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초기 젖산이 낮은 패혈성 쇼크 환자에서 젖산제거율과 예후
심윤수,함초롬,임소연,서지영,전경만 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.2
Background: Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels. Methods: To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February−July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (≥4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality. Results: Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041−1.298) and lactate clearance (OR 0.654, 95% CI 0.498−0.859). Conclusions: In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.
Standardized Combination Antibiotic Treatment of Mycobacterium avium Complex Lung Disease
심윤수,박혜윤,전경만,서지영,권오정,고원중 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.6
Purpose: The optimal treatment regimen for Mycobacterium avium complex (MAC) lung disease has not yet been fully established. We evaluated the efficacy of standardized combination antibiotic therapy and the factors that might affect unfavorable microbiologic responses in patients with MAC pulmonary disease. Materials and Methods: This retrospective study reviewed data from 96 patients (56 females; median age 59 years) treated with newly diagnosed MAC lung disease between January 2003 and December 2006. Results: All patients received standardized combination antibiotic therapy, consisting of clarithromycin, rifampicin,and ethambutol. Streptomycin was additionally given in 72 patients (75%)for a median duration of 4.5 months. The overall favorable microbiologic response rate was 79% (76/96); 20 patients (21%) had unfavorable microbiologic responses,including failure to sputum conversion (n = 13), relapse (n = 3), and MACrelated death (n = 4). A positive sputum acid-fast bacillus smear at the start of treatment was an independent predictor of an unfavorable microbiologic response. Conclusion: Standardized combination antibiotic therapy consisting of clarithromycin,rifampicin, and ethambutol with or without initial use of strepto
Spirometry and Bronchodilator Test
심윤수,이지현,리원연,서동인,오연목,윤종서,이진화,조재화,권철석,장중현 대한결핵및호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.2
Spirometry is a physiological test for assessing the functional aspect of the lungs using an objective indicator to measure the maximum amount of air that a patient can inhale and exhale. Acceptable spirometry testing needs to be conducted three times by an acceptable and reproducible method for determining forced vital capacity (FVC). Until the results of three tests meet the criteria of reproducibility, the test should be repeated up to eight times. Interpretation of spirometry should be clear, concise, and informative. Additionally, spirometry should guarantee optimal quality prior to the interpreting spirometry results. Our guideline adopts a fixed normal predictive value instead of the lower limit of normal as the reference value because fixed value is more convenient and also accepts FVC instead of vital capacity (VC) because measurement of VC using a spirometer is impossible. The bronchodilator test is a method for measuring the changes in lung capacity after inhaling a short-acting b-agonist that dilates the airway. When an obstructive ventilatory defect is observed, this test helps to diagnose and evaluate asthma and chronic obstructive pulmonary disease by measuring reversibility with the use of an inhaled bronchodilator. A positive response to a bronchodilator is generally defined as an increase of ≥12% and ≥200 mL as an absolute value compared with a baseline in either forced expiratory volume at 1 second or FVC.
Association of Bone Mineral Density with Airway Obstruction and Emphysema
심윤수,이진화,김유경,장중현 대한결핵및호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.3
Background: Airway obstruction and the extent of emphysema are reported to be responsible for reduced bone mineral density (BMD). Corresponding to different phenotypes of a pulmonary disease, different severity in extra pulmonary features may exist. We compared BMDs of subjects with or without airway obstruction and/or emphysema and investigated the relationships among BMD, the severity of airway obstruction, and the extent of emphysema. Methods: Using a university hospital database, we reviewed patients over 40 years old who performed spirometry, computed tomography of chest, and measurement of BMD of the lumbar (L) spine. According to the presence or absence of airway obstruction and/or emphysema, four groups were classified. Results: Among a total of 59 subjects, 33 (56%) had osteoporosis. The prevalence of osteoporosis in subjects with no airway obstruction and no emphysema, those with only emphysema, those with only airway obstruction, and those with both airway obstruction and emphysema were 42%, 57%, 64%, and 73%, respectively (p=0.047 by linear-by-linear association). The mean T-scores of BMD of L1 (p=0.032) and L1-4 spines were different among the four groups (p=0.034). Although the T-score of L1 BMD negatively correlated with the extent of emphysema (r=−0.275, p=0.035) and positively with each of body mass index (BMI) (r=0.520, p<0.001), forced expiratory volume in one second (FEV1) (r=0.330, p=0.011), FEV1/forced vital capacity (r=0.409, p=0.001), and forced expiratory flow at 25∼75% of FVC (FEF25-75%) (r=0.438, p=0.0001), respectively, multiple linear regression analysis indicated that BMI (p<0.001) and FEF25-75% were predictive of BMD (p=0.012). Conclusion: Low BMI and airway obstruction were strongly associated with reduced bone density rather than the extent of emphysema.