• 제목/요약/키워드: pressure injury

검색결과 471건 처리시간 0.032초

분심기음(分心氣飮)이 고혈압 백서와 인간유래 혈관내피세포주(ECV 304)에 미치는 영향에 대한 연구 (An Experimental Study of Effect on ECV 304 Cells, Platelet Rich Plasma and Rats treated with L-NAME by Boonsimgieum extract)

  • 전연이;박창국;이소연;윤현덕;신오철;박치상
    • 대한한방내과학회지
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    • 제26권1호
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    • pp.182-198
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    • 2005
  • Object : This study was designed to research whether the protection and inhibitory effects of cardiovascular diseases in L-NAME induced rat or ECV 304 cell lines through the Cell morphological pattern, Tunel assay, LDH activity, heart rate, blood pressure and immunohistochemistric analysis by Boonsimgieum water extract Methods : Nitric oxide(NO) play an important role in normal and pathophysiological cells including as a messenger molecule, neurotransmitter, microbiocidal agent, or dilator of blood vessels and artheriosclerosis, hypertension, myocardial infarction, respectively. Endothelial cell products can modulate the magnitude of a response to a vasoconstrictor, as evinced by the greater constriction after endothelium removal or NO synthesis blockade. To investigate that Boonsimgieum in the potential contribution of the levels of nitric oxide generated by endothelial nitric oxide synthase (eNOS) and the mechanisms of protection against NG-nitro-L-arginine methyl ester (L-NAME), human ECV 304 cells, which normally do not express eNOS, were expressed by L-NAME. L-NAME stimulated rat or cells were found to be resistant to injury and delayed death following the Boonsimgieum. Inhibition of nitric oxide synthesis abolished the protective effect against L-NAME, thrombin and collagen exposure. Interestingly, such effects have been observed during stimulation with agents such as phenylephrine and KCl on L-NAME mediate rats, were damaged by the NOS inhibitor L-NAME. Result : As the result of this study, In group, the anti-apoptosis and necrosis in the cardiovascular system have a potential capacity for prevented, protected and treating the diseases of cardiovascular system, against the necrosis of rat and ECV 304 cells with Caspase 3 and calpain expression by L-NAME is promoted. Conclusion : these results demonstrate neuroprotective and memory enhancing effects of ZIBU, suggesting its beneficial actions for the treatment of AD.

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스쿼트 동작 시 수동적 발목 가동범위와 무릎 관절 운동역학적 변인 간 상관성 분석 (Analysis of correlation between passive ankle movement range and knee joint kinetic variables during squat movement)

  • 이재우;박준성;임영태;권문석
    • 한국응용과학기술학회지
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    • 제37권3호
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    • pp.509-515
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    • 2020
  • 본 연구의 목적은 딥 스쿼트 동작 시 발목 관절 유연성이 무릎 관절의 운동역학적 요인들간의 관련성을 분석하는데 있었다. 본 연구는 최근 1년간 하지 근골격계 병력이 없는 성인 남성 19명과 여성 8명이 연구대상자로 참여하였다. 딥 스쿼드 시 발목 관절 유연성과 하지 관절의 운동역학적 요인들과 상관관계를 검증하기 위해 pearson의 적률상관계수(pearson's correlation coefficient)를 이용하였고(SPSS 24.0, Armonk, NY, USA), 통계적으로 유의미한 상관성을 나타낸 변인들은 단순회기분석(simple regression analysis)을 실시하였으며, 유의 수준은 .05로 설정하였다. 본 연구를 통해 발목 관절 유연성과 무릎 관절의 압력을 결정하는 최대 관절모멘트와 관절반발력 요인들 간의 관련성을 확인할 수 있었다. 그러므로 근력 트레이닝 시 딥 스쿼트와 같은 무릎 관절에 많은 부하를 발생시킬 수 있는 운동을 적용할 때 개인에 신체적 특성 중 발목 관절의 유연성의 정도를 확인하는 것은 신체의 안정성과 무릎 관절의 상해 위험성을 감소시킬 수 있는 운동 강도를 설정하는데 도움이 될 수 있을 것으로 기대한다.

제2형 당뇨 마우스에서 십조탕(十棗湯)에 의한 혈당 및 신기능 부전 개선효과 (Improvement Effect of Sibjotang on Blood Glucose and Renal Dysfunction in Type II Diabetic Mice)

  • 윤정주;이윤정;김혜윰;안유미;김현준;홍미현;황진석;이호섭;강대길
    • 대한본초학회지
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    • 제32권1호
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    • pp.15-23
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    • 2017
  • Objectives : It is well known that Sibjotang (Shizaotang), traditional herbal medicine formula, regulates the body fluid blood pressure homeostasis. This study is to investigate whether Sibjotang improves diabetic renal dysfunction in type II diabetes mellitus animal model, db/db mice. Methods : The animals model were divided into three groups at the age of 8 weeks; control group (C57BLKS/J-db/m mice), diabetic group [(C57BLKS/J+Lepr)-db/db mice], and Sibjotang group [(C57BLKS/J+Lepr)-db/db mice + Sibjotang 100 mg/kg/day]. During 8 weeks of treatment, blood glucose and urinary albumin excretion were checked in metabolic chamber at 8, 12, and 16 weeks of age, respectively. Results : Body weight and food intake of diabetic group were significantly higher than control group after 8 weeks administration. However, there were not significant different between the diabetic group and Sibjotang group. Urinary albumin excretion was significantly decreased in the Sibjotang group than the diabetic group. In addition, supplementation with Sibjotang significantly lowered levels of blood glucose, insulin, and homeostatic model assessment-insulin resistance (HOMA-IR), suggesting reduced insulin resistance. The ratio of mesangial matrix/glomerular area was markedly larger in diabetic group than control group, whereas Sibjotang significantly reduced this expansion. Moreover, immunohistological study revealed that Sibjotang attenuated the increase of transforming growth $factor(TGF)-{\beta}$ expression in kidney. Conclusion : Sibjotang ameliorates diabetes-associated renal injury through the improvement of the blood glucose and insulin sensitivity, and inhibiting the $TGF-{\beta}1$ expression. Therefore, Sibjotang may be a new therapeutic formula for the treatment of diabetic-associated renal dysfunction.

CO2 임시 저장 탱크에서의 물리적 폭발에 따른 피해영향 고찰 (A Study of Consequence Analysis of Physical Explosion Damage in CO2 Storage Tank)

  • 서두현;장갑만;이진한;이광원
    • 한국가스학회지
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    • 제19권2호
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    • pp.12-19
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    • 2015
  • CCS(Carbon Dioxide Capture and Storage)은 온실가스의 주원인 중 하나인 $CO_2$를 감축하기 위한 대안으로 발전, 시멘트 및 철강 산업 등에서 발생하는 대량의 $CO_2$를 포집, 압축 액화하여 저장소에 격리하는 일련의 전 과정을 말한다. 이때, 포집된 $CO_2$는 수송 과정 전 후에 임시저장소에 저장 하게 된다. $CO_2$는 일반적으로 비 가연성, 무독성 가스로 저장소에서 화학적 폭발을 일으킬 가능성이 희박한 가스지만, 임시로 저장되어 보관될 동안 100bar이상의 압력으로 보관되고 있으며, 포집된 가스에 포함된 불순물과 산화물 등에 의해 용기의 부식으로 인한 물리적 폭발이 일어날 가능성이 있다. 폭발 강도는 일반적으로 TNT 상당질량을 통해 계산할 수 있으며, $CO_2$ 임시 저장소는 대량의 $CO_2$를 보관하기 위한 시설로 용기의 용량을 100,000L(100톤)로 가정하여 계산하였다. 계산을 통하여 약 100bar로 압축되어 저장된 100톤의 임시저장소 1개가 폭발할 때의 폭발위력을 산출하면, 대략 2346 lb 이며, 이를 환산하면 약 1064 kg의 TNT가 폭발하는 위력과 동일한 것으로 계산된다. 폭발중심으로부터의 거리에 따른 과압은 환산법칙(scaling law)을 통해 계산하였다. 또한, 폭발과압으로 인한 인체 상해에 대해 폐출혈(Lung Haemorrhage)로 인한 사망과 고막파열 등의 상해를 고려하여 Probit 모델을 통하여 추정하였다.

하모니카를 활용한 호흡재활 훈련이 척수손상환자의 호흡기능에 미치는 영향 (Effects of Respiratory Rehabilitation Training Using a Harmonica for Patients With Spinal Cord Injuries)

  • 김혁건;김민서;임한밀;정소;신욱주
    • 인간행동과 음악연구
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    • 제15권2호
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    • pp.23-39
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    • 2018
  • 본 논문은 척수손상환자의 호흡재활을 위한 하모니카 활용 프로그램이 호흡기능에 어떠한 영향을 미치는지 확인하고자 시행한 연구이다. 평균 연령 37세의 복식호흡이 불가능한 척수손상환자 8명이 본 연구에 참여하였다. 3개월 동안 1회 60분씩 총 10회의 프로그램이 실시되었고, 호흡재활 전후 호흡량을 측정한 결과를 비교 분석하였다. 본 프로그램에서는 신체적 움직임, 특히 목 움직임에 제한이 있는 환자 특성을 고려하여 길이가 짧은 10홀로 구성된 다이아토닉 하모니카를 사용하였고, 척수손상 정도에 따라 손 움직임에 제약이 있는 목걸이 거치대를 사용하였다. 또한 하모니카 연주를 위해 과거 음악경험과 상관없이 쉽게 배울 수 있는 기초적인 악곡을 선정하였고, 음정을 내기 위해 복식호흡을 유도하여 긴 음정과 강한 호흡이 필요한 지점들을 훈련하였다. 연구 결과, 프로그램 참여 후 호흡량이 유의하게 증가하였고, 호흡 기능과 관련된 어지럼증과 가래 증상이 개선된 것으로 나타났다. 또한 삶의 질이 증가하고 우울감이 감소한 것으로 나타나 본 프로그램이 척수손상환자의 호흡재활을 위해 효과적으로 적용될 수 있음을 확인할 수 있었다. 신경학적 손상 환자에 개입하는 프로그램의 필요성이 계속 증가하는 것을 고려할 때, 본 연구는 척수손상환자의 호흡 기능에 효과적으로 개입할 수 있는 프로그램을 제시한 데 그 의의가 있다.

비외상센터에서 외상센터로의 전원이 예후에 미치는 영향 (Impact of interhospital transfer on outcomes for trauma patients: impact of direct versus non-direct transfer)

  • 양욱태;민문기;류지호;이대섭;이강호;신진욱;염석란;한상균
    • 대한응급의학회지
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    • 제29권5호
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    • pp.415-422
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    • 2018
  • Objective: This study compared the prognosis of patients who visited the trauma center directly (direct visit group) with those transferred from the non-trauma center (transferred group). Methods: The patients, who were 18 or older with Injury Severity Score of 15 or more in the trauma center at Busan, were studied from October 2015 to October 2016. To compare the treatment time between the direct visit and transferred group, first treatment time, final treatment time, and time to visit the trauma center were examined. To compare the prognosis, this study compared the 48-hour, 7-day, and in-hospital mortality rate as well as the duration of intensive care unit (ICU) and total hospital stay. To analyze the factors affecting the outcome of transferred group, the physician's level and procedures that had been performed at the non-trauma center were examined. Results: The mortality was similar in the direct visit and transferred group (48-hour 7.6% vs. 4.6%, P=0.111; 7-day 11.1% vs. 7.2%, P=0.89; and in-hospital 14.6% vs. 11.3%, P=0.214). The length of ICU and total hospital stay were similar in the two groups. The mortality was higher in the patients in the transferred group when using intubation, transfusion, and pressure intensifier. The intubated patients showed higher mortality according to logistic regression. Conclusion: The mortality, length of ICU, and hospital stay were similar but the time to visit the trauma center and the final treatment time were longer in transferred group. Stabilizing the patient at the near non-trauma center may be more helpful for some patients.

균형과 보행분석을 위한 스마트 인솔의 신뢰도와 타당도 분석 (The Reliability and Validity of Smart Insole for Balance and Gait Analysis)

  • 이병권;한동욱;김창용;김기영;박대성
    • 대한통합의학회지
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    • 제9권4호
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    • pp.291-298
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    • 2021
  • Purpose: The Pedisole is a newly developed shoe-mounted wearable assessment system for analyzing balance and gait. This study aimed to determine the reliability and validity of the parameters provided by the system for static balance and gait analysis of healthy adults. Methods: This study included 38 healthy adults (22.4±1.9 years) with no history of injury in the lower limbs. All participants were asked to perform balance and gait tasks for undertaking measurements. For analysis of balance, both the smart Pedisole and Pedoscan systems were concurrently used to analyze the path length of the center of pressure (COP) and the weight ratio of the left and right for 10 s. Gait was measured using the smart Pedisole and GaitRite walkway systems simultaneously. The participants walked at a self-selected preferred gait speed. The cadence, stance time, swing time, and step time were used to analyze gait characteristics. Using the paired t-test, the intra-class coefficient correlation (ICC) was calculated for reliability. The Spearman correlation was used to assess the validity of the measurements. In total, data for balance from 36 participants and the gait profiles of 37 participants were evaluated. Results: There were significant differences between the COP path lengths (p<.050) derived from the two systems, and a significant correlation was found for COP path length (r=.382~.523) for static balance. The ICC for COP path length and weight ratio was found to be greater than .687, indicating moderate agreement in balance parameters. The ICC of gait parameters was found to be greater than .697 except for stance time, and there was significant correlation (r=.678~.922) with the GaitRite system. Conclusion: The newly developed smart insole-type Pedisole system and the related application are useful, reliable, and valid tools for balance and gait analysis compared to the gold standard Pedoscan and the GaitRite systems in healthy individuals.

The Unique Relationship between Neuro-Critical Care and Critical Illness-Related Corticosteroid Insufficiency : Implications for Neurosurgeons in Neuro-Critical Care

  • Yoon Hee Choo;Moinay Kim;Jae Hyun Kim;Hanwool Jeon;Hee-Won Jung;Eun Jin Ha;Jiwoong Oh;Youngbo Shim;Seung Bin Kim;Han-Gil Jung;So Hee Park;Jung Ook Kim;Junhyung Kim;Hyeseon Kim;Seungjoo Lee
    • Journal of Korean Neurosurgical Society
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    • 제66권6호
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    • pp.618-631
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    • 2023
  • The brain houses vital hormonal regulatory structures such as the hypothalamus and pituitary gland, which may confer unique susceptibilities to critical illness-related corticosteroid insufficiency (CIRCI) in patients with neurological disorders. In addition, the frequent use of steroids for therapeutic purposes in various neurological conditions may lead to the development of steroid insufficiency. This abstract aims to highlight the significance of understanding these relationships in the context of patient care and management for physicians. Neurological disorders may predispose patients to CIRCI due to the role of the brain in hormonal regulation. Early recognition of CIRCI in the context of neurological diseases is essential to ensure prompt and appropriate intervention. Moreover, the frequent use of steroids for treating neurological conditions can contribute to the development of steroid insufficiency, further complicating the clinical picture. Physicians must be aware of these unique interactions and be prepared to evaluate and manage patients with CIRCI and steroid insufficiency in the context of neurological disorders. This includes timely diagnosis, appropriate steroid administration, and careful monitoring for potential adverse effects. A comprehensive understanding of the interplay between neurological disease, CIRCI, and steroid insufficiency is critical for optimizing patient care and outcomes in this complex patient population.

잡종견 급성폐손상 모델에서 Prone position 시행시 PEEP 수준에 따른 호흡 및 혈류역학적 효과 (The Respiratory and Hemodynamic Effects of Prone Position According to the Level of PEEP in a Dog Acute Lung Injury Model)

  • 임채만;진재용;고윤석;심태선;이상도;김우성;김동순;김원동
    • Tuberculosis and Respiratory Diseases
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    • 제45권1호
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    • pp.140-152
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    • 1998
  • 배 경: 호흡부전의 치료에 있어 환자 체위를 prone position으로 하는 시도는 20년 전부터 보고되어 왔으며 폐산소화 및 심박출량 향상에 효과가 있다는 것이 알려져 있다. Prone position시 폐산소화의 호전은 임상 및 동물 실험에서 단락 감소에 의한 것으로 알려져 있으며 그 중요 기전은 supine position에 비해 prone position때 중력 의존부 폐의 늑막압이 더 작아 폐포 개방압이 줄어들기 때문인 바 저자 등은 prone position이 폐산소화에 미치는 효과는 supine position에서 사용한 PEEP의 폐포 고비 개방압과의 관계에 따라 달라질 것으로 추정하였다. Prone position에서의 심박출량 증가에 대하여는 양압환기시 발생하는 cardiac fossa lifting 현상이 prone position에 의해 완화될 수 있다는 주장이 제기된 바 있어 prone position이 또한 supine position에서 PEEP에 의해 초래된 심박출량 저하를 완화시킬 수 있는지를 잡종견 급성 폐손상 모델을 통해 알아보고자 하였다. 방 법 : 잡종견 7 마리 ($20.0{\pm}3.9$ kg)를 정맥 마취 후 기관내관을 삽관하고 인공호흡기를 Vt 15 ml/kg, f 20/min, I : E=1 : 3, pause 10%, PEEP 0 cm $H_2O$, $F_1O_2$ 1.0으로 설정하였다. 혈압, 분당맥박수, 폐동맥쐐기압, 심박출량 등의 측정과 동맥혈가스분석을 위해 서혜동맥과 폐동맥 천자술을 시행하였다. 대조기에 supine position 및 prone position 30분에 각각 호흡 지표 ($PaO_2/F_1O_2$[P/F], 총호흡기계탄성 [Cst]와 supine position, prone position 5분 및 prone position 30분에 혈류역학적 지표(평균동맥압, 분당 맥박수, 심박출량, 박출용적)을 측정하고 섭씨 38도의 생리식염수 (30~50 ml/kg)를 기관내관을 통하여 주입하여 급성 폐손상을 유도한 뒤 constant flow 법에 의해 inflection point(Pflex)를 측정하였다. 급성 폐손상에서의 supine position과 prone position실험은 Pflex보다 2 cm $H_2O$ 낮은 PEEP(Low PEEP)과 2 cm $H_2O$ 높은 PEEP (Optimal PEEP)에서 순차적으로 시행하고 각각 통일 시간대에 상기 지표들을 측정하였으며 Optimal PEEP 실험 마지막에 다시 supin position으로 체위를 바꾸고 5분 뒤 혈류역학적 지표들을 측정하였다. 결 과: 1. Prone position 시행시 Low PEEP 및 Optimal PEEP에서의 호흡 효과의 차이 Low PEEP하에서 P/F 비는 supine position에서 $195{\pm}112$ mm Hg, prone position 30분에서 $400{\pm}33$ mm Hg였고 (p<0.001) Optimal PEEP하에서 P/F 비는 supine position에서 $466{\pm}63$ mm Hg, prone position 30분에서 $499{\pm}63$ mm Hg였다 (p=0.016). Prone position에 의한 P/F 비 싱승량은 Low PEEP하에서 $205{\pm}90$ mm Hg로 Optimal PEEP($33{\pm}33$ mm Hg) 하에서 보다 유의하게 높았다(각각 p<0.05). 2. Prone position의 혈류역학적 효과 Low PEEP하에서 심박출량은 supine position($3.0{\pm}0.7$ L/min) 과 비교하여 prone position 5분 $3.3{\pm}0.7$ L/min(p=0.0180)로 증가하였고 prone position 30분 $3.7{\pm}0.8$ L/min(p=0.0630)로 차이가 없었다. 분당맥박수는 각각 $141{\pm}22\;min^{-1}$, $141{\pm}22\;min^{-1}$(p=0.8658) 및 $176{\pm}28\;min^{-1}$(p=0.0280)이었고 폐동맥쐐기압은 차이가 없었다. Optimal PEEP하에서 평균동맥압은 각각 $87{\pm}19$ mm Hg, $107{\pm}18$ mm Hg(p=0.0180) 및 $108{\pm}16$ mm Hg(p=0.0180), 심박출량은 각각 $2.4{\pm}0.5$ L/min, $3.3{\pm}0.6$ L/min(p=0.0180) 및 $3.6{\pm}0.7$ L/min(p=0.0180), 그리고 박출용적은 각각 $14{\pm}2$ml, $20{\pm}2$ ml(p=0.0180) 및 $21{\pm}2$ ml(p=0.0180)였다. 분당맥박수는 체위 변경에 따른 차이가 없었고 폐동맥쐐기압은 각각 $10.1{\pm}2.4$ mm Hg, $9.1{\pm}2.7$ mm Hg(p=0.0180) 및 $9.0{\pm}3.1$ mm Hg(p=0.0679) 이었다. Optimal PEEP하 prone position에서 다시 supine position으로 체위를 바꾸고 5분 후 평균동맥압은 $92{\pm}23$ mm Hg, 심박출량은 $2.4{\pm}0.5$ L/min, 그리고 박출용적은 $14{\pm}1$ ml로 모두 감소하였다(모두 p<0.05). 결 론 : 잡종견 급성폐손상 모델에서 prone position은 비교적 낮은 수준 PEEP의 폐산소화 호전 효과를 중대시켰고, 비교적 놓은 수준 PEEP에 의한 심박출량 저하를 완화시켰다. 이러한 결과들은 심박출량을 유지하면서 폐산소화를 호전시키고자 하는 ARDS 환자에서의 기계환기의 목표를 달성하는데 있어 prone position이 supine position보다 유리하다는 것을 시사한다.

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전척수(全脊髓) 및 경막외차단(硬膜外遮斷)으로 편타성(鞭打性) 손상(損傷)의 통증치험(痛症治驗) (4례(例) 보고(報告)) (Total Spinal Block and Cortical Epidural Block for Whiplash Syndrome and Reflex Sympathetic Dystrophy (Report of Four Cases))

  • 박오;옥시영;송후빈
    • The Korean Journal of Pain
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    • 제1권1호
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    • pp.106-119
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    • 1988
  • For the relief of pain in 3 cases of whiplash syndromes (case I, II and IV) and in one of reflex sympathetic dystrophy (case III), we have carried out six intentional. total spinal blocks (TSB) which attempted two times in case I, three in case II and one in carte III whoso various symptoms were chronically unresponsive to the usual conservative treatments, and a time of cervical epidural and right suprascapular nerve block in case W whose acute symptom lasted 4 drys following the cervical injury (see fables from 1 to 9). During the 753, we have observed clinically the sequential charges of respiration, lid and pupil reflexes, body motion and consciousness. And checked the blood pressure, pulse rate and arterial Pco2. The effectiveness of those blocks has been assessed by using the Visual Analog Scale which is designed to measure the patient$\acute{s}$ subjective intensity of pain and also we have found out the sequelae following those blocks. The methods of the blocks were as the following: 1. Under the N.P.O. for 8~10 hours, the preparations of immediate cardiopulmonary resuscitation and premedication with atropine 0.5mg at thirty minutes before the TSB, it was performed by injecting the mixture of 2% mepivacaine 10 or 15ml and normal saline 10 or 5ml through No. 23 G. spinal needle into the subarachnoid space of $C_7-T_1$ interspinous region with fully flexed neck on the lateral posture. Immediately after the injection of the local anesthetic in the lateral position, the patient$\acute{s}$ were hasten to change Trendelenburg$\acute{s}$ position in order to act the drugs cephalad and to make easy controlled respiration with oxygen. 2. The cervical epidural block was done by injecting the mixture of 0.5% bupivacaine 4ml, normal saline 4ml and triamcinolone 15mg through No. 18 G. Tuohy needle into the epidural space on the same region and posture as the above without premedication.7he suprascapular nerve block was done by injecting of 0.5% bupivacaine 3ml only into the right suprascapular fossa on the sitting posture. The results were as the following: 1. The cessation of respiration was seen within 5 minutes following the subarachnoidal injection of the above 20ml mixture in 2 to 3 minutes and then soon the consciousness began to disappear. The loss of Lid and pupil reflexes noted between 5 to 10 minutes and the size of the dilated pupils was equal between 5 to 20 minutes, but the pupil of the dependent side on tile lateral position was dilated 1 to 3 minutes earlier than that of the independent. The patients had r=ever responded to any stimulations during the TSB except their heart funtion. 2. The recovery of the TSB was as the following, firstly the ankle and lower limb of the independent side began to move slightly with in 34 to 75 minutes after the injection and then that of the dependent Secondly the neck and upper limb moved 6 to 15 minutes later than the lower limb. Thirdly the self respiration began to appear between 40 to 80 minutes from the block. The lid and pupil reacted to touch and light respectively between 40 to 80 minutes but the pupil of the independent side responded earlier than that of the depends. Lastly the consciousness recovered completely between 80 to 125 minutes from the block. 3. In the cardiopulmonary function during the TSB, the blood pressure were stable except the 210/130 tory at the and block of case I. There were bradycardias between 65 to 85 minutes in case I and II but no arrythmia on the EKG. The level of the arterial Pco2 was maintained to 43~45 torr during the TSB. 4. The effectiveness of the above blocks was no pain(0%) in case IV, and light (10~20%) in case I and II but no improvement in case III. 5. The right arm weakness has been complicated as to be Injected accidently the "COLD" local anesthetic at the End block of case I.

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