흉추 경막외 차단법과 Esmolol 에 의한 유도 저혈압 마취후 술후 간기능검사의 비교

강정권,연준흠,홍기혁,한송욱 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.3

Background: Induced hypotension reduces blood loss in the surgical field and provies better visibility. May methods have been used for induced hypotension. Recently Esmolol is favored in induced hypotension because of its short action of sympathetic beta-1 receptor antagonist and easy to control. Thoracic epidural block can provide cadiovascular stability in induced hypotension. The purpose of the study is to compare postoperative liver function after induced hypotension between thoracic epidural blockade and esmolol combined with general anesthesia with isoflulane. Method : Fourty patients scheduled for spinal posterior fusion under general anesthesia were randomly divided into two groups. In thoracic epidural blockade group(Group I, 20 patients), 8∼10 ml of 2% lidocaine was injected into the epidural catheter located in T6∼7 interspace in a bolus. In Esmolol group(Group II, 20 patients) received 0.5 mg/kg as loading dose and 50∼150 g/kg/min continuously. We measured preoperative and postoperative 1, 3, 7 day's serum glutamic-oxaloacetic transaminase(SGOT), serum glutamic-pyruvate transaminase(SGPT) and alkaline phosphatase(ALP). Result : In the thoracic epidural blockade group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. Similarly, in the esmolol group, there was statistically significant increase of SGOT level above normal range on postoperative 1 day, which decreased on postoperative 3 and 5 day(p<0.05). But it was within normal range on postoperative 7 day. SGPT was increased within normal range. The level of ALP was increased within normal range in both groups. There was no statistically significant difference in liver function between two groups. Conclusion : We consider that postoperative liver function is little influenced with induced hypotension by thoracic epidural blockade and esmolol combin with general anesthesia with isoflurane. (Korean J Anesthesiol 1998; 34: 601∼607)

임신성 융모성 질환에서 혈청 β-hCG의 소실기간과 양상에 관한 연구

강정권,구인상,차진영,김현희,김영재,이유석,배은경,나영정,김경태,조수현,조삼현,문형,조헌영,황윤영 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.4

목적 : 혈청 융모성 성선자극 호르몬 (hCG)은 임신성 융모성 질환에서 종양 활성도를 반영하는 가장 보편적인 지표로 사용되고 있으며 연속적 혈청 β-hCG 소퇴양상의 분석은 이 질환의 경과를 평가하는데 중요하다. 이에 본 연구에서는 임신성 융모성 질환을 포상기태와 악성 융모성 질환으로 나누어 혈청 β-hCG 소실기간을 분석하고 그 값들의 소퇴양상을 보고자 하였다. 연구 방법 : 1990년 1월초부터 2000년 12월말까지 한양대학병원 산부인과에서 병리조직학적으로 임신성 융모성 질환으로 진단 받고 치료받은 46예의 환자를 대상으로 하였다. 비교분석을 위하여 19예의 포상기태군과 27예의 악성 융모성 질환군, 두 군으로 대별하였으며 후자를 다시 비전이성군 17예와 전이성군 10예로 나누었다. 이들은 혈청 β-hCG가 음성 (<3 mIU/ml)이 될 때까지 1주일 간격으로 추적 검사를 하였으며 3회 연속 혈청 β-hCG 값이 음성이 나온 경우 1달 간격으로 1년간 추적 검사를 시행하였다. 혈청 β-hCG 정량은 이중접합 면역측정법 (Chiron Diagnostics Automated Chemoiluminescence System 180)으로 측정하였으며 통계학적 분석은 SPSS에 의한 t-test와 ANOVA test를 이용하였다. 결과 : 임신성 융모성 질환의 빈도는 182.7분만수당 1건이었다. 포상기태에서 혈청 β-hCG의 소실기간은 평균 12.8±1.1 (SEM)주 (7-26주) 이었으나, 악성 융모성 질환에서는 평균 17.9±1.4 (SEM)주 (8-34주) 이었다. 혈청 β-hCG 평균 소실기간은 악성 융모성 질환보다는 포상기태에서 통계학적으로 유의하게 짧았다 (P<0.01). 그러나 비전이성군 (18.0주)과 전이성군 (17.8주)간의 혈청 β-hCG 평균 소실기간은 통계학적으로 유의한 차이가 없었다 (P=0.946). 포상기태군과 악성 융모성 질환군의 혈청 β-hCG 평균 측정값은 로그지수 소퇴곡선을 따라 감소하는 양상이었다. 결론 : 본 연구에서의 혈청 β-hCG 값의 소퇴양상은 서구의 혈청 β-hCG 값의 소퇴양상과 비슷하였으며, 또한 1980년대 우리나라의 혈청 β-hCG 값의 소퇴곡선과도 비슷하였다. 또한 개개인의 연속적 혈청 β-hCG 값의 소퇴양상은 향후 치료방침 결정과 악성 융모성 질환 진단을 용이하게 하는데 그 효용성이 있음을 유추할 수 있었다. Objectives : It is now conventional practice to use human chorionic gonadotropin (hCG) as the marker of tumor activity in gestational trophoblastic disease (GTD). The interpretation of serial serum β-hCG regression patterns is important in monitoring the course of the disease. The purpose of this study was to establish a regression time and pattern of the serum β-hCG in which GTD is divided into hydatidiform mole and malignant trophoblastic disease. Materials & Methods : During the period from January 1990 through December 2000, 46 patients with GTD were histopathologically diagnosed and treated at the department of Obstetrics and Gynecology in Hanyang University Hospital. For the purpose of analysis and comparison, patients were divided into 19 cases of hydatidiform mole and 27 cases of malignant trophoblastic disease which was subdivided into nonmetastatic (17) and metastatic (10). Patients were followed clinically and by weekly estimations of quantitative serum β-hCG until negative (<3 mIU/ml). After three consecutive negative β-hCG, serum β-hCG were drawn monthly in all patients for one year. The level of serum β-hCG was detected by two-site sandwich immunoassay (Chiron Diagnostics Automated Chemiluminescence System 180). The obtained data were analyzed using t test and ANOVA test by SPSS. Results : The incidence of the GTD compared with delivery was one per 182.7 deliveries. The mean value of serum β-hCG regression time in hydatidiform mole was 12.8±1.1 (SEM) weeks (7.0-26.0 weeks) and 17.9±1.4 (SEM) weeks (8.0-34.0 weeks) in malignant trophoblastic disease. The regression time was significantly shorter in hydatidiform mole than that of malignant trophoblastic disease (P<0.01). The differences of mean value of serum β-hCG regression time between the groups with nonmetastatic (18.0 weeks) and metastatic (17.8 weeks) were not statistically significant(P =0.946). The mean values of serum β-hCG in both hydatidiform mole and malignant trophoblastic disease declined following a log-normal distribution. Conclusions : The regression pattern of serum β-hCG in present study was similar to that of which in Western and also similar to that of which in Korea in 1980s. The present study supports the continued use of individual patients serum β-hCG regression curve to make treatment decision and to recognize malignant trophoblastic disease promptly.

견관절통 환자에서 통증 유발점 치료의 효과

강정권,손지영,신동엽,홍기혁 인제대학교 1998 仁濟醫學 Vol.19 No.1

관절 운동이 큰 견갑부는 여러가지 질환들이 발생하며 대부분 통증 및 기능 이상을 유발한다. 저자들은 이와같은 통증의 주된 원인을 견관절을 감싸고 움직이는 근육들의 과긴장 또는 위축으로 생각하고 견관절통 환자에서 극상근, 소원근 및 극하근에 발생한 통증 유발점을 치료함으로써 제통 효과를 보았기에 문헌적 고찰과 함께 보고하는 바이다. It has been generally known that shoulder joint pains is attributed to the degenerative changes around the shoulder joint. However, localized or radiating pain in the arm and shoulder joint may result from faulty alignment causing compression or tension on nerves, blood vessels, or supporting soft tissues. The activity of the trigger point on terms minor compressing the axillary nerve causes pain to develop in the shoulder joint and area of sensory distribution of cutaneous branch of the axillary nerve. Spasm of the supraspinatus and infraspinatus compressing the suprascapular nerve causes pain to develop in the shoulder joint and scapular area. Accordingly, relieving the compression of the axillary nerve by local anesthetic infilteration on the identified trigger point together with ordinary physical therapy is found to be effective in the treatment of shoulder joint pain.

역 채색 형광 제자리 보합법과 비교 유전자 보합법을 이용한 표지염색체의 동정

강정권 ( Jung Kweon Kang ),조율희 ( Youl Hee Cho ),김지홍 ( Jee Hong Kyhm ),신은심 ( Eun Sim Shin ),호정규 ( Jeong Kyu Hoh ),정성노 ( Sung Ro Chung ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.9

B군 β-용혈성 연쇄상구균 패혈증에 의한 신생아 사망

강정권(Jung Kweon Kang),조삼현(Sam Hyun Cho),김승룡(Seung Ryong Kim),조수현(Soo Hyun Cho),김경태(Kyung Tai Kim),문형(Hyung Moon),황윤영(Youn Yeung Hwang) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.6

Since 1970, the group B streptococcus(GBS) has been a significant cause of neonatal sepsis in the West. Two distinct forms of disease occur in neonates. Early-onset disease which occurs within 7 days after birth is characterized by respiratory distress, apnea, shock, pneumonia, and occasionally meningitis. Late onset disease usually occurs at 3-4 weeks of age(ranging from 7 days to 3 months) and presents occult bacteremia or meningitis. The GBS is thought to be a rare causative agent for neonatal sepsis in Korea. Lately, we experience a case of early-onset GBS sepsis who died at 3rd day of life. We present this case with brief review of literatures.

일반연제 발표 : 산과학 1 ; 태아 성차(性差)에 따른 태아심박동 양상의 변화

김성희,강정권,황정혜,박문일,정성로,문형,황윤영,박영선,차경준 대한산부인과학회 2001 대한산부인과학회 학술대회 Vol.87 No.-

만성통증 환자의 신경차단술을 위한 Propofol 목표농도 주입법을 이용한 진정수면

이윤석,오완수,강정권,우승훈,연준흠,김정원,홍기혁 대한정맥마취학회 1999 정맥마취 Vol.3 No.3

서론: Propofol 정맥마취는 다른 마취제와 비교할 때 깨끗하게 각성하기 때문에 외래수술을 위한 마취에 적합하다고 알려져 있다. 저자들은 당일 귀가를 예정하고 수술실에서 신경차단술을 시행받는 환자들에서 propofol 목표농도 주입법을 사용하여 진정수면을 적용하였다. 적절한 진정수면 깊이를 파악하기 위해서 뇌파의 bispectral index (BIS) 점수를 관찰하였다. 본 연구의 목적은 신경차단술 환자들의 propofol 진정수면에 대한 만족도와 임상적 안정성을 평가하는 것이다. 방법: 통증클리닉 외래로 방문하여 수술실에서 신경차단술을 받는 40명의 성인 환자를(18∼75세) 대상으로 하였다. 시술 중 맥박산소포화도, 맥박수를 측정하고 저자들이 변형시킨 경비산소투여기로 산소를 분당 5 L로 투여하면서 호기말 이산화탄소 분압을 측정하여 분당 호흡수를 측정하였다. BIS 센서를 이마에 부착하였다. Lidocaine 40 ㎎과 ketorolac 30 ㎎을 정주하고 propofol 목표농도 주입을 시작하였다(목표농도=3.0 mcg/㎖, 유도시간=3분). 손에 쥐고 있던 베개를 떨어뜨리는 시점을 진정유도로 간주하고 이때의 효과부위농도(effect site concentration at induction, Ce_I)와 BIS 점수(BIS_I)를 기록한 뒤, 이후로의 진정 깊이는 propofol 목표농도를 Ce_I로 부터 0.8∼1.6배까지 임의로 조정해서 조절하였다. 신경차단을 위한 바늘 천자 부위에 통증치료의에 의한 국소마취제 침윤 때 효과부위농도(Ce at lidocaine infiltration, Ce_L)와 BIS 점수 (BIS_L), 이때 환자의 저항성 움직임 여부를 기록하였다. 시술이 끝나면 propofol 주입을 중단하였다. 환자가 호명에 반응하여 눈을 뜨고 대답을 할 수 있는 시기를 회복으로 평가하였고 회복에 걸린 시간과 이때의 효과부위농도(Ce at recovery, Ce_R), BIS 점수(BIS_R)를 기록하였다. Propofol 총 투여시간과 총 사용량을 기록하였다. 환자의 전반적인 만족도를 6단계로 구반하였고 회복실에서 약 1시간동안 관찰한 뒤 보호자와 함께 퇴원시켰다. 결과: 진정유도에 걸린 시간은 5.8±2.4분, Ce_I는 2.0±0.6 mcg/㎖, BIS_I는 68.1±15.9였다. 회복에 걸린 시간은 4.7±3.0분(평균±표준편차)이었으며 회복실에서의 오심과 어지러움으로 퇴원이 늦어진 환자가 두 명 있었다. 환자들의 시술에 대한 전반적인 만족도는 5 [0](중위수 [사분범위])로서 우수하였다. 국소마취제 침윤 중 저항성 움직임을 보인 환자는 19명이었다. 움직임 여부에 따른 Ce_L, Ce_L/Ce_I, BIS_L의 차이는 관찰되지 않았다. 결론: Propofol 목표농도 주입법을 이용한 진정수면 하에서 신경차단술을 시행받은 환자들의 만족도는 매우 높았다. 그러나 안전한 진정수면을 위해서는 맥박산소포화도, 호흡수의 감시가 필요하며, propofol 진정수면만으로는 BIS를 감시하고 있더라도 국소마취 침윤 때 나타나는 환자들의 저항성 움직임을 예측할 수 없으므로 이에 대한 주의를 요한다. Background: Propofol has been known to be proper in ambulatory anesthesia as its well-known rapid recovery characterized by "clear-headedness". Authors conducted a sedo-hypnosis by propofol target-controlled infusion in to whom the neural blockade was given. Bispectral index (BIS) of EEG was monitored to measure the depth of sedo-hypnosis. Purpose of this study was to evaluate the patient's subject feeling for propofol sedo-hypnosis and its safety. Methods: Fourty adult patients (18~75 year-old) were selected for this study. They were scheduled the elective neural blockade in operatihg room. We obtained the informed consent. Without premedication, they arrived at operating room via outpatient clinic. After proper positioning, pulse oximetry, pulse rate, respiration rate and BIS score were monitored. Following lidocane 40 mg and ketorolac 30 mg ⅳ, propofol was administered by target-controlled infusor (initial target concentration 3.0 mcg/ml, induction time 3 minutes) Loss of hand grasping power was regarded as induction of sedo-hypnosis. BIS_I (BIS at induction) and Ce_I (effect-site concentration at induction) of propofol were noted. After induction, target concentration was adjusted randomly in a range of 0.8 ~ 1.6 times Ce_I. BIS_L and Ce_L (BIS and Ce at local infiltration) were also noted. Withdrawal movement immediately following local anesthetic infiltration to needle puncture site was noted. Propofol infusion was ceased when the procedure was finished. Recovery time, BIS_R and Ce_R (BIS and Ce at recovery) were evaluated. Patient's overall satisfaction was classified into 6 classes by numeric rating scale. Patients were moved to recovery room and discharged home when matched with discharge criteria. Results: Induction time, Ce_I and BIS_I were 5.8±2.4 min, 2.0±0.6 mcg/ml, and 68.1±16.9, respectively. Withdrawal movement during local anesthetic infiltration was occured in 19 patients. Recovery time was 4.7±3.0 min (mean±standard deviation). All patients were met by discharge criteria within 4 hours. Patient's overall satisfaction was 5 [0] (median [interquartile range]). Conclusions: Patient's satisfaction for propofol sedo-hypnosis during the neural blockade was high. There's no impediment in one day discharge. Monitoring of pulse oximetry and respiratory rate will be needed for safe practice. Patient's withdrawal movement cannot be predicted in propofol alone sedo-hypnosis, even by BIS monitoring.

C 자형 영상증강장치를 사용한 방사선 투시하에 피부로부터 대요근 근구까지의 깊이에 대한 연구

오완수,우승훈,홍기혁,강정권 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.1

Background: Psoas compartment block with local anesthetics and corticosteroids is one of the treatments which provides long term analgesia of the lower back and anterior thigh unilaterally, and its technical easiness and safety allows blind application without C-arm guidance in the out-patient clinic. This study aimed to evaluate the mean of the depth from the skin to the psoas compartment, and its correlation to the following attributes: age, weight, height and PI (Ponderal Index), Methods: We investigated 28 patients who underwent psoas compartment block. All blocks were performed using Chayen's method (punctured at the point of 3 cm caudally and 5 cm laterally from the 4th lumbar vertebral spinous process) with a 22 G, 8 cm Tuohy needle under C-arm guidance. We recorded the depth from skin to the psoas compartment, height, weight and PI (weight (kg)/height (cm) x 100 (%)). Data were analyzed using the Pearson product-moment correlation coefficients. The correlations between the depth and other attributes identified by p-value of less than 0,05 were considered statistically significant. Results: The mean depths from skin to the psoas compartment were 6.02±0.28 cm in men, 5.44±0.22 cm in women. There is no significant correlation between the depth and other patients attributes. Conclusions: The mean depths from skin to the psoas compartment may be one of the guide for psoas compartment block in outpatient clinics without C-arm guidance.

섬유근통 증후군 환자에서 Somatomedin C (Insulin - Like Growth Factor 1)의 농도와 임상증상과의 관계

유병훈(Byung Hoon Yoo),강정권(Jeong Kweon Kang),오 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1

N/A Background: Fibromyalgia is a common syndrome of musculoskeletal pain and fatigue. Lacking distinctive histological or laboratory abnormality in diagnosis, it has often been considered a form of psychogenic rheumatism. Fibromyalgia causes much distress to the affected patients and often frustrates physicians, who are unable to start rational therapy on any logical disease pathology. Methods: Growth hormone is essential for muscular homeostasis. In the present study, the notion that the stage-4 sleep anomaly typically seen in the fibromyalgia syndrome may disrupt growth hormone secretion was tested. Because growth hormone has a very short half-life, serum levels of somatomedin C were measured; somatomedin C is the major mediator of growth hormones anabolic actions and is a prerequisite for normal muscle homeostasis. Serum levels of somatomedin C using acid-extraction procedure and two-site immunoradiome-tric assay (IRMA) and number of tender points were measured in 27 female patients with fibromyalgia from 40 to 60 years old and 27 healthy controls. Results: There were no differences in the concentration of somatomedin C between fibromyalgia patients and controls (mean+SD: 178.3+75.5 ng/ml versus 166.3+76.6 ng/ml; p 0.55). And there were no correlations between number of tender point and serum somatomedin C level by linear regression analysis. Conclusions: These findings did not support that there is a distinctive disruption of the growth hormone-somatomedin C neuroendocrine axis in a fibromyalgia syndrome. But we can not discard the hypothesis that disturbed sleep predispose to muscle pain.

체성감각 유발전위 감시하의 척추교정수술시 Propofol-Fentanyl 마취와 Propofol-Ketamine 마취의 비교 연구

이상석,이윤석,연준흠,강정권,김계민,홍기혁 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.4

Background: Somato-sensory evoked potential (SSEP) monitoring has been used to help minimize neurologic morbidity during spinal surgery. However, SSEP is affected by anesthetics, technical errors and physiologic aspects, We reviewed 50 cases of spinal surgery done with total intravenous anesthesia under SSEP monitoring. Methods: Fifty patients, ASA class I-II, free of neurologic disease and scheduled for elective spinal surgery were randomly selected for the study. All of the operations were performed under general anesthesia employing the method of total intravenous anesthesia with propofol and fentanyl (Group I, P-F) or ketamine (Group II, P-K), and monitored by SSEP. We checked the changes of blood pressure and heart rates during the operation, recorded latency and amplitude of SSEP in the pre-induction, post-induction, during screw insertion and post-distraction periods. Also, we checked the number transfers to the ICU and application of a ventilator. Results: Systolic and diastolic blood pressure were increased significantly in the propofol-ketamine group (p $lt; 0.05), but there was no difference in heart rate between both groups. In additioa there were no statistical differences in latencies and amplitudes of SSEP. The number of patients transferred to the ICU and placed on a ventilator showed no statistical difference. Conclusions: We think that the combination of propofol and fentanyl or ketamine used for total intravenous anesthesia is a very useful method in spinal surgery under SSEP monitoring.