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당뇨병 환자에서 급성 심근경색증의 관상동맥 중재술시 혈당이 No-reflow현상에 미치는 영향
홍택종 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.24
Background : Diabetes mellitus is associated with endothelial dysfunction and platelet activation that may contribute to the occurrence of coronary no-reflew, But the precise mechanism of coronary no-reflow in diabetes is not well known until now. Even more there are many debates in its role of acute and chronic hyperglycemia. It was evaluated whether hyperglycemia at admission might or not be associated with the occurrence of coronary no-reflow in diabetic patients undergoing coronary angioplasty for acute myocardial infarction. Subjects and Methods: Of the 475 acute myocardial infarction patients who had underwent coronary angioplasty between February 2003 to June 2005, angiographic and clinical characteristics were investigated in 117 diabetic patients to know the impact of hyperglycemia on the occurrence of coronary no-reflew in diabetic patients with acute myocardial infarction. Results : Of the 117 diabetic patients, 22 patients(19.5%) showed coronary no-reflow. Glucose level on admission was not different regardless of reflow disturbance(199.4 ± 88.8 vs. 212.7 ± 88.9, p = 0.568). But glycosylated hemoglobin (HbA1c) suggesting chronic hyperglycemia is higher in diabetic patients with no-reflow than in those with normal flow(7.8 ± 1.5 vs. 7.0 ± 1.2, p = 0.05). Conclusion : Intensive glucose control may improve coronary flow disturbance in diabetic patients with acute myocardial infarction undergoing coronary angioplasty. 배경 및 목적 당뇨환자는 미세혈관의 기능 장애와 혈소판의 활성으로 인해 관상동맥 혈류가 감소될 수 있는데, 그 기전은 아직 정확히 알려져 있지 않다. 더구나 급성 및 만성 고혈당이 관상동맥 no-reflow 발생에 미치는 역할에 대해 이론이 아직도 많은 실정이다. 본 연구에서는 당뇨병을 동반한 급성 심근경색증 환자에서 스텐트를 이용한 관상동맥 중재술시 행시 급성 또는 만성 고혈당이 no-reflow 현상의 발생에 미치는 영향을 알아보고자 하였다. 대상 및 방법 2003년 2월 부터 2005년 6월까지 급성 심근경색증으로 부산대학교 병원을 방문하여 관상동맥 중재술을 시행 받은 475명의 환자 중 당뇨병으로 진단받은 117명 (24.6%) 의 의무기록을 바탕으로 입원 중 시행한 당화혈색소 및 시술 전 혈당 그리고 관상동맥조영술 소견을 후향적으로 분석하였다. 결과 117명의 대상 환자 중 80.5 %인 95명에서 정상적인 혈류가 관찰되었으며 (normal flow 군) 19.5 % 인 22명에서 no-reflow 현상이 관찰되었다(no-reflow 군). 내원 당시 혈당치 (199.4±88.8 vs 212.7±88.9, p = 0.568) 는 양군 사이에 통계학적인 유의성은 없었으나 당화혈색소(7. 0 ±1.5 vs 7.8±1.2, p = 0.05)는 normal flow 군에서 no-reflow 군에 비해 낮았다. 당뇨조절은 no-reflow 군에서 인슐린 치료를 필요로 하는 빈도가 normal flow 군에 비해 높은 경향을 보였다(33. 3 % vs 14.7% p = 0.058). 결론 당뇨환자에서 적절한 혈당조절은 급성심근경색으로 인한 관상동맥 중재시술시 관상 동맥 혈류장애를 개선시킬 수 있을 것이다.
홍택종,고우석,하재경,이한철,신영우 부산대학교 병원 암연구소 2006 부산대병원학술지 Vol.- No.20
Background The instent restenosis due to intimal hyperplasia after stent implantation occurs approximately 6~40%, so it is thought to be the significant problem. To overcome this problem, drug eluting stents are introduced, but only limited data are yet available on instent restenosis because of short term follow-up interval. I intended to assess the coronary angiographic finding, clinical features, incidence of instent restenosis by comparing with carbon stents or other bare metal stents. Method and Materials The study population comprised 193 patients undergoing follow-up coronary angiography between August 2003 and July 2004 not related to clinical symptoms, were implantated historically coronary stents because of significant ischemic heart disease. According to the chart records and quantative coronary angiographic analysis, I assort the instent restenosis(focal <10mm, diffuse ≥ 10mm), age, coronary artery lesion site, mimimal luminal diameter(MLD), stent diameter, stent length, follow up interval, ACC/AHA lesion classification, post MLD according to a kind of stents. Result Drug eluting stent implantation patients were 65 persons(male:52, female:13), mean age was 60.9±8.9 years. One patient of totally 55 Sirolimus eluting stent implantation patients(0.02%) occurred focal type instent restenosis(ISR), which was implantated 3.5mm x 18mm stent at proximal left circumflex, B2 lesion, and follow up interval was 170 days. Two patients of totally 10 Paclitaxel eluting stent implantation patients(20%) occured one focal type ISR, one diffuse type ISR. One focal type ISR patient was implantated 3.0mm x 28mm stent at left anterior descending artery, B1 lesion, follow up interval was 180 days. One diffuse type ISR patient was implantated 3.0mm x 24mm stent at left anterior descending artery, B2 lesion, follow up interval was 210 days. Carbon stent implantation patients were 55 persons(male:35, female:20), mean age was 62.9±11.5 years. 14 patients had ISR(25%), focal type was 9, diffuse type was 5 case. Other bare metal stent implantation patients were 73 persons(male:49, female:24), mean age was 58.9±9.1 years. 18 patients had ISR(22%), focal type was 14, diffuse type was 5 case. Conclusions Drug eluting stent implantation reduced incidence of angiographic instent restenosis compared with carbon or other bare metal stents.
호흡기 감염증에 대한 Ceftriaxone의 임상적 효과 관찰
홍택종,이주홍,박순규,정원태,배상균,신영기 대한감염학회 1986 감염 Vol.18 No.2
Clinical effectiveness of Ceftriaxone was evaluated in 20 patients of respiratory tract infection and 5 patients for prophylactic use in surgery cases. The drug was administered intravenously in dose of 1-2gm daily(once in 21 cases and twice in 4 cases). The clinical response was favourable in 23 of 25 patients(92%). During the treatment, 2 patients showed adverse effects including nausea, erythema, respectively, which disappeared within 2-3 days. The results of this study indicate that Ceftriaxone is effective in the treatment of respiratory tract infection with a dose of 1gm single daily in most patients.