• Title/Summary/Keyword: factor movement

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The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery (계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로-)

  • 이소우
    • Journal of Korean Academy of Nursing
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    • v.12 no.2
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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A Rheological Study on Creep Behavior of Clays (점토(粘土)의 Creep 거동(擧動)에 관한 유변학적(流變學的) 연구(研究))

  • Lee, Chong Kue;Chung, In Joon
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.1 no.1
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    • pp.53-68
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    • 1981
  • Most clays under sustained load exhibit time-dependent deformation because of creep movement of soil particles and many investigators have attempted to relate their findings to the creep behavior of natural ground and to the long-term stability of slopes. Since the creep behavior of clays may assume a variety of forms depending on such factors as soil plasticity, activity and water content, it is difficult and complicated to analyse the creep behavior of clays. Rheological models composed of linear springs in combination with linear or nonlinear dashpots and sliders, are generally used for the mathematical description of the time-dependent behavior of soils. Most rheological models, however, have been proposed to simulate the behavior of secondary compression for saturated clays and few definitive data exist that can evaluate the behavior of non-saturated clays under the action of sustained stress. The clays change gradually from a solid state through plastic state to a liquid state with increasing water content, therefore, the rheological models also change. On the other hand, creep is time-dependent, and also the effect of thixotropy is time-function. Consequently, there may be certain correlations between creep behavior and the effects of thixotropy in compacted clays. In addition, the states of clay depend on water content and hence the height of the specimen under drained conditions. Futhermore, based on present and past studies, because immediate elastic deformation occurs instantly after the pressure increment without time-delayed behavior, the factor representing immediate elastic deformations in the rheological model is necessary. The investigation described in this paper, based on rheological model, is designed to identify the immediate elastic deformations and the effects of thixotropy and height of clay specimens with varing water content and stress level on creep deformations. For these purposes, the uniaxial drain-type creep tests were performed. Test results and data for three compacted clays have shown that a linear top spring is needed to account for immediate elastic deformations in the rheological model, and at lower water content below the visco-plastic limit, the effects of thixotropy and height of clay specimens can be represented by the proposed rheological model not considering the effects. Therefore, the rheological model does not necessitate the other factors representing these effects. On the other hand, at water content higher than the visco-plastic limit, although the state behavior of clays is visco-plastic or viscous flow at the beginning of the test, the state behavior, in the case of the lower height sample, does not represent the same behavior during the process of the test, because of rapid drainage. In these cases, the rheological model does not coincide with the model in the case of the higher specimens.

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The Research on Online Game Hedonic Experience - Focusing on Moderate Effect of Perceived Complexity - (온라인 게임에서의 쾌락적 경험에 관한 연구 - 지각된 복잡성의 조절효과를 중심으로 -)

  • Lee, Jong-Ho;Jung, Yun-Hee
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.2
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    • pp.147-187
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    • 2008
  • Online game researchers focus on the flow and factors influencing flow. Flow is conceptualized as an optimal experience state and useful explaining game experience in online. Many game studies focused on the customer loyalty and flow in playing online game, In showing specific game experience, however, it doesn't examine multidimensional experience process. Flow is not construct which show absorbing process, but construct which show absorbing result. Hence, Flow is not adequate to examine multidimensional experience of games. Online game is included in hedonic consumption. Hedonic consumption is a relatively new field of study in consumer research and it explores the consumption experience as a experiential view(Hirschman and Holbrook 1982). Hedonic consumption explores the consumption experience not as an information processing event but from a phenomenological of experiential view, which is a primarily subjective state. It includes various playful leisure activities, sensory pleasures, daydreams, esthetic enjoyment, and emotional responses. In online game experience, therefore, it is right to access through a experiential view of hedonic consumption. The objective of this paper was to make up for lacks in our understanding of online game experience by developing a framework for better insight into the hedonic experience of online game. We developed this framework by integrating and extending existing research in marketing, online game and hedonic responses. We then discussed several expectations for this framework. We concluded by discussing the results of this study, providing general recommendation and directions for future research. In hedonic response research, Lacher's research(1994)and Jongho lee and Yunhee Jung' research (2005;2006) has served as a fundamental starting point of our research. A common element in this extended research is the repeated identification of the four hedonic responses: sensory response, imaginal response, emotional response, analytic response. The validity of these four constructs finds in research of music(Lacher 1994) and movie(Jongho lee and Yunhee Jung' research 2005;2006). But, previous research on hedonic response didn't show that constructs of hedonic response have cause-effect relation. Also, although hedonic response enable to different by stimulus properties. effects of stimulus properties is not showed. To fill this gap, while largely based on Lacher(1994)' research and Jongho Lee and Yunhee Jung(2005, 2006)' research, we made several important adaptation with the primary goal of bringing the model into online game and compensating lacks of previous research. We maintained the same construct proposed by Lacher et al.(1994), with four constructs of hedonic response:sensory response, imaginal response, emotional response, analytical response. In this study, the sensory response is typified by some physical movement(Yingling 1962), the imaginal response is typified by images, memories, or situations that game evokes(Myers 1914), and the emotional response represents the feelings one experiences when playing game, such as pleasure, arousal, dominance, finally, the analytical response is that game player engaged in cognition seeking while playing game(Myers 1912). However, this paper has several important differences. We attempted to suggest multi-dimensional experience process in online game and cause-effect relation among hedonic responses. Also, We investigated moderate effects of perceived complexity. Previous studies about hedonic responses didn't show influences of stimulus properties. According to Berlyne's theory(1960, 1974) of aesthetic response, perceived complexity is a important construct because it effects pleasure. Pleasure in response to an object will increase with increased complexity, to an optimal level. After that, with increased complexity, pleasure begins with a linearly increasing line for complexity. Therefore, We expected this perceived complexity will influence hedonic response in game experience. We discussed the rationale for these suggested changes, the assumptions of the resulting framework, and developed some expectations based on its application in Online game context. In the first stage of methodology, questions were developed to measure the constructs. We constructed a survey measuring our theoretical constructs based on a combination of sources, including Yingling(1962), Hargreaves(1962), Lacher (1994), Jongho Lee and Yunhee Jung(2005, 2006), Mehrabian and Russell(1974), Pucely et al(1987). Based on comments received in the pretest, we made several revisions to arrive at our final survey. We investigated the proposed framework through a convenience sample, where participation in a self-report survey was solicited from various respondents having different knowledges. All respondents participated to different degrees, in these habitually practiced activities and received no compensation for their participation. Questionnaires were distributed to graduates and we used 381 completed questionnaires to analysis. The sample consisted of more men(n=225) than women(n=156). In measure, the study used multi-item scales based previous study. We analyze the data using structural equation modeling(LISREL-VIII; Joreskog and Sorbom 1993). First, we used the entire sample(n=381) to refine the measures and test their convergent and discriminant validity. The evidence from both the factor analysis and the analysis of reliability provides support that the scales exhibit internal consistency and construct validity. Second, we test the hypothesized structural model. And, we divided the sample into two different complexity group and analyze the hypothesized structural model of each group. The analysis suggest that hedonic response plays different roles from hypothesized in our study. The results indicate that hedonic response-sensory response, imaginal response, emotional response, analytical response- are related positively to respondents' level of game satisfaction. And game satisfaction is related to higher levels of game loyalty. Additionally, we found that perceived complexity is important to online game experience. Our results suggest that importance of each hedonic response different by perceived game complexity. Understanding the role of perceived complexity in hedonic response enables to have a better understanding of underlying mechanisms at game experience. If game has high complexity, analytical response become important response. So game producers or marketers have to consider more cognitive stimulus. Controversy, if game has low complexity, sensorial response respectively become important. Finally, we discussed several limitations of our study and suggested directions for future research. we concluded with a discussion of managerial implications. Our study provides managers with a basis for game strategies.

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Distortion of the Dose Profile in a Three-dimensional Moving Phantom to Simulate Tumor Motion during Image-guided Radiosurgery (방사선수술에서 종양 움직임을 재현시킨 움직이는 팬텀을 이용하여 선량 분포의 왜곡에 대한 연구)

  • Kim, Mi-Sook;Ha, Seong-Hwan;Lee, Dong-Han;Ji, Young-Hoon;Yoo, Seong-Yul;Cho, Chul-Koo;Yang, Kwang-Mo;Yoo, Hyung-Jun;Seo, Young-Seok;Park, Chan-Il;Kim, Il-Han;Ye, Seong-Jun;Park, Jae-Hong;Kim, Kum-Bae
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.268-277
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    • 2007
  • Purpose: Respiratory motion is a considerable inhibiting factor for precise treatment with stereotactic radiosurgery using the CyberKnife (CK). In this study, we developed a moving phantom to simulate three-dimensional breathing movement and investigated the distortion of dose profiles between the use of a moving phantom and a static phantom. Materials and Methods: The phantom consisted of four pieces of polyethylene; two sheets of Gafchromic film were inserted for dosimetry. Treatment was planned to deliver 30 Gy to virtual tumors of 20, 30, 40, and 50 mm diameters using 104 beams and a single center mode. A specially designed robot produced three-dimensional motion in the right-left, anterior-posterior, and craniocaudal directions of 5, 10 and 20 mm, respectively. Using the optical density of the films as a function of dose, the dose profiles of both static and moving phantoms were measured. Results: The prescribed isodose to cover the virtual tumors on the static phantom were 80% for 20 mm, 84% for 30 mm, 83% for 40 mm and 80% for 50 mm tumors. However, to compensate for the respiratory motion, the minimum isodose levels to cover the moving target were 70% for the $30{\sim}50$ mm diameter tumors and 60% for a 20 mm tumor. For the 20 mm tumor, the gaps between the isodose curves for the static and moving phantoms were 3.2, 3.3, 3.5 and 1.1 mm for the cranial, caudal, right, and left direction, respectively. In the case of the 30 mm tumor, the gaps were 3.9, 4.2, 2.8, 0 mm, respectively. In the case of the 40 mm tumor, the gaps were 4.0, 4.8, 1.1, and 0 mm, respectively. In the case of the 50 mm diameter tumor, the gaps were 3.9, 3.9, 0 and 0 mm, respectively. Conclusion: For a tumor of a 20 mm diameter, the 80% isodose curve can be planned to cover the tumor; a 60% isodose curve will have to be chosen due to the tumor motion. The gap between these 80% and 60% curves is 5 mm. In tumors with diameters of 30, 40 and 50 mm, the whole tumor will be covered if an isodose curve of about 70% is selected, equivalent of placing a respiratory margin of below 5 mm. It was confirmed that during CK treatment for a moving tumor, the range of distortion produced by motion was less than the range of motion itself.

A study on Development Process of Fish Aquaculture in Japan - Case by Seabream Aquaculture - (일본 어류 양식업의 발전과정과 산지교체에 관한 연구 : 참돔양식업을 사례로)

  • 송정헌
    • The Journal of Fisheries Business Administration
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    • v.34 no.2
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    • pp.75-90
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    • 2003
  • When we think of fundamental problems of the aquaculture industry, there are several strict conditions, and consequently the aquaculture industry is forced to change. Fish aquaculture has a structural supply surplus in production, aggravation of fishing grounds, stagnant low price due to recent recession, and drastic change of distribution circumstances. It is requested for us to initiate discussion on such issue as “how fish aquaculture establishes its status in the coastal fishery\ulcorner, will fish aquaculture grow in the future\ulcorner, and if so “how it will be restructured\ulcorner” The above issues can be observed in the mariculture of yellow tail, sea scallop and eel. But there have not been studied concerning seabream even though the production is over 30% of the total production of fish aquaculture in resent and it occupied an important status in the fish aquaculture. The objectives of this study is to forecast the future movement of sea bream aquaculture. The first goal of the study is to contribute to managerial and economic studies on the aquaculture industry. The second goal is to identify the factors influencing the competition between production areas and to identify the mechanisms involved. This study will examine the competitive power in individual producing area, its behavior, and its compulsory factors based on case study. Producing areas will be categorized according to following parameters : distance to market and availability of transportation, natural environment, the time of formation of producing areas (leaderㆍfollower), major production items, scale of business and producing areas, degree of organization in production and sales. As a factor in shaping the production area of sea bream aquaculture, natural conditions especially the water temperature is very important. Sea bream shows more active feeding and faster growth in areas located where the water temperature does not go below 13∼14$^{\circ}C$ during the winter. Also fish aquaculture is constrained by the transporting distance. Aquacultured yellowtail is a mass-produced and a mass-distributed item. It is sold a unit of cage and transported by ship. On the other hand, sea bream is sold in small amount in markets and transported by truck; so, the transportation cost is higher than yellow tail. Aquacultured sea bream has different product characteristics due to transport distance. We need to study live fish and fresh fish markets separately. Live fish was the original product form of aquacultured sea bream. Transportation of live fish has more constraints than the transportation of fresh fish. Death rate and distance are highly correlated. In addition, loading capacity of live fish is less than fresh fish. In the case of a 10 ton truck, live fish can only be loaded up to 1.5 tons. But, fresh fish which can be placed in a box can be loaded up to 5 to 6 tons. Because of this characteristics, live fish requires closer location to consumption area than fresh fish. In the consumption markets, the size of fresh fish is mainly 0.8 to 2kg.Live fish usually goes through auction, and quality is graded. Main purchaser comes from many small-sized restaurants, so a relatively small farmer and distributer can sell it. Aquacultured sea bream has been transacted as a fresh fish in GMS ,since 1993 when the price plummeted. Economies of scale works in case of fresh fish. The characteristics of fresh fish is as follows : As a large scale demander, General Merchandise Stores are the main purchasers of sea bream and the size of the fish is around 1.3kg. It mainly goes through negotiation. Aquacultured sea bream has been established as a representative food in General Merchandise Stores. GMS require stable and mass supply, consistent size, and low price. And Distribution of fresh fish is undertook by the large scale distributers, which can satisfy requirements of GMS. The market share in Tokyo Central Wholesale Market shows Mie Pref. is dominating in live fish. And Ehime Pref. is dominating in fresh fish. Ehime Pref. showed remarkable growth in 1990s. At present, the dealings of live fish is decreasing. However, the dealings of fresh fish is increasing in Tokyo Central Wholesale Market. The price of live fish is decreasing more than one of fresh fish. Even though Ehime Pref. has an ideal natural environment for sea bream aquaculture, its entry into sea bream aquaculture was late, because it was located at a further distance to consumers than the competing producing areas. However, Ehime Pref. became the number one producing areas through the sales of fresh fish in the 1990s. The production volume is almost 3 times the production volume of Mie Pref. which is the number two production area. More conversion from yellow tail aquaculture to sea bream aquaculture is taking place in Ehime Pref., because Kagosima Pref. has a better natural environment for yellow tail aquaculture. Transportation is worse than Mie Pref., but this region as a far-flung producing area makes up by increasing the business scale. Ehime Pref. increases the market share for fresh fish by creating demand from GMS. Ehime Pref. has developed market strategies such as a quick return at a small profit, a stable and mass supply and standardization in size. Ehime Pref. increases the market power by the capital of a large scale commission agent. Secondly Mie Pref. is close to markets and composed of small scale farmers. Mie Pref. switched to sea bream aquaculture early, because of the price decrease in aquacultured yellou tail and natural environmental problems. Mie Pref. had not changed until 1993 when the price of the sea bream plummeted. Because it had better natural environment and transportation. Mie Pref. has a suitable water temperature range required for sea bream aquaculture. However, the price of live sea bream continued to decline due to excessive production and economic recession. As a consequence, small scale farmers are faced with a market price below the average production cost in 1993. In such kind of situation, the small-sized and inefficient manager in Mie Pref. was obliged to withdraw from sea bream aquaculture. Kumamoto Pref. is located further from market sites and has an unsuitable nature environmental condition required for sea bream aquaculture. Although Kumamoto Pref. is trying to convert to the puffer fish aquaculture which requires different rearing techniques, aquaculture technique for puffer fish is not established yet.

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Effects of climate change on biodiversity and measures for them (생물다양성에 대한 기후변화의 영향과 그 대책)

  • An, Ji Hong;Lim, Chi Hong;Jung, Song Hie;Kim, A Reum;Lee, Chang Seok
    • Journal of Wetlands Research
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    • v.18 no.4
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    • pp.474-480
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    • 2016
  • In this study, formation background of biodiversity and its changes in the process of geologic history, and effects of climate change on biodiversity and human were discussed and the alternatives to reduce the effects of climate change were suggested. Biodiversity is 'the variety of life' and refers collectively to variation at all levels of biological organization. That is, biodiversity encompasses the genes, species and ecosystems and their interactions. It provides the basis for ecosystems and the services on which all people fundamentally depend. Nevertheless, today, biodiversity is increasingly threatened, usually as the result of human activity. Diverse organisms on earth, which are estimated as 10 to 30 million species, are the result of adaptation and evolution to various environments through long history of four billion years since the birth of life. Countlessly many organisms composing biodiversity have specific characteristics, respectively and are interrelated with each other through diverse relationship. Environment of the earth, on which we live, has also created for long years through extensive relationship and interaction of those organisms. We mankind also live through interrelationship with the other organisms as an organism. The man cannot lives without the other organisms around him. Even though so, human beings accelerate mean extinction rate about 1,000 times compared with that of the past for recent several years. We have to conserve biodiversity for plentiful life of our future generation and are responsible for sustainable use of biodiversity. Korea has achieved faster economic growth than any other countries in the world. On the other hand, Korea had hold originally rich biodiversity as it is not only a peninsula country stretched lengthily from north to south but also three sides are surrounded by sea. But they disappeared increasingly in the process of fast economic growth. Korean people have created specific Korean culture by coexistence with nature through a long history of agriculture, forestry, and fishery. But in recent years, the relationship between Korean and nature became far in the processes of introduction of western culture and development of science and technology and specific natural feature born from harmonious combination between nature and culture disappears more and more. Population of Korea is expected to be reduced as contrasted with world population growing continuously. At this time, we need to restore biodiversity damaged in the processes of rapid population growth and economic development in concert with recovery of natural ecosystem due to population decrease. There were grand extinction events of five times since the birth of life on the earth. Modern extinction is very rapid and human activity is major causal factor. In these respects, it is distinguished from the past one. Climate change is real. Biodiversity is very vulnerable to climate change. If organisms did not find a survival method such as 'adaptation through evolution', 'movement to the other place where they can exist', and so on in the changed environment, they would extinct. In this respect, if climate change is continued, biodiversity should be damaged greatly. Furthermore, climate change would also influence on human life and socio-economic environment through change of biodiversity. Therefore, we need to grasp the effects that climate change influences on biodiversity more actively and further to prepare the alternatives to reduce the damage. Change of phenology, change of distribution range including vegetation shift, disharmony of interaction among organisms, reduction of reproduction and growth rates due to odd food chain, degradation of coral reef, and so on are emerged as the effects of climate change on biodiversity. Expansion of infectious disease, reduction of food production, change of cultivation range of crops, change of fishing ground and time, and so on appear as the effects on human. To solve climate change problem, first of all, we need to mitigate climate change by reducing discharge of warming gases. But even though we now stop discharge of warming gases, climate change is expected to be continued for the time being. In this respect, preparing adaptive strategy of climate change can be more realistic. Continuous monitoring to observe the effects of climate change on biodiversity and establishment of monitoring system have to be preceded over all others. Insurance of diverse ecological spaces where biodiversity can establish, assisted migration, and establishment of horizontal network from south to north and vertical one from lowland to upland ecological networks could be recommended as the alternatives to aid adaptation of biodiversity to the changing climate.

The Patterns of Change in Arterial Oxygen Saturation and Heart Rate and Their Related Factors during Voluntary Breath holding and Rebreathing (자발적 호흡정지 및 재개시 동맥혈 산소포화도와 심박수의 변동양상과 이에 영향을 미치는 인자)

  • Lim, Chae-Man;Kim, Woo-Sung;Choi, Kang-Hyun;Koh, Youn-Suck;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.4
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    • pp.379-388
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    • 1994
  • Background : In sleep apnea syndrome, arterial oxygen saturation($SaO_2$) decreases at a variable rate and to a variable degree for a given apneic period from patient to patient, and various kinds of cardiac arrythmia are known to occur. Factors supposed to affect arterial oxygen desaturation during apnea are duration of apnea, lung voulume at which apnea occurs, and oxygen consumption rate of the subject. The lung serves as preferential oxygen source during apnea, and there have been many reports related with the influence of lung volume on $SaO_2$ during apnea, but there are few, if any, studies about the influence of oxygen consumption rate of an individual on $SaO_2$ during breath holding or about the profile of arterial oxygen resaturation after breathing resumed. Methods : To investigate the changes of $SaO_2$ and heart rate(HR) during breath holding(BH) and rebreathing(RB) and to evaluate the physiologic factors responsible for the changes, lung volume measurements, and arterial blood gas analyses were performed in 17 healthy subjects. Nasal airflow by thermistor, $SaO_2$ by pulse oxymeter and ECG tracing were recorded on Polygraph(TA 4000, Gould, U.S.A.) during voluntary BH & RB at total lung capacity(TLC), at functional residual capacity(FRC) and at residual volume(RV), respectively, for the study subjects. Each subject's basal metabolic rate(BMR) was assumed on Harris-Benedict equation. Results: The time needed for $SaO_2$ to drop 2% from the basal level during breath holding(T2%) were $70.1{\pm}14.2$ sec(mean${\pm}$standard deviation) at TLC, $44.0{\pm}11.6$ sec at FRC, and $33.2{\pm}11.1$ sec at RV(TLC vs. FRC, p<0.05; FRC vs. RV, p<0.05). On rebreathing after $SaO_2$ decreased 2%, further decrement in $SaO_2$ was observed and it was significantly greater at RV($4.3{\pm}2.1%$) than at TLC($1.4{\pm}1.0%$)(p<0.05) or at FRC($1.9{\pm}1.4%$)(p<0.05). The time required for $SaO_2$ to return to the basal level after RB(Tr) at TLC was not significantly different from those at FRC or at RV. T2% had no significant correlation either with lung volumes or with BMR respectively. On the other hand, T2% had significant correlation with TLC/BMR(r=0.693, p<0.01) and FRC/BMR (r=0.615, p<0.025) but not with RV/BMR(r=0.227, p>0.05). The differences between maximal and minimal HR(${\Delta}HR$) during the BH-RB manuever were $27.5{\pm}9.2/min$ at TLC, $26.4{\pm}14.0/min$ at RV, and $19.1{\pm}6.0/min$ at FRC which was significantly smaller than those at TLC(p<0.05) or at RV(p<0.05). The mean difference of 5 p-p intervals before and after RB were $0.8{\pm}0.10$ sec and $0.72{\pm}0.09$ sec at TLC(p<0.001), $0.82{\pm}0.11$ sec and $0.73{\pm}0.09$ sec at FRC(p<0.025), and $0.77{\pm}0.09$ sec and $0.72{\pm}0.09$ sec at RV(p<0.05). Conclusion Healthy subjects showed arterial desaturation of various rates and extent during breath holding at different lung volumes. When breath held at lung volume greater than FRC, the rate of arterial desaturation significantly correlated with lung volume/basal metabolic rate, but when breath held at RV, the rate of arterial desaturation did not correlate linearly with RV/BMR. Sinus arrythmias occurred during breath holding and rebreathing manuever irrespective of the size of the lung volume at which breath holding started, and the amount of change was smallest when breath held at FRC and the change in vagal tone induced by alteration in respiratory movement might be the major responsible factor for the sinus arrythmia.

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