• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.115-125
• /
• 2014

Purpose: Stable vital signs (SVSs) are thought to be the most important criteria for successful non-operative management (NOM) of blunt spleen injury (BSI). However, a consistent definition of SVSs has been lacking. We wanted to evaluate the diversity of the definitions of SVSs by using a nationwide survey. Methods: A questionnaire regarding the definition of SVSs was sent to the trauma surgeons working at the Department of Trauma Surgery and Emergency Medicine at a level-I trauma center between October 2011 and November 2011. Data were compared using analyses of the variance, t-tests, ${\chi}^2$ tests and logistic regressions. Results: Among 201 surgeons, 198 responded (98.2%). Of these 198 responses, 45 were incomplete, so only 153 (76.1%) were analyzed. In defining the SVSs, significant diversity existed on the subjects of type of blood pressure (BP), cut-off value for hypotension, technique for measuring BP, duration of hypotension, whether or not to use the heart rate (HR) as a determinant, cut-off value of hypotension when the patient had a comorbidity or when the patient was a child. Of the 153 surgeons whose responses were analyzed, 91.5% replied that they were confused when defining SVSs. Conclusion: Confusion exists regarding how to define SVSs. Most surveyed surgeons felt that a need existed to clarify both the definition of SVSs and the use of SVSs to determine hemodynamic stability for NOM.

• 한국생활과학회지
• /
• 제15권6호
• /
• pp.1037-1047
• /
• 2006

In this paper, various structures of the healthcare smart clothing for real-time measurement of vital sign were suggested. The wearing efficiency was evaluated to find out the best ergonomic clothing in the suggested design. The supplementary effects of the clothing components (princess line, double fabric, cushion) on the stable and tight positioning of sensors to the body were evaluated with wear test. Five experimental clothing for male subject were made with closely-fitted shape and they included two representative structure: one was the integrated type of inner and outer garments and the other was the separated type with two garments. Eight subjects in their twenties were participated in the wear test to evaluate the wearing efficiency of experimental clothing. As results, the clothing structure of the separated garments with the inner and the outer shells were evaluated as more efficient and comfortable. However, the effects of clothing components on the light positioning of the sensors to the body surface were not differentiated each other in the subjective evaluation.

• 한국산학기술학회논문지
• /
• 제16권2호
• /
• pp.1189-1199
• /
• 2015

본 연구의 목적은 산부인과 전신마취 수술환자의 불안과 활력징후에 선호음악이 미치는 효과를 검증하는 것이다. 연구 설계는 비동등성 대조군 전후 시차설계이다. 연구기간은 2013년 5월 1일부터 7월 30일까지이며, 대상자는 W대학병원의 산부인과 수술환자로 실험군 21명, 대조군 23명, 총 44명이다. SPSS Win 18.0을 활용하여 Repeated measures ANOVA로 자료를 분석하였다. 연구 결과 선호음악을 제공받은 실험군과 제공받지 않은 대조군 간의 불안은 수술실 입실 시와 마취직전 사이 및 마취 직전과 의식 회복 후(p=.003; p=.011)의 시점에서 유의한 차이를 보였다. 수축기 혈압은 의식 회복 후와 회복실 퇴실 시 사이에 유의한 차이를 보였으며(p=.023), 맥박은 마취 직전과 의식 회복 후 사이에서 유의한 차이가 있었다(p=.016). 향후 선호음악 요법은 산부인과 전신마취 수술환자의 불안 감소 및 안정된 활력징후를 유지를 위한 효과적인 간호중재로 적용될 수 있다.

• Journal of Trauma and Injury
• /
• 제30권2호
• /
• pp.47-50
• /
• 2017

A 21-year-old male visited our emergency room. He could not remember the mechanism of injury. He was found beside a motorcycle. Initial vital sign was stable. Observation and conservative treatment were planned at the intensive care unit (ICU). On the third day at ICU, he complained sudden flank pain. It was colicky and hard to control. Without the pain, he had no specific symptom, sign, or laboratory findings. On computed tomography, renal pelvis was filled with hematoma which induced hydronephrosis. Double-J catheter and percutaneous nephrostomy was implemented by an intervention radiologist. Hematome in the renal pelvis was aspirated during the procedure. Symptom of the patient was subsided after the procedure. He was discharged without specific complications.

• 대한치과마취과학회지
• /
• 제7권2호
• /
• pp.120-125
• /
• 2007

Background: Propofol has been used extensively for short-acting intravenous sedative agent during monitored anesthesia care (MAC). This study was designed to evaluate the safety and availability of MAC using propofol in implant surgery of the one-day admission patients. Methods: In this study, subjects were divided into two groups according to ASA physical status. The heart rate, blood pressure, peripheral oxygen saturation and ECG of a patient were estimated under MAC by an anesthesiologist and the vital signs were recorded in recovery room periodically afterwards. The subjective satisfaction with regard to outpatient ambulatory surgery under MAC procedure was evaluated the next day. Results: Systolic and diastolic blood pressure were significantly decreased during MAC in ASA I group, but other remarkable changes in vital sign were not observed. There was no significant difference in pain and anxiety level between ASA I and ASA II, III group. Satisfaction rate was high in both groups. Conclusion: Monitored-Anesthesia Care using propofol during implant surgery of the one-day admission patients might be safe and available procedure because heart rate, blood pressure and oxygen saturation are stable before and during surgery, and adequate control of pain and anxiety is supported.

• Advances in pediatric surgery
• /
• 제14권1호
• /
• pp.37-47
• /
• 2008

Recently, the survival rates of extremely low-birth-weight (ELBW) infants have improved with the development of neonatal intensive care. However, these infants were susceptible to intestinal perforation due to prematurity, fluid restriction, and injection of indomethacin, etc. Because of the risks of transportation, anesthesia and surgery itself, peritoneal drainage has been compared with laparotomy. Through our experience, we investigate the usefulness of peritoneal drainage retrospectively. From 1997 to 2007, six ELBW (M:F=5:1) underwent primary peritoneal drainage for intestinal perforation. Their median birth weight was 685g (405~870) and gestational age was $25^{+1}$ weeks ($24^{+3}{\sim}27^{+0}$). We noticed the intestinal perforation at median 10.5 days (8~18) after birth, and placed Penrose drain or Jackson-Pratt drain through right lower quadrant incision under local anesthesia. The cause of intestinal perforation was necrotizing enterocolitis in one patient, but that of the others was not clear. Three patients who showed normal platelet count and stable vital signs recovered uneventfully. Two patients (birth weight less than 500g) who showed unstable vital signs and low platelet count (12,000 / $mm^3$ to 30,000 / $mm^3$)expired despite aggressive resuscitation. One patient required laparotomy due to persistent intestinal obstruction after drain removal and survived. Our experience shows that peritoneal drainage was an acceptable treatment for ELBW infants and the prognosis was related to vital sign and platelet count at the time of intestinal perforation, and birth weight.

• 대한소아치과학회지
• /
• 제26권3호
• /
• pp.513-519
• /
• 1999

진정요법을 위한 경구 투여 약물에는 비교적 안전하고 부작용이 적은 것으로 알려진 chloral hydrate가 있으나, 체내에 흡수되는 용량이 환자에 따라 다양하여 이것에 대한 정확한 측정이 어렵고, 환자의 불안 정도와 주변환경 등의 영향을 받아 약효발현이 충분히 이루어지지 않는 경우가 적지 않다. 이런 경우 환자와 보호자 모두에게 고통과 불편함을 줄 수 있으며, 재내원시의 치료도 더욱 어려워지는 고충을 흔히 겪게 된다. 이런 문제점을 해결하기 위해 chloral hydrate와 midazolam의 추가 투여, chloral hydrate와 hydroxyzine, 또는 아산화질소-산소와 함께 사용하는 등 소아환자의 행동조절을 위한 많은 연구와 노력이 시행되어지고 있다. 본 증례에서는 Chloral hydrate 경구 투여 후 진정효과가 나타나지 않은 37명의 소아환자에게 아산화질소-산소와 함께 Enflurane을 사용하여 초기 수면을 유도하여 다음과 같은 결과를 얻었다. 1. Enflurane 투여 및 국소마취 시행시 말초동맥혈 산소 포화도와 이완기 혈압의 변화는 관찰되지 않았으며 정상범위 내에서 안정된 양상을 보였다(p<0.05). 2. Enflurane 투여 및 국소마취 시행시 심박수와 수축기 혈압의 일시적인 변화가 관찰되었지만 곧 정상범위 내로 회복되었으며 안정되었다(p<0.05). 3. Enflurane 투여 후 바람직한 행동양상(Q:Quiet)의 증가를 관찰할 수 있었다. 4. 안정된 생징후와 바람직한 행동양상으로 재 내원의 약속을 하지 않고 97%이상이 치료를 성공적으로 마칠 수 있게 되어 환자, 보호자, 술자 모두에게 만족할 만한 결과를 준 것으로 평가되었다.

• Journal of Acupuncture Research
• /
• 제24권4호
• /
• pp.225-235
• /
• 2007

2007년 2월 20일부터 3월 12일까지 대전대학교 둔산 한방병원에 입원한 근위축성 측삭 경화증 환자 1례에 대한 임상 고찰을 통하여 다음과 같은 결론을 얻었다. 1. 본 증례의 환자는 한의학적으로 위증으로 진단 하였으며 폐열엽초(肺熱葉焦), 기혈양허(氣血兩虛)로 변증하였다. 2. 독취양명(獨取陽明)치법을 기준으로 비위경(脾胃經)의 경혈 위주로 자침하였고 입원초기의 한약은 기혈대보(氣血大補)하는 십전대보탕(十全大補湯), 자신양혈건보탕(滋腎養血健步湯)을 사용하였으나 입원 중기부터는 객담, 인후부 불편감을 사지무력감보다 심하게 호소하여 우담리습(祐痰利濕)의 효능이 있는 보음전(補陰煎), 절제화담환(節齊化痰丸)을 처방하였다. 3. 환자는 입원 초기 객담이 줄어들면서 연하작용도 완화되었으나 입원후기에는 객담이 다시 증가하여 연하 및 호흡곤란을 호소하였다. 4. 근육의 위축 속도 및 정도를 파악하기 위하여 1주일에 1회 하지둘레를 확인하였으며 입원 첫 주보다 퇴원 주에 1cm 가량 감소하였다. 5. 우상지부 악력은 입원 초기 6kg이었으나 입원 후기에는 11kg까지 증가하였다. 6. ALS는 아직 뚜렷한 치료법이 없는 상태로 향후 적극적인 한방치료에 대한 연구가 필요할 것이라고 사료된다.

• 가정∙방문간호학회지
• /
• 제6권
• /
• pp.5-18
• /
• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 대한정형외과스포츠의학회지
• /
• 제2권2호
• /
• pp.168-175
• /
• 2003

근위 상완골 골절은 골절의 형태에 따라 크게 관절편 또는 해부학적 경부, 대 결절, 소 결절, 상완골 간부 또는 외과적 경부의 4개의 골절편으로 나눌 수 있다. 현재 널리 사용되고 있는 Neer의 근위 상완골 골절의 분류는 골절선에 의해 골절편을 나누는 분류가 아니며, 1 cm이상전이나 45$^{\circ}$ 이상의 각형성 이 있는 경 우를 전 이 골절편으로 생각하였다. 골절에 대한 관혈적 정 복 및 내고정술의 일차적 적응증은 골다공증이 없는 젊은 환자에서 발생된 튼튼한 내고정물을 시행할 수 있는 삼분 골절로 만족할 만한 결과를 위해 술후 오랜 기간동안 시행할 재활치료에 잘견딜수 있는 활동력 이 좋은 환자여야 한다. 수술적 치료의 절대적 적응증은 개방성 골절 ,혈관이 나 신경 손상이 동반될 때 , 정복이 불가능한 골절 탈구등이다. 반대로 환자가 골다공증이 심하거나, 근위 상완 골절편의 분쇄정도가 심하며 , 튼튼한 내고정을 시행할 가능성 이 희박한 나이가 많은 경 우에는 관혈적 정복 및 내고정술보다 일차적 인공삽입물을 이 용한 관절성형 술을 시행한 후 조기 재활 치료를 시행하는 것을 고려할 수 있다. 상완골 근위부 골절의 수술적 요법에는 다양한 수술 기법과 이에 따른 여러 합병증이 발생할 수 있으며 지속적 이고 체계적 인 재활 치 료가 꼭 필요하다. 여러 수술 기 법 중 관혈적 정복 및 장력 대 강선 기법을 시행할 때 만족할 만한 결과를 얻 을 수 있다. 이 방법 은 수술적 기법이 어렵지 않고, 골에 대한 고정과 함께 회전근 개의 건부착 부위에 대한 봉합을 추가할 수 있으나 역시 여러 가지 합병증이 있으므로 골절의 양상이 나 환자의 상태 ,환자의 활동력 등을 고려하여 치료 방법을 결정하여야 할것으로 사료된다.EX>46N으로, 슬개건-티타늄 간섭나사군이평균 1067.4$\pm$145N에서평균 601.8$\pm$134N으로, 슬개건-생체흡수성간섭나사군이평균 987.1$\pm$168N에서588.7$\pm$124N으로각각40$\%$, 39$\%$, 50$\%$, 24$\%$, 44$\%$, 40$\%$가감소하였다. 결론: 수술후초기고정력은슬괵건을LA나사(R) 또는Semifix(R)로고정하는방법과슬개건을티타늄및생체흡수성간섭나사로고정하는방법등이우수하였으며, 슬괵건을생체흡수성간섭나사나Endobutton(R)으로 고정하는 방법 등은고정력이 상대적으로매우약함을 알수있었다. 최대인장력은단순인장검사로는이상의대퇴골측고정방법의고정력이초기부하를견뎌내는데충분하다고생각되었으나주기성부하실험후현저히감소되어충분한초기안정성을제공하지못함을알수있었다.를 나타내었다. 또한 3m깊이에서의 측방 선량분포에서 Spoiler의 거리변화(6, 10cm)는 심부선량의 변화에 영향을 주지 않는 것으로 확인할 수 있었다. 그리고 위의 실험측정치를 치료계획 시스템에 입력하여 선량분포를 확인한 결과 Spoiler를 사용하는 경우 OPEN에 비해 선량분포 영역을 표면으로 끌어 올릴 수 있으며 Bolus 보다 피부 보호효과는 어느 정도 유지가 되는 것을 보여주었다. 4.결론 이와 같이 Spoiler는 Bolus와 비교하여 6MV 광자선의 build up 영역을 표면으로 증가시키는 동시에 Skin Sparing(피부보호)효과를 유지할 수 있으며 두경부암의 치료에서 Spoiler의 사용이 가능한 조건으로는 조사면이