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허혈성 심장질환을 동반한 말기신부전 환자에서 관상동맥 스텐트 시술과 우회로 이식술의 임상성적
이준승(Joon Seung Lee),장재원(Jai Weon Chang),이미숙(Mee Sook Lee),장상필(Sang Pil Chang),박성욱(Seong Wook Park),이철환(Cheol Whan Lee),송현(Hyun Song),박정식(Jung Sik Park) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2
N/A The purpose of this study was firstly, to evaluate the efficacy of coronary stenting in ESRD patients compared with non uremic patients and secondly, to compare the perioperative mortality of coronary artery bypass grafting(CABG) in ESRD patients with that in non-uremic patients exhibiting a similar degree of left ventricular function. We examined the clinical restenosis of coronary stenting and 30 day mortality rate after CABG in this retrospective, casecontrolled study. The case histories of twenty-five ESRD patients with ischemic heart disease(IHD) and twenty-five non-uremic IHD patients matched for age, sex, ejection fraction and number of implanted stents, who had undergone first, elective, primarily successful coronary stenting were reviewed. The case of histories of another sixteen ESRD patients with IHD and sixteen non-uremic IHD patients matched for age, sex, ejection fraction and number of grafted vessels, who had undergone first elective CABG were also reviewed. Clinical restenosis developed in nine of the twenty-five ESRD patients and in eight of the twenty-five non-uremic patients after coronary stenting within follow up periods of 16.9±14.5 months and 17.6±14.6 months, respectively. There was no significant difference in the cumulative clinical restenosis free curves between the two groups(p=0.79). Three out of sixteen for the ESRD patients and one out of sixteen for the non-uremic patients died in 30 days after CABG, follow up periods being 11.3±9.6 months and 11.1±8.9 months, respectively. The perioperative mortality did not differ between the two groups(p=0.28). We conclude that coronary stenting in ESRD patients is as effective as in non-uremic patients regarding initial coronary revascularization and perioperative mortality rate of CABG in ESRD patients is not significantly higher compared with non-uremic patients when Left ventricular function is matched.
통상적인 투석처방을 받는 혈액투석 환자에서 실제 투석량에 영향을 미치는 인자의 분석
김연선 ( Yeun Sun Kim ),이현희 ( Hyun Hee Lee ),이종호 ( Jong Ho Lee ),김은수 ( Eun Soo Kim ),진경순 ( Kyoung Soon Jin ),김정곤 ( Jung Gon Kim ),유승민 ( Seung Min Yoo ),이준승 ( Joon Seung Lee ),정우경 ( Woo Kyung Chung ),주권욱 대한내과학회 2005 대한내과학회지 Vol.69 No.5
목적 : 적절한 혈액투석의 평가에 요소역동학을 이용한 Kt/V지표가 사용되나 일부 환자에서는 적절한 Kt/V값을 유지하지 못하여 이로 인한 임상적 문제가 발생할 수 있다. 저자들은 통상적인 주 3회, 회당 4시간의 혈액투석을 처방받는 환자에서 처방된 투석량과 전달된 투석량을 조사하고, 부적절한 투석량 전달에 미치는 요인을 분석하고자 하였다. 방법 : 안정된 상태로 투석 중인 97명의 만성신부전 환자를 대상으로 처방된 투석량은 Kt/V공식에서 K값으로 in vitro 요소청소율을 V값으로 Watson 식을 이용한 요소분포용적을 구하여 계산하였고, 전달된 투석량은 Daugirdas의 single pool, variable volume공식을 사용하여 계산하였다. 또, 전달된 투석량에 영향을 줄 수 있는 기술적, 임상적 인자들별로 전달된 투석량의 차이를 분석하였다. 결과 : 처방된 투석량의 평균은 1.37±0.21, 전달된 투석량의 평균은 1.23±0.27로 양의 상관관계는 있었으나 유의한 차이를 보였다(p<0.03). 전달된 투석량이 1.2 미만인 군은 45%였고, 이 군은 체중이 높았으며, 투석 처방량이 낮았다. ΔKt/V값은 헤파린을 사용한 군에서 사용하지 않은 군에 비해 유의하게 낮았으며(0.11±0.16 vs. 0.28±0.20, p<0.002), 저혈압, 투석 중 증상, 투석시간의 단축, 재순환율 등의 인자에 따른 차이는 보이지 않았다. 결론 : 통상적인 투석 처방으로 혈액투석 중인 환자에서 체중, 투석 처방량, 헤파린 사용 여부 등의 인자들이 투석의 적절도에 영향을 줄 수 있으므로 환자에 따른 개별적 처방이 필요함을 알 수 있었다. Background : Although adequate removal of small solutes are essential for effective hemodialysis, many patients are suffering from inadequate delivery of hemodialysis, especially with the conventional fixed regimen of dialysis for 4 hours three times per week. We tried to evaluate actual delivered dose of hemodialysis in patients receiving 4 hours of low-flux hemodialysis, and to analyze factors affecting inadequate delivery of hemodialysis. Methods : 97 stable maintenance hemodialysis patients who were undergoing 4 hours of hemodialysis thrice weekly were included for analysis. Prescribed dose of dialysis was calculated by Kt/V where K was in vitro urea clearance of dialyzer membrane and V was estimated according to the Watson`s formula. Delivered dose of dialysis was calculated according to the Daugirdas equation. To find factors that may impair adequate delivery of hemodialysis, various clinical and technical parameters were analyzed. Results : Prescribed dose of hemodialysis was 1.37±0.21, while delivered dose was 1.23±0.27, and thus, there was a significant difference (p<0.03). In 45% of the patients, delivered dose was less than 1.2. They were heavier and prescribed dose was low. ΔKt/V (Prescribed dose-Delivered dose) was significantly greater in patients who did not use heparin therapy compared to patients who used heparin. Other parameters such as hypotension, missed treatment, sex, type of vascular access and degree of recirculation were not associated with impaired delivery of hemodialysis. Conclusions : Delivered dose of hemodialysis can be affected by patient`s body weight, prescribed dose and heparin use in conventional low-flux hemodilaysis regimen. Therefore, each patient should be prescribed individually for adequate delivery of hemodialysis, and delivered dose should be measured regularly.(Korean J Med 69:510-517, 2005)
만성신부전과 B 형 간염에 의한 간경화가 동반되었던 혼자에서의 간 - 신장 동시 이식 2 예
김유미(Yu Mi Kim),이윤정(Yun Jeong Lee),이준승(Joon Seung Lee),장상필(Sang Pil Chang),박종하(Jong Ha Park),김은경(Eun Kyung Kim),정성희(Sung Hee Jung),이영상(Yung Sang Lee),박수길(Su Kil Park),한덕종(Duck Jong Han),이승규(Seung Gyu L 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1
We here report two cases of combined liver-kidney transplantation in patients with both end stage renal disease and hepatitis B related liver cirrhosis. The first case was a 55-year-old man with hepatitis B related liver cirrhosis and chronic renal failure, who received cadaveric liver and kidney transplantation. Immunosuppressants were cyclosporine, prednisolone, and mycophenolate mofetil. Clinical course was uneventful except for hemolytic anemia due to alloimmunization that occurs after ABO- mismatched solid organ transplantation. Hemoglobin level became stable after plasmapheresis. His renal and hepatic function is maintained up to the present time. The second case was a 42-year-old rnan with nephrotic syndrome and liver cirrhosis. The patient underwent living related-combined liver-kidney tran- splantation. Donors were his son and brother. Blood type of the patient and donors were identical and the result of HLA crossmatch was negative. On the 14th postoperative day, stenosis at anastomotic site of hepatic artery was detected. After balloon angioplasty hepatic function was normalized. At 8 months after the transplantation, the patient is stable without adverse events.