• The Korean Journal of Pain
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• 제34권1호
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• pp.106-113
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• 2021

Background: We aimed to investigate the analgesic efficacy of an erector spinae plane block (ESPB) in immediate breast reconstruction (IBR) with a tissue expander. Methods: Adult women undergoing IBR with a tissue expander after mastectomy were randomly assigned to either intravenous patient-controlled analgesia (IV-PCA) alone (group P) or IV-PCA plus ESPB (group E). The primary outcome was the total amount of opioid consumption during 24 hours postoperatively between the two groups. Secondary outcomes were patient satisfaction, pain score at rest and on shoulder movement using numerical rating scale, incidences of postoperative nausea and vomiting (PONV), and a short form of the brief pain inventory (BPI-SF) at 3 and 6 months after surgery between the groups. Results: Fifty eight patients completed the study. At 24 hours postoperatively, total opioid consumption was significantly less in group E than in group P (285.0 ± 92.0, 95% confidence interval [CI]: 250.1 to 320.0 vs. 223.2 ± 83.4, 95% CI: 191.5 to 254.9, P = 0.005). Intraoperative and cumulative PCA fentanyl consumption at 3, 6, 9, and 24 hours were also less in group E than in group P (P = 0.004, P = 0.048, P = 0.020, P = 0.036, and P < 0.001, respectively). Patient satisfaction was higher in group E (6.9 ± 1.8 vs. 7.8 ± 1.4, P = 0.042). The incidences of PONV was similar. Conclusions: The ESPB decreased postoperative opioid consumption and increased patient satisfaction without significant complications after IBR with a tissue expander after mastectomy.

• Journal of Gastric Cancer
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• 제9권4호
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• pp.215-222
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• 2009

목적: 원위부 위절제술 후 재건술의 하나인 Billroth II 위공장문합술은 오랫동안 사용되어온 방법이나 역류성 위염의 빈도가 높다는 것이 문제점 중의 하나이다. 이를 보완하기 위한 여러 시도가 있었으나 그 중 잔위의 크기에 따라 Roux-en-Y 위공장문합술, Braun 공장문합술 및 Billroth II 위공장문합술을 달리 시행한 후 그 적용의 적합성을 알아보고자 하였다. 대상 및 방법: 2003년 9월부터 2007년 4월까지 하부 및 중위 위선암으로 단일 술자에 의해 원위부 위절제를 받은 후 잔위의 크기가 10% 이하일 때 Roux-en-Y 위공장문합술 (14명)을, 잔위가 10~20%일 때 Braun 공장문합술(17명)을, 잔위가 20~40%일 때 Billroth I이 부적합하다고 판단된 경우 - Billroth II 위공장문합술(14명)을 시행 후, 각각의 치료성적을 분석하였다. 분석 방법은 전화 설문과 의무기록을 조사하여 환자의 증상 및 내시경 소견을 평가하였고 술 후 영양 상태를 평가하기 위하여 혈중알부민, 혈색소농도 및 체중의 변화를 측정하였다. 결과: 수술 사망률 0%, 수술 합병률 8.9% (4/45)로 모든 수술은 안전하게 시행되었다. 내시경 소견에서 역류성 위염은 Roux-en-Y군, Braun군 및 Billroth II군에서 각각 7.63%, 18.65%, 40.0%에서 보였다(P=0.13). 가벼운 역류성 식도염이 Roux-Y군과 Braun군에서 각각 1명씩 있었다. 내시경적 위저류는 Roux-en-Y군에서 2예가 보였으며 이 중 1예는 역류성식도염의 원인이 되었다. Roux-en-Y군과 Braun군이 Billroth II 군보다 식사량의 감소가 적었으며(각각 7.1%, 0.0%, 28.7%, P=0.036), 식후 불편감(각각 14.3%, 23.5%, 57.1%, P=0.035)과 역류 증상(각각 0.0%, 11.8%, 42.9%, P=0.009)을 적게 호소하였다. 결론: 작은 잔위를 가지는 환자에서 시행된 Roux-en-Y 위공장문합술과 Braun 공장문합술은 역류증상의 방지와 위절제 후 불편감을 줄이는데 효과적이라고 생각하며, 10% 미만의 잔위에서는 Roux-en-Y를, 그 외의 경우에는 Braun 문합을 확대적용을 고려하는 것이 좋겠다.

• 한국의료질향상학회지
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• 제7권1호
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• pp.118-131
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• 2000

Background : A continuous healthcare quality improvement is needed to provide high quality healthcare service as well as to maintain trust in terms of satisfying the needs of the patients. Recently it also became an essential issue. in hospital management, recognized for it's competitive potentiality among healthcare organization groups. This study was conducted to analyze patient complaints and issues received by the Quality Improvement Department. Its purpose is to improve healthcare qualities within the hospital, as well as establish policies and appropriate strategies in hospital management. Method : From July 1st to September 30th of the year 1999, we analyzed all complaints and issues made by various patients and their families, which were received through 24 hour phone consultation, numerous suggestion boxes, letters and E-mails, The issues were classified into 16 different categories based on a Patient Satisfaction Assessment Tool. All data were segregated according to the departmental frequencies and their contents. To come up with for environmental and patient satisfaction improvement, all complaints or issues were communicated with hospital administrators, medical and nursing staff and employees. Comprehensive customer satisfaction activities including improving phone etiquette were discussed in Customer Satisfaction Team, CQI Team and each Department. All opportunities for improvement were implemented. Feedback actions were discussed. Results : A total of 317 cases were collected. Issues regarding parking and other accommodation facilities were most common complaints that were 14.5% of total. Issues regarding admission rooms (10.7%), admission procedures (10.7%), waiting room environment (8.8%), nurses and nurse assistants (7.6%), physicians (6.6%) and others (23%) followed. Thirteen of 45 departments received more than 8 complaints. The Nursing Department had the most complaint, receiving 9.8% of total complaints. Complaints regarding the Nursing Department were predominantly related to the environment of patient rooms. The Department of Psychiatry for phone etiquette (4.7%), Department of Otolaryngology for the nursing staff's attitude and phone etiquette (4.4%), and the Admission Department followed. As a part of efforts to improve patient satisfaction, a new parking structure was built and reallocation of the parking space was done. Renovation of other accommodation facilities were carried out by hospital administration, Monthly phone call and answering attitude survey was done by QI Department. Based on this survey we made a phone etiquette manual and distributed throughout the hospital. Compare to the last year, Patient Satisfaction Index measured by Korea Productivity Center using National Customer Satisfaction Index was improved 7 points. According to our organization's own study, we confirmed the phone etiquette was improved 11% than last year. Conclusions : Issues related to parking and other accommodation facilities ranked first followed by complaints made regarding the patient care area, the admission and cashier process, and nurses' and doctors' attitude. The Nursing and Psychiatry Departments need improvement regarding phone etiquette. Results were shared and played a vital role in policymaking and strategic planning of the hospital. It is imperative that we keep our database updated by listening to and solving the needs of each patient. The CQI activities can be achieved only by full commitment of the hospital top management supported by related personal.

• 대한약리학회지
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• 제32권1호
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• pp.1-11
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• 1996

흰쥐 해마(hippocampus)에서 norepinephrine(NE) 유리에 미치는 $A_1-adenosine$ 수용체의 post-receptor 기전에 관한 지견을 얻고자 하여 $^3H-norepinephrine$으로 평형시킨 해마 절편을 사용하여 adenosine의 $^3H-NE$ 유리에 미치는 여러가지 약물의 영향을 관찰하였다. Adenosine($1{\sim}30{\mu}M$)은 전기자극(3 Hz, 2 ms, 5 Vcm-1, 구형파)에 의한 NE 유리를 용량 의존적으로 감소시켰고, 이 효과는 선택적인 $A_1-adenosine$ 수용체 차단제인 $8-cyclopentyl-1,3-dipropylxanthine(2{\mu}M)$에 의해 차단되었다. G-단백 억제제인 N-ethylmaleimide(NEM, 10과 $30{\mu}M$)는 그 자체로써 전기자극으로 유발시킨 NE 유리를 증가시켰으며, adenosine의 NE 유리 억제효과는 NEM 전처리에 의하여 완전히 소실되었다. Protein kinase C 활성화제인 $4{\beta}-phorbol$ 12,13-dibutyrate(PDB, $1{\mu}M$)는 NE 유리 증가를 일으켰고, 이 효소 억제제인 $4{\beta}-polymyxin$ B(PMB, 0.1 mg)는 NE 유리감소를 일으켰으며, adenosine에 의한 NE 유리 감소효과는 PDB에 의해 억제되었고, PMB 전처리하에서는 감소효과가 출현하지 않았다. $Ca^{2+}$-통로 차단제인 $nifedipine(1{\mu}M$)은 adenosine의 NE 유리 억제효과에 영향을 미치지 못하고, ATP에 의존적인 $K^+-$통로 차단제인 glibenclamide역시 adenosine의 NE 유리 억제효과에 영향을 미치지 못하였다. 그러나 delayed rectifier $K^+-$통로 차단제인 tetraethylammonium(TEA, 3 mM)은 그 자체로 NE 유리를 증가 시켰으며, adenosine의 NE 유리 억제효과를 차단함을 볼 수 있었다. 8-bromo-cAMP(100과 $300{\mu}M$) 그 자체로는 NE 유리에 별다른 영향을 미치지 못하였으나 8-bromo-cAMP 전처리에 의하여 adenosine의 NE 유리 억제효과가 억제됨을 볼 수 있었다. 이상의 실험결과로 흰쥐 해마에서 $A_1-adenosine$ 수용체를 통한 adenosine의 NE 유리 감소는 G-단백에 의존적이며, 이러한 효과에 protein kinase C, TEA에 예민한 $K^+-$통로 및 adenylate cyclase계가 복합적으로 관여하고 nifedipine에 예민한 $Ca^{2+}-$통로와 glibenclamide에 예민한 $K^+-$통로는 관여하지 않는 것으로 사료된다.