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전경만 사단법인 한국국가전략연구원 2017 한국국가전략 Vol.2 No.3
한반도는 북한 핵무장과 장거리 탄도미사일 보유로 한국전쟁 이래 가장 심각한 안보 딜레마에 직면하게 되었고, 동북아 지역 국가 간 협력증진과 갈등확산의 분수령이 되고 있다. 한반도 문제에 다중의 전략적 딜레마를 안게 된 배경은 한반도 내부요인과 분단상황을 동북아 영향력 경합에 이용하려는 역내 강대국의 갈등구조도 한 몫하고 있으며, 미중간의 협력과 갈등의 향방에 따라 한국이 겪을 한반도 문제로 인한 전략적 딜레마는 그 존속과 강도 또한 변동할 것이다. 한국이 극복할 전략적 딜레마는 한국의 중장기 국가목표인 안보, 평화, 재통일 및 국제협력은 지정학적 여건이 변하지 않는 한 그 순위가 변경될 수 없다. 한국이 전략적 딜레마를 극복함에 있어 목표 조정보다는 딜레마의 원인과 그 대응수단을 능동적이고 올바르게 결합하는 일이 관건이다. 한국은 외교, 정보, 군사 및 경제수단을 효과적으로 총동원함과 동시에 국제핵질서와 국제규범을 관장하는 유엔안보리의 중심국가에게 한국의 해결방안을 제시하여야 한다. 미중의 지지하에 대북협상을 주도하고, 정전협정을 평화협정으로 대체하여, 한반도 비핵화를 달성함으로써 동북아 평화에 기여하는 한반도로 재탄생 시켜야 한다. The Korean Peninsula is facing the most serious security dilemma with North Korean nuclear weapons and long-range ballistic missiles ever since Korean War. North Korean issue becomes a watershed for promoting not only cooperations but also conflicts among Northeast Asian countries. The reason why the Korean Peninsula is facing various strategic dilemmas is due to the conflict structure of the regional powers in order to use internal factors and division status on the Korean Peninsula to compete for influence in Northeast Asia. The strategic dilemma of the Korean peninsula issue will continue to fluctuate due to the U.S.-China cooperation and conflict. South Korea’s national security, peace, reunification and international cooperations which are mid-to-long-term national goals never be changed unless the geopolitical conditions change. In order to overcome the strategic dilemma, the key should be actively and properly combining causes and countermeasures of the dilemma rather than goal setting. South Korea should effectively mobilize diplomatic, intelligence, military and economic means, while at the same time present Korea's solution to the UN Security Council's central nations that determine the international nuclear orders and international norms. Korea should lead the negotiations with North Korea under the auspice both of U.S and China, and replace the armistice agreement with the peace treaty to accomplish denuclearization rebuilding the Korean Peninsula to contribute to peace in Northeast Asia.
전경만,서재경,장은진,조송희,류호걸,나성원,홍상범,이현주,김재열,이상민 대한의학회 2019 Journal of Korean medical science Vol.34 No.14
Background: The objective of this study was to establish the efficacy and safety of procalcitonin (PCT)-guided antibiotic discontinuation in critically ill patients with sepsis in a country with a high prevalence of antimicrobial resistance and a national health insurance system. Methods: In a multi-center randomized controlled trial, patients were randomly assigned to a PCT group (stopping antibiotics based on a predefined cut-off range of PCT) or a control group. The primary end-point was antibiotic duration. We also performed a cost- minimization analysis of PCT-guided antibiotic discontinuation. Results: The two groups (23 in the PCT group and 29 in the control group) had similar demographic and clinical characteristics except for need for renal replacement therapy on ICU admission (46% vs. 14%; P = 0.010). In the per-protocol analysis, the median duration of antibiotic treatment for sepsis was 4 days shorter in the PCT group than the control group (8 days; interquartile range [IQR], 6–10 days vs. 14 days; IQR, 12–21 days; P = 0.001). However, main secondary outcomes, such as clinical cure, 28-day mortality, hospital mortality, and ICU and hospital stays were not different between the two groups. In cost evaluation, PCT- guided therapy decreased antibiotic costs by USD 30 (USD 241 in the PCT group vs. USD 270 in the control group). The results of the intention-to-treat analysis were similar to those obtained for the per-protocol analysis.Conclusion: PCT-guided antibiotic discontinuation in critically ill patients with sepsis could reduce the duration of antibiotic use and its costs with no apparent adverse outcomes.