뇌졸중 환자의 일상생활동작, 우울과 삶의 질의 관계

김원옥 ( Won Ock Kim ),강현숙 ( Hyun Sook Kang ),왕명자 ( Jmyung Ja Wang ),김정화 ( Jeong Hwa Kim ),최진이 ( Jin Yi Choi ) 경희대학교 동서의학연구소 2007 동서간호학연구지 Vol.13 No.2

본 연구는 뇌졸중 환자의 일상생활동작, 우울, 삶의 질의 관계를 파악하고자 하는 서술적 조사 연구로서 일상생활동작,’ 우울, 삶의 질 정효〉 관계가 있음을 확인하였다. 그러므로 본 안구의 주요한 결과를 중심으로 다음과 같이 고찰하였다. 뇌졸중 환자들의 일상활동 수행능력을 측정하는 도 구로 FIM, Modificd Barthel Index (MBI) 등이 많이 쓰 이고 있는데 FIM은 분야에 상관없이 표준화를 통한 높은 실용성,실행성, 이해도로· 인하여 널리 사. 하고 있는 도구로 이를 이용하여 측정한 본 연구에서는 872점으로 국내에서 만성 뇌졸중 환자와 퇴원 시 뇌졸중 환자를 대상으로 측정한 85. 9점 (Hw떼g, 2004) 과 85. 3점 (Kim, 2004) , 85. 8점 (Hong et al., 1998) 에 비하 여 약간 높아졌으나 비슷하였고, 일본 뇌졸중 환자를 대상으로 한 연구의 77. 1점보다는 높은 결과이었다 (Hama et al., 2007) . 특히 하부역역인 운동영역은 다 른 연구에 비해 높았으나 인지영역은 다른 연구에 비 해 낮은 편이었다 (Hwang, 2004二 Hama et al. , 2007, Hong 嫩 al. , 200긱 Kim, 2004) . 미국의 지역사회시설 에 있는 뇌졸중이 처음 발병한 환자들을 대상으로 재 활 후 5년간 환자를 추적한 연구에서 3년 후까지는 FIM점수가 상승하였으나 그 이후 감소되는 양상을 보였고 본 연구에서는 친단 후 경과 기간이 35.5개월 (87.2점)로 퇴원 후 3년 된 시점의 결과no도4점) 와 비교하였을 때 낮은 편이었다〈 Leonard, Mnler, Griffiths, Mcclatchie, & wherry, 1998) . 이러한 결과는 지역사 회와 집에서 간호를 받고 있는 뇌졸중 환자들에게 지속적인 재활 프로그램의 필요성이 높다는 것을 시사 한다고 볼 수 있다. 그러므로 입원을 한 직후부티 환 자에게 적절한 재활프로그램을 계획하여 시작하고 퇴원 후에는 연계되어 재활을 받을 수 있는 시설과 연결하여 환자가 지속적으로 재활을 할 수 있도록 돕는 병원과 지역사회가 공동으로 개발하고 시행하는 개활프로그램이 필요하다. 우울은 뇌졸중을 진단 받은 환자들의 급성기와 회 복기에 많이 동반되는 증상으로 본 연구에서도 CES- D를 이용하여 우울을 측정한 결과 23. 8점으로 Bak (2003) 의 연구와 비슷한 정도로 높게 측정되어 이 전의 연구결과와 같이 뇌졸중 환자의 가장 흔한 후유 증이 우울임을 다시 확인할 수 있었다 (Cho et al. 2003, `` Chon & Rhee, 1992, `` Kim, 2005, `` Kim, Seo, & Kang, 2000; singh et al. , 2000) . 그러므로 입원 시부터 신체적인 증상 뿐 아니라 우울도 같이 사정하고 우울이 진행되지 않도록 지속적인 관찰과 정서적인 간호가 뇌졸중 환자를 위한 재활프로그램에 포함이 되어야 한다. 삶의 질은 3 ``03점으로 뇌졸중 환자 l이명을 대상으로 한 chung (2000) 의 연구에서 의 3. 41점보다는 낮았으나 Kim과 Kim (2003) 의 연구의 3. 17점과는 비슷하였고 전체적으로 낮은 편이었다. 이런 결과는 최근 의학기술의 발전으로 뇌졸중으로 인한 사망률이 감소 되고 만성적인 뇌졸중 환자가 증가함에도 불구하고 재가뇌졸중 환자들에 대한 재활과 관리가 효과적으로 이루어지지 않고 있음으로 확인할 수 있었다. 따라서 뇌졸중과 삶의 질은 단기간에 향상되는 것이 아니므로 개활 프로그램이 단기적인 것보다는 체계적으로 계획되고 지속적으로 수행되어져 삶의 질을 관찰하는 연구가 필요할 것으로 생각된다. 또한 일상생활 동작을 잘 할수록 우울점수가 낮게 나타났고 삶의 질 정도가 높게 나타났다. 그리고 우 울 정도가 심할수록 삶의 질 정도가 낮은 것으로 나타났다. 뇌졸중 환자들에 대한 선행연구결과들을 살 펴보면 뇌졸중은 일상생활동작 수행과 같은 신체적인 문제, 우울, 대인관계 감소 등의 사회적 문제가 발생 되고 장기적인 치료와 간호를 요구하는 질병으로서 최종적으로. 삶의 질이 저하되는 것을 보고하고 있다 (Chung, 2000; Hama et al. , 2007, `` Ingrid, Kwakkel, Bruin, & Lindeman, 2007; Khan, 2004; Kim & Kim, 2003; singh et al. , 2007) . 이러한 연구 결과는 일상생활동작, 우울, 삶의 질이 단계적으로 순환되는 관계로 서 모두 뇌졸중환자를 위한 재활프로그램 내용에 포함되어야 함을 의미한다. 이런 연구결과들을 종합하여 볼 때 뇌졸중은 환자 의 뇌손상을 일으켜 장기적인 우울과 신체적인 기능 장애를 발생시킬 가능성이 높으므로 뇌졸중 환자의 재활프로그램은 입원을 하자마자 계획하여 치료와 동 시에 시작하고 특히 우울은 뇌졸중의 만성적인 건강 문제로 재활과정을 방해할 수 있으므로 신체적인 중 재와 더불어 정서적인 중재를 포함한 포괄적인 내용 의 프로그램이 바람직하고 장기적으로 삶의 질을 평 가함이 바랑직할 것이다. 또한 뇌졸중은 장기적인 재 활이 요구되는 질환이므로 단기간의 재활 프로그램을 병원에서만 시행하는 것이 아니라 퇴원 후 병원과 지 역 사회에서 연계하여 치료적인 연속성을 가지고 유지 할 수 있는 재활 프로그램의 개발이 반드시 필요할 것이 라고 본다. Introduction: The purpose of this study was to examine relationships among stroke patients`` activities of daily living(ADL), depression, and quality of life(QOL). Methods: Data were collected by questionnaires from 251 stroke patients at 5 hospitals and 2 public health centers in Seoul and Kyonggi-Do. The following Questionnaires were utilized for this study: Functional independence measure(FIM) from Grange, Hamilton, and Sherwin(1986), the Korean CES-D scale from Randloff(1977), and quality of life scale from Bang, Hwal-Lan(1991). Results: Data were analyzed using the pearson correlation, t-test, and ANOVA with SPSS/WIN 12.0. The results of this study were as follow; The subjects consisted of 110 females and 141 males. The mean score of activity of daily living was 87.2(range 18-126). Age, family history, comorbidity, paralysis site, and duration after diagnosis were significantly associated with activity of daily living. The mean score of depression was 23.8(range 11-44). Age, gender, education, and job were significantly associated with depression. The mean score of quality of life scale was 3.0(range 1-5). Gender, religion, education, job, economic status, and duration after diagnosis were significantly associated with quality of life. Relationships among activity daily living, depression, and quality of life scale: The activity of daily living had a negative relationship with depression score. The activity of daily living had a positive relationship with QOL score. The depression had a negative relationship with QOL score. Conclusion: Based on these results, it is necessary to run rehabilitation programs to improve stroke patients`` ADL, depression. Also, it research for of identifying stroke patients`` quality of life according to rehabilitation program.

65세 이상의 노령층에서 고지혈증의 위험요인

김용배,장원기,황보영,김화성,안규동,이병국,이용진,김세훈,김승수,김승훈,김영록,김웅빈,이성수 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

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Film Session Q&A 2 : 05 ; How to remove a huge ovarian tumor in single port laparoscopic surgery using XXXL endopouch

( Jin Hwa Lee ),( Ga Won Yim ),( Eun Ji Nam ),( Sung Hoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2014 대한산부인과학회 학술대회 Vol.100 No.-

목적: Demonstrate a new instrument, technique or procedure 방법: In this video, we showed how to remove huge ovarian tumors in sinlgel port laparoscopic surgery by SW KIM`s method. SW KIM`s method is the technique to put a huge ovarian tumor into a specially designed extremely large endopouch (XXXL: 30x30㎠sized) using two conventional laparoscopic needle holders and one laparoscopic grasper and gravity by changing the patient`s position. After identifying the infundibulopelvic and uteroovarian ligaments salpingooophorectomy including huge ovarian tumor was performed by LigaSure. And then ovarian tumor was located in the pelvic cavity by changing the patient`s position into reverse-trendelenberg position and a XXXL endopouch was inserted and un-rolled inside the abdominal cavity. To insert a huge tumor into the XXXL endopouch, the endopouch was opened in triangular shape. Bilateral apex of baseline of trianglular opening of the endopouch was hold by two needle holders and then the upper apex was hold by a grasper. After holding three point of endopouch opeing, the patient`s position was changed into deep trendelenberg postion, then the tumor came into the endopouch by gravity. While changing the patient`s position, 2 needle holders and a graspers were moved into the pelvic cavity from the abdominal cavity. Aftere identifying the tumor inside the endopouch, tumors could be removed through the single port opening site or transvaginally in laparoscopic hysterectomy case without spillage of ovarian tumor. 결과: The advantage of SW KIM`s method is to remove ovarian tumor without spillage in a single port laparoscopic surgery by putting it into the large endoscopic bag despite narrow space. 결론: Using a specially designed 30×30 cm sized XXXL Endopouch and SW Kim`s technique, huge ovarian tumors could be removed without spillage in single port laparoscopic surgery.

연쇄중합효소반응을 이용한 태아성별진단

이희섭,김용신,김화선,김정중,김원신 원광대학교 생명공학연구소 1996 생명공학연구소보 Vol.4 No.1

For sex determination by the PCR method, oligoprimers to Y-chromosome gene, DYZ1, SRY, and AMGL were synthesized and genomic DNA was extracted from male and female placenta for the control use. DYZ1 represented 154 bp single band to 0.001pg/ml male genomic DNA but did not represent 154 bp band in female genomic DNA, SRY represented 341 bp band to 1 pg/ml male genomic DNA but did not represent 341 bp band in female genomic DNA, and AMGL represented 977 and 788 bp double band to 1 pg/ml male genomic DNA and 977 bp single band to 1 pg/ml female genomic DNA in 2% agarose gel electrophoresis stained with ethidium bromide. DYZ1 was 1,000-fold sensitive than SRY and AMGL. DYZ1 and SRY could not identify the PCR failure from female but AMGL identified. To increase the sensitivity, the dual amplification of AMGL was performed and the sensitivity increased to 1,000-fold. During the dual amplification of female genomic DNA mixed with male genomic DNA, 0.00125pg/l, 1:400 part male genomic DNA contamination represented double bands as male. In 2 cases of 46, XY female, DYZ1 and AMGL amplification represented male band but SRY amplification did not represent male band. It was suggested that SRY gene was deleted in two 46, XY female cases. for fetal sex determination, PCR with DYZ1, SRY, and AMGL was performed in 10 cases of chorionic villi and 15 cases of amnionic cells. By the comparison with karyotyping result, fetal sex determination was achieved successfully in all 23 samples using PCR of SRY and AMGL but false result was detected in 3 cases(13%) using DYZ1. According to our results, it was concluded that DYZ1 was 1,000-fold sensitive than SRY and AMGL but could not be used because of its false results, and AMGL and SRY must be used concomitantly for precise sex determination.

Urapidil, Labetalol의 투여가 기관내 삽관시 심혈관계에 미치는 영향

신용섭,윤석화,손수창,이원형,이정은,황원재,김만수,김영주,김혜자,최세진 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

We have examined the comparative efficacy of small doses of intravenous urapidil and labetalol in blunting hemodynamic response to endotracheal intubation and surgical incision in 30 patients without cardiovascular diseases. After intravenous urapidil 0.2 mg/kg or labetalol 0.2 mg/kg anesthesia was induced with thiopental 5mg/kg. Endotracheal intubation was facilitated by vecuronium 0.15 mg/kg with priming principle and anesthesia was maintained with enflurane and nitrous oxide in oxygen. Systolic, diastolic and mean arterial pressure and heart rate were measured before administration of the drugs, 5 minute after administration, just prior to endotracheal intubation and 1, 3, 5, 10 minute after intubatin. Also the peak blood pressures and heart rate within 10 minutes after surgical incision were measured. Endotracheal intubation and surgical stimulation were associated with significant increases in blood pressures and heart rate in both urapidil and labetalol group. Comparison of the changes in systolic, diastolic, and mean artrial pressures and heart rate between urapidil and labetalol group showed no significant difference except peak systolic pressure after surgical incision. It is concluded that the pressor response to endotracheal intubation and surgical stimulation are not influenced significantly by urapidil 0.2 mg/kg or labetalol 0.2 mg/kg. However, urapidil and labetalol preloading may be similarly effective in the blunting of the increases in blood pressures with larger doses of the durgs during anesthetic induction.

토끼 복부 내벽으로부터 분리된 경락으로 믿어지는 관조직

손준형 ( Joon Hyung Sohn ),윤진하 ( Jin-ha Yoon ),김영주 ( Young Joo Kim ),김민경 ( Min Kyung Kim ),김지화 ( Ji Hwa Kim ),권오현 ( Ohyun Kwon ),김현원 ( Hyun-won Kim ) 대한미용학회(구 대한미용과학회) 2016 대한미용학회지 Vol.12 No.4

Investigation of meridian line and acupoints as anatomical entities should be very important, as acupuncture and meridian massage for medical purpose in the hospital or for skin care in beauty shop are each based on the traditional meridian theory. We isolated tubular structures under the skin of rabbits where the traditional meridian lines are located. The characteristics of these tubular structures isolated from the abdominal wall matches those of Bonghan tubes and Bonghan tubules found by Bong Han Kim. The Bonghan theory established by Bong Han Kim suggests that meridian lines consist of Bonghan tubes and Bonghan tubules. We could observe the presence of large cells inside the Bonghan tubule and the presence of small granules referred to as Sanal in Bonghan theory inside the striae consisting of the Bonghan tubules. Present research suggests that there exist a third unique tubular structure where Sanals flow other than Bonghan tube and Bonghan tubules.

마늘 Alliinase의 효소적 특성

김명화,허원녕 목포대학교 자연자원개발연구소 2000 자연자원연구 Vol.3 No.-

Garlic allinase had the optimum substrate concentration of 40 mM Sallyl-L cysteine sulfoxide, the optimum temperature of 40℃ and the optimum pH of 8.0. The enzyme appeared to be stable until 40℃ for 10 minutes and above pH 6.5. Also among three storage temperatures, freeze temperature storage(-10℃) was most effective on the allinase activity.

고요산혈증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이종은,이준숙,이찬구,이한정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : Serum uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities. The aim of this study is to evaluate risk factors which influence hyperuricemia in the citizens of Asan. Method : The study design was cross-sectional and research subjects were 1086 citizens of Asan. General characteristics, cigarette smoking, alcohol consumption, and past history were obtained by interview using a structural questionnaire. Also, we measured height, weight and blood pressure, and serum uric acid of the subjects. Results : The mean serum uric acid level was 5.27 ㎎/㎗ in men and 4.01 ㎎/㎗, in women, In the multiple logistic regression analysis, statically significant risk factors of hyperuhcemia were gender, body mass index, blood lead concentration, and serum creatinine. Conclusion : Our results suggest that gender, body mass index, blood lead concentration, and serum creatinine might be the most important risk factors of hyperurcemia. Education program as well as routine check-up for serum uric acid was highly recommended for the effective prevention of hyperuricemia.

능동 망의 보안 기술

김종원,김화종 강원대학교 정보통신연구소 2002 정보통신논문지 Vol.6 No.-

In 1994, DARPA proposed solutions that solve the problem originated from classic network. Main problem is first, it takes long time to integrate with new technology and related standards, second, performance deterioration caused to duplicated operation among many protocol layers, third, trouble is arisen when current and studied in many research institutes and universities. In this paper, we introduced the concept and architecture of active network. Also we propose method related to security which is most important part with regard to active network and presented new policy in implementing.

전신성 홍반성 낭창이 속발된 헐괄 면역아구성 임프선종 1예

양기화,김병기,심상인,김원일,김선무 大韓血液學會 1984 大韓血液學會誌 Vol.19 No.2