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임상연구 : 전신적 동맥경화성 혈관염 환자에서 동맥우회술 시 항응고 요법의 효과
이가영 ( Ka Young Rhee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.5
Background: The administration of low dose heparin and dextran therapy in patients with arterial bypass surgery is thought to prevent thrombosis and graft occlusion. The purpose of this study was to evaluate the effectiveness of low dose heparin and dextran in atherosclerosis patients presenting hypercoagulability. Methods: Whole blood coagulation was evaluated using thrombelastography and standard coagulation testing before and a day after surgery in nine atherosclerotic patients and nine control patients. Heparin 5000 U and dextran 500 ml were administrated in atherosclerotic patients during their operations. Results: Atherosclerotic patients showed higher maximal amplitude compared to the control patients during preoperative thrombelastography. After surgery atherosclerotic patients revealed no significant change, but the control group became more hypercoagulable in status compared to the preoperative period. Conclusions: Intravenous heparin and dextran prevented postoperative change to a more hypercoagulable state than the preoperative status in atherosclerotic patients undergoing arterial bypass surgery. (Korean J Anesthesiol 2003; 45: 617∼621)
구강악안면 수술환자에서 술 후 오심 및 구토에 대한 프로포폴의 예방효과
윤필영,이가영,김영균,Yun, Pil-Young,Rhee, Ka-Young,Kim, Young-Kyun 대한치과마취과학회 2006 Journal of Dental Anesthesia and Pain Medicine Vol.6 No.1
Background: The aim of this study was to evaluate the preventive effect of propofol on postoperative nausea and vomiting (PONV) following general anesthesia to the patients having oral and maxillofacial surgery. Methods: In a prospective, randomized. case-controlled study. 200 patients were divided into two groups (n = 100 in each). In propofol (P) group, patients received 0.5 mg/kg of propofol intravenously at the end of anesthesia. In control (C) group, no antiemetics was given. Emetic symptoms like nausea, retching and vomiting were assessed by a blind nurse at 1 hour and at 24 hours after anesthesia respectively. Also level of sedation was checked by a blind anesthesiologist at 1 hour after anesthesia. Results: There were no significant differences in frequencies of nausea, retching and vomiting between C group and P group at 1 hour after anesthesia. However, nausea, retching and vomiting were all decreased in P group compared with C group at 24 hours after anesthesia (P < 0.05). Also there was no significant difference in level of sedation at 1 hour after anesthesia between C group and P group (P > 0.05). Conclusions: From the results, prophylactic use of subhypnotic dose of propofol could be effective for preventing PONV without change in level of sedation to the patients undergoing general anesthesia for oral and maxillofaical surgery.
증예(症例) : Kartagener 증후군 환자의 급성호흡부전-비침습적 환기치료로 호전된 1예
백경현 ( Kyung Hyun Paeck ),홍윤경 ( Yun Kyung Hong ),이가영 ( Ka Young Lee ),김소리 ( So Ri Kim ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이홍범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.1
Kartagener 중후군 환자에서 급성호흡부전이 발생할 경우, 원인이 되는 호흡기 감염과 염증을 조기에 치료하고 이에 더불어 발생하는 심각한 호흡부전상태를 해결하기 위해 기관내 삽관을 통한 침습적 기계호흡을 대신하여 비침습적 양압환기를 시도해 볼 수 있다. 이러한 비침습적 양압환기는 효과적으로 적절한 가스 교환과 호흡근의 휴식을 가능하게 하여 생존율을 향상시키며, 반복되는 기관내 삽관 또는 기관절개술로 인한 합병증을 줄이고 언어, 식사 등의 일상생활을 가능하게 하여 삶의 질을 향상시킬 수 있는 장점을 가진다. 효과적인 비첨습적 양압환기를 위해서는 적절한 마스크의 선택과 정확한 착용이 중요하고 환자의 교육과 격려가 필요하다. 저자들은 Kartagener 증후군으로 치료받던 환자에서 폐렴과 동반되어 발생한 급성호흡부전을 항생제 치료와 함께 흡기시 양기도압과 호기시 양기도압을 조절하는 자발호흡 방식의 비첨습적 양압환기를 시행하여 성공적으로 치료하였기에 문헌 고찰과 함께 증례를 보고하는 바이다. Kartagener`s syndrome is characterized by the triad of situs inversus, bronchiectasis, and chronic pansinusitis. With pulmonary infection such as pneumonia or other certain conditions, pulmonary symptoms of Kartagener`s syndrome are aggravated and hypoventilation and hypercapnia are exacerbated. These conditions may induce acute respiratory failure (ARF). Noninvasive positive pressure ventilation (NPPV) is well tolerated and safe, and it has assumed a prominent role in the management of ARF. The attraction for NPPV relates primarily to its advantages over invasive mechanical ventilation. It is used in patients with ARF due to exacerbations in chronic obstructive pulmonary disease or cardiogenic pulmonary edema. We report a case that ARF in a patient with kartagener`s syndrome is successfully treated with NPPV.
만성 폐쇄성 폐질환 급성 악화 시 C-반응단백과 폐동맥 고혈압의 관계
김소리 ( So Ri Kim ),최영훈 ( Yeong Hun Choe ),이가영 ( Ka Young Lee ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.64 No.2
연구배경: COPD 환자에서 혈청 C-반응단백은 증가하는 것으로 알려져 있으며 이러한 변화는 급성 악화 시 보다 두드러진다. 폐동맥 고혈압은 COPD의 흔한 합병증 중 하나이며, C-반응단백은 전신적 심혈관계 질환 발생 위험과 밀접한 관련이 있다고 알려져 왔다. 하지만, COPD에서 이차적으로 발생하는 폐동맥 고혈압에 대한 C-반응단백의 영향에 대해서는 연구가 미비한 상태이다. 방법: 본 연구는 AECOPD에 대해 입원 치료를 시작한 72명의 환자를 대상으로 전향적으로 연구하였다. 환자들은 AECOPD에 대한 즉각적인 치료를 받았고 입원 2일 또는 3일째 실내 환기 하에서 혈청 C-반응단백, 동맥혈 산소 분압, 폐동맥 고혈압에 대한 이환 여부 등에 대한 검사를 시행 받았다. 결과: 폐동맥 고혈압에 이환된 환자는 47명으로 전체 환자 중 65.3%에 달하였다. COPD의 중증도가 심할수록 폐동맥 고혈압의 이환율과 C-반응단백 평균치가 증가하였고, C-반응단백 평균치가 증가할수록 평균 우심실 수축압 역시 증가하는 것을 관찰할 수 있었다. 폐동맥 고혈압 환자군과 비환자군에서 C-반응단백은 각각 37.6±7.4 mg/L 와 19.9±6.6 mg/L 통계적으로 의미 있게 폐동맥고혈압 환자군에서 높았지만, 동맥혈 산소분압은 양 군간 의미 있는 차이를 보이지 않았다(77.8±3.6 mmHg vs. 87.2±6.0 mmHg). 결론: 본 연구는 COPD의 급성 악화 시 증가된 C-반응 단백은 폐동맥 고혈압의 이환 여부와 밀접한 관련이 있는 것을 보여 주고 있으며, 이는 COPD의 예후에 심혈관계 질환의 이환 여부가 중요하다는 점을 감안할 때 C-반응단백의 COPD에 대한 독립적 예후인자로서의 가능성을 시사해 준다. Background: In chronic obstructive pulmonary disease (COPD) patients, the serum levels of C-reactive protein (CRP) are elevated and an increase of CRP is more exaggerated in the acute exacerbation form of COPD (AECOPD) than in stable COPD. Pulmonary arterial hypertension is a common complication of COPD. An increased level of CRP is known to be associated with the risk of systemic cardio-vascular disorders. However, few findings are available on the potential role of CRP in pulmonary arterial hypertension due to COPD. Methods: This study was performed prospectively and the study population was composed of 72 patients that were hospitalized due to AECOPD. After receiving acute management for AECOPD, serum CRP levels were evaluated, arterial oxygen pressure (PaO2), was measured, and the existence of pulmonary arterial hypertension under room air inhalation was determined in the patients. Results: The number of patients with pulmonary arterial hypertension was 47 (65.3%)., There was an increased prevalence of pulmonary arterial hypertension and an increase of serum CRP levels in patients with the higher stages of COPD (e.g., patients with stage 3 and stage 4 disease; P<0.05). The mean serum CRP levels of patients with pulmonary arterial hypertension and without pulmonary arterial hypertension were 37.6±7.4 mg/L and 19.9±6.6 mg/L, respectively (P<0.05). However, there was no significant difference of the mean values of PaO2 between patients with pulmonary arterial hypertension and without pulmonary arterial hypertension statistically (77.8±3.6 mmHg versus 87.2±6.0 mmHg). Conclusion: We conclude that higher serum levels of CRP can be a sign for pulmonary arterial hypertension in AECOPD patients. (Tuberc Respir Dis 2008;64:125-132)
症例(증례) : 원발병소가 없느 폐암의 흉막전이를 PET-CT로 확인한 1예
김이식 ( Yi Shik Kim ),고강석 ( Kang Suk Ko ),조양동 ( Yang Tong Cho ),김웅지 ( Woong Ji Kim ),이가영 ( Ka Young Lee ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keum Rhee ),박성주 ( Seoung Ju Park ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.1
The discovery of malignant cells in pleural fluid and/or parietal pleura indicates a disseminated or advanced disease in the patients with various malignancies. For 5-10% of patients with these malignant pleural effusions, the site of origin cannot be identified even though extensive work-up. Recently, 18F fluorodeoxyglucose positron emission tomography (FDG PET) has been shown to be a highly reliable and accurate test for detection and staging of lung cancer. We report here a case of histopathologically diagnosed metastatic bronchogenic adenocarcinoma of pleura without detection of primary lung cancer which was evaluated by PET, and review the diagnostic work-up and the role of PET in the malignant pleural effusion.