flurbiprofen were investigated after intravenous injection of flurbiprofen solution, flurbiprofen-loaded microemulsion and flurbiprofen axetil-loaded microemulsions equivalent to 10mg/kg of flurbiprofen to rats. Blood samples were collected from the anterior ciliary artery of rats for 24hr, and flurbiprofen in plasma and organs was analyzed by HPLC. Stable microemulsions were prepared. Even though there is a little change in droplet size just after the preparation, no creaming and no separation were occured during the storage period for 6 months at 4, 21, 37 and 45$^{\circ}C$. Pharmacokinetic parameters and organ distribution of flurbiprofen after intravenous injection of flurbiprofen- and flurbiprofen axetil-loaded microemulsions emulsified with poloxamer 407 were not significantly different from those of commercial lipid microemulsion emulsified with lecithin. Therefore, it is concluded that flurbiprofen- and flurbiprofen axetil-loaded microemulsion prepared with poloxamer 407 could be used as a parenteral formulation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권5호
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• pp.493-499
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• 2019

Thiamine (vitamin $B_1$) is a water-soluble vitamin that is not endogenously synthesized in humans. It is absorbed by the small intestine, where it is activated. Its active form acts as a coenzyme in many energy pathways. We report a rare case of thiamine deficiency in a 3.5-year old boy with short bowel syndrome secondary to extensive bowel resection due to necrotizing enterocolitis during his neonatal age. The patient was parenteral nutrition-dependent since birth and had suffered from recurrent central catheter-related bloodstream infections. He developed confusion with disorientation and unsteady gait as well as profound strabismus due to bilateral paresis of the abductor muscle. Based on these and a very low thiamine level he was diagnosed and treated for Wernicke encephalopathy due to incomplete thiamine acquisition despite adequate administration. He fully recovered after thiamine administration. After 1999 eight more cases have been reported in the PubMed mostly of iatrogenic origin.

• 임상간호연구
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• 제27권1호
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• pp.77-84
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• 2021

Purpose: Malnutrition affects all age groups, but older adults are particularly more vulnerable to nutritional deficiencies. This study evaluated the age-specific factors affecting malnutrition in hospitalized older adults. Methods: A retrospective study was conducted on inpatient elderly people who received artificial nutrition from 2010 to 2017. Data of demographics, diagnosis, type of nutrition therapy, number of comorbidity, fall risk assessment, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and intensive care unit admission were collected. Malnutrition was defined as a body mass index (BMI) of less than 18.5 kg/m². Patients were classified as the young-old (65~74 years old), the old-old (75~84 years old), or the oldest-old (85 years old or older). Results: A total of 7,130 older adults were included, and 4,028 patients were classified as the young-old, 2,506 into the old-old, and 596 into the oldest-old. Proportion of malnutrition was higher in the oldest-old compared to the other groups. In multivariate analysis, parenteral nutrition, alcohol, and high risk of falls were factors affecting malnutrition in all groups. Parenteral nutrition and alcohol in the young-old, high risk of falls in the old-old, and male sex in the oldest-old were the factors affecting malnutrition by the age group. Conclusion: Older age was the most significant factor affecting malnutrition. Specific strategies by age are needed to improve nutritional status in hospitalized older adults as influencing factors for malnutrition vary among different age groups.

• 한국임상약학회지
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• 제15권1호
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• pp.9-20
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• 2005

Cholestatic liver disease is a frequent complication of prolonged parenteral nutrition, especially in premature infants. Numerous factors have been cited as contributing to TPN associated cholestasis. However the exact etiology remains obscure. Ursodeoxycholic acid (UDCA) has been reported to be beneficial far children and adults with various chronic cholestatic liver disease. The aim of this prospective, randomized, double-blind, placebo-controlled study was to determine the preventive effects of UDCA administration during TPN. Seventeen pediatric patients (8 boys and 9 girls) undergoing TPN were assigned randomly to two groups, UDCA and placebo group. UDCA group (n=9) received 15 mg/kg/day UDCA and placebo group (n=8) received 15 mg/kg/day placebo enterally during the TPN period. Liver function tests (total bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase) were per-formed before TPN and weekly or three times a week. The patients' weights, complete blood count, composition of TPN, and the infusion rate of TPN and lipid were monitored everyday. Calcium and phosphate were monitored twice a week. Between the UDCA and placebo groups, there were no differences in weight at the onset of TPN, birth weight, duration of TPN, respiratory distress syndrome associated with prematurity, age at the onset of TPN, gestational age, the number of days the patients received antibiotics, the number of patients received enteral nutritions and the composition of TPN. In contrast, there was a significant difference between the UDCA and placebo groups in alanine aminotransferase levels during TPN. It doesn't seem that UDCA administration during TPN correlates directly with improvement of liver function. But the preventive administration of UDCA may be effective in reducing liver enzyme, alanine aminotransferase and has no adverse effects.

• Journal of Pharmaceutical Investigation
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• 제31권3호
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• pp.151-160
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• 2001

The purpose of this study is to investigate the interaction of progesterone with various cyclodextrins (CDs) in the aqueous solution and in solid state, and finally to formulate a parenteral aqueous formulation. CDs used were ${\alpha}-$, ${\beta}-$, and ${\gamma}-CD$, $2-hydroxypropyl-{\beta}-CD$ (HPCD), sulfobutyl $ether-{\beta}-CD$ (SBCD), $dimethyl-{\beta}-CD$ (DMCD) and $trimethyl-{\beta}-CD$ (TMCD). The solubility studies of progesterone were performed in the presence of various CDs as a function of concentration or temperature. The solubility of progesterone increased in the rank order of ${\alpha}-CD$ < ${\beta}-CD$ < ${\gamma}-CD$ < TMCD$ < HPCD < DMCD < SBCD. Addition of SBCD (200 mg/ml) in water increased the aqueous solubility $(9.36\;{\mu}g/ml)$ about 3,200 times, and lowering the temperature facilitated the solubilization of progesterone. However, the addition of HPCD and SBCD in 20:80 (v/v) polyethylene glycol 300-water and propylene glycol-water cosolvents markedly decreased the solubility of progesterone, compared with solubilizing effects in water. Physical mixtures and solid dispersions of progesterone with HPCD or SBCD were prepared, and evaluated by differential scanning calorimetry (DSC), Fourier-transform infrared spectroscopy (FT-IR), near IR spectroscopy and dissolution studies. By DSC and IR studies, it was found that progesterone was dispersed in HPCD in monotectic state and dissolved rapidly from both solid dispersions. Based on solubility studies, new aqueous progesterone fonnulations (5 mg/ml) containing SBCD (200 mg/ml) could be prepared and did not form precipitates even after 2 months at $4^{\circ}C$. The solution was transparent when mixed with normal saline and 5% dextrose injection at 1: 1, 1:10 and 1:20 (v/v) even after 7 days. Permeation rates of progesterone through a cellulose membrane from 20% PEG 300 solution $(50\;{\mu}g/ml)$ containing HPCD or SBCD were compared with oily formulation. Permeation of progesterone from oily formulation did not occur up to 8 hr, but aqueous formulations showed fast permeation rates from early stage of permeation study. The addition of HPCD or SBCD retarded the permeation rates of progesterone with the increase of CD concentrations, suggesting the possibility of a controlled absorption from the site administered intramuscularly. These results demonstrate that it is feasible to develop a new progesterone parenteral aqueous injection (5 mg/ml) using SBCD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권2호
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• pp.122-129
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• 2008

목 적: 만성 설사, 흡수 장애 등의 소화기 질환에서 경구 영양 공급이 불충분할 경우 미량원소 결핍 발생의 빈도가 높으나, 이러한 환아에서 미량원소 결핍 증상에도 불구하고 혈액 검사 결과 정상으로 나타나기도 한다. 따라서 미량원소 결핍 고위험군 환아에서 결핍된 미량원소를 확인하고, 적절한 공급 및 추적 관찰 지표로서 모발 검사의 유용성을 알아보고자 하였다. 방 법: 서울대학교 어린이병원에 내원하여 만성 소화기 질환으로 경구 영양 장애 또는 성장 발육 부전을 보였던 13명을 대상으로 모발과 혈액의 미량원소 검사를 시행하여, 결핍 소견을 보인 모발과 혈액의 미량원소에 대해 장기 정맥영양군과 경구영양군, 그리고 증상군과 무증상군으로 나누어 비교, 분석하였다. 결 과: 전체 13명 중 11명에서 모발 또는 혈액 검사에서 미량원소 결핍이 있었으며, 결핍된 미량원소는 아연, 셀레늄, 구리였다. 모발 내 아연 결핍은 8명(62%), 모발 내 셀레늄 결핍은 6명(46%)이었고, 혈액 내 아연농도가 정상인 환자의 67% (8/12명), 혈액 내 셀레늄 농도가 정상 환자의 57% (4/7명)에서 각각 모발 내 아연, 모발 내 셀레늄 결핍을 보였다. 모발 내 아연 농도는 장기 정맥영양군에서 경구영양군에 비해 유의하게 낮았으며(p=0.015) 결핍 발생 빈도 또한 유의하게 높았다(Fisher's exact test, p=0.032). 모발 내 셀레늄 농도는 증상군에서 무증상군에 비해 유의하게 낮았다(p=0.034). 결 론: 만성 소화기 질환으로 경구 영양 장애 또는 성장 발육 부전이 있을 경우 증상 여부에 상관없이 혈액검사와 함께 모발 미네랄 검사로 결핍 여부를 평가하는 것이 필요할 것으로 보인다.

• The Korean Journal of Pain
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• 제6권2호
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• pp.213-219
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• 1993

수술후 통증관리에 있어서 경막외 buprenorphine의 유용성을 알아보기 위하여 상복부 수술을 받은 환자에 있어서 morphine 2 mg 및 4 mg, buprenorphine 0.15 mg, 및 0.3 mg을 경막외로 각각 투여하여 혈압과 맥박의 변화, 작용발현기간, 작용 지속 시간, 부작용의 발생을 관찰하여 다음과 같은 결과를 얻었다. 1) 모든 군에서 혈압 및 맥박의 유의한 변동은 초래하지 않았다. 2) 작용 발현은 morphine 2 mg군에서는 약물 주입후 30분에, 나머지 군에서는 15분에 유의하게 나타났다. 3) 진통 지속 시간은 morphine 2 mg 군에서는 $10.79{\pm}3.64$시간이었고, morphine 4 mg군에서는 $21.13{\pm}4.36$시간, buprenorphine 0.15 mg군에서는 $15.19{\pm}3.12$시간, buprenorphine 0.3 mg군에서는 $33.94{\pm}3.97$시간이었다. 4) 부작용의 발생은 buprenorphine군에서 오심, 구토가 많았으며, 졸림증이 현저하게 많았고, 소양감과 배뇨 곤란은 morphine군에서 많았다. 이상의 결과로 수술후의 통증관리에 있어서 경막외로의 buprenorphine주입은 유용한 방법이며, 경막 외 morphine에 비해 장점과 단점을 아울러 포함하고 있다고 사료된다.

• Journal of Clinical Nutrition
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• 제10권2호
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• pp.45-50
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• 2018

Purpose: Intense multidisciplinary team effort is required for the intestinal rehabilitation of patients afflicted with the short bowel syndrome (SBS). These include enteral and parenteral nutrition (PN) support, monitoring of complications related to treatment, and considering further medical or surgical options for intestinal adaptation. Methods: In the Intestinal Rehabilitation Team (IRT) at the Samsung Medical Center, we have experienced 20 cases of adult SBS requiring multidisciplinary intestinal rehabilitation. This study is a retrospective review of the collected medical records. Results: Of the 20 subjects treated, 12 patients were male and 8 patients were female. At the time of referral to the IRT, the mean age was 51.5 years, and the mean body weight was 50.1 kg, which was 90% of the usual body weight. The diseases or operative managements preceding massive bowel resection were malignancy in 11 cases, cardiac surgery in 2 cases, trauma in 2 cases and one case, each of tuberculosis, corrosive esophagitis, atrial fibrillation, simultaneous pancreas and kidney transplantation, and perforated appendicitis. Of these, there were 14 survivals and 6 mortalities. The fatalities were attributed to progression of disease, intestinal failure-associated liver disease, and sepsis (unrelated to intestinal failure) (2 cases each). Among the 14 surviving patients, 8 patients have been weaned off PN, whereas 6 are still dependent on PN (mean PN dependence 36%). Conclusion: This paper reports the results of multidisciplinary intestinal rehabilitation of adult short bowel patients treated at the Samsung Medical Center. Further studies are required to improve survival and enteral tolerance of these patients.