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착화탄 연소에 의한 가스 중독 환자에서 혈중 중금속 농도의 영향에 대한 예비연구
이상환 ( Sang Hwan Lee ),이준철 ( Juncheol Lee ),조용일 ( Yongil Cho ),고벽성 ( Byuk Sung Ko ),오재훈 ( Jaehoon Oh ),강형구 ( Hyunggoo Kang ) 대한임상독성학회 2021 대한임상독성학회지 Vol.19 No.2
Purpose: It is known that the most common cause of gas poisoning in Korea is suicide attempts by burning ignition coals. Ignition coals are made from waste wood, and studies have been reported that heavy metals are emitted when this coal is burned. However, there was no study on how much heavy metal poisoning occurs in the human body through this, so this study was planned to find out whether the concentration of heavy metals in the blood increased in patients exposed to ignition coal combustion. Methods: From April 2020 to April 2021, blood lead, mercury, and cadmium concentrations were investigated in carbon monoxide poisoning patients who visited one regional emergency medical center in Seoul, and their association with exposure time, source of poisoning, and rhabdomyolysis were investigated. Results: During the study period, a total of 136 carbon monoxide poisoning patients were tested for heavy metals, and 81 cases of poisoning by ignition coal were reported. When comparing poisoning caused by combustion of ignition coal and other substances, there was no difference in the concentrations of lead, mercury, and cadmium in the blood, and there was no difference in the number of patients above the reference range. However, the patients exposed to more than 5 hours of ignition coal gas exposure are more frequent than those in the group less than 5 hours in lead (51.4% vs. 23.9%, p=0.012). Conclusion: Compared to poisoning with other combustible substances, the blood concentration of lead, mercury, and cadmium does not increase further in patients with gas poisoning by ignition coal. However, prolonged exposure may result in elevated levels of lead.
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비정맥류성 상부위장관 출혈로 내원한 정상 혈압 환자에서 Blatchford 점수와 내시경 전 Rockall 점수가 저혈압 발생을 예측할 수 있는가?
김준성 ( June Sung Kim ),고벽성 ( Byuk Sung Ko ),손창환 ( Chang Hwan Son ),안신 ( Shin Ahn ),서동우 ( Dong Woo Seo ),이윤선 ( Yoon Seon Lee ),이재호 ( Jae Ho Lee ),오범진 ( Bum Jin Oh ),임경수 ( Kyoung Soo Lim ),김원영 ( Won Youn 대한소화기학회 2016 대한소화기학회지 Vol.67 No.1
목적: 이 연구의 목적은 처음 정상 혈압으로 응급실을 내원한 비정맥류성 상부위장관 출혈 환자에서 Glasgow-Blatchford 점수와 내시경 전 Rockall 점수가 24시간 이내에 발생하는 저혈압을 예측할 수 있는가이다.대상 및 방법: 2011년 1월부터 2013년 12월까지 서울아산병원 응급의료센터로 내원한 상부위장관 출혈 환자를 대상으로 후향적인 연구를 시행하였다. 대상이 되는 환자군을 24시간이내 저혈압 발생 여부에 따라 두 군으로 나누었으며, 인구학적 특성, 기저 질환, 혈액 검사 결과를 비교하였다. 각 환자의 Glasgow-Blatchford 점수와 내시경 전 Rockall 점수를 구하고 저혈압 발생의 예측도를 평가하였다.결과: 연구 기간 동안 비정맥류성 상부위장관 출혈로 내원한 환자들 중 초기 정상혈압을 보인 환자는 747명이었다. 이 중120명(16.1%)이 응급실에 내원한 지 24시간 이내에 저혈압이 발생하였다. 저혈압이 발생한 환자군과 그렇지 않은 군 간의 Glasgow-Blatchford 점수와 내시경 전 Rockall 점수의 중간 값은 통계적으로 차이를 보였다(각각 8점 vs. 10점, 2점 vs.3점, p<0.001). ROC 분석 결과, 두 점수 간 곡선 아래 면적은 각각 66%, 64%로 24시간 내에 저혈압 발생에 대한 예측력은 유의한 차이가 나지 않았다.결론: Glasgow-Blatchford 점수와 내시경 전 Rockall 점수는 비정맥류성 출혈 환자의 저혈압 발생을 예측할 수 없으며, 다른 점수 체계 개발이 필요할 것으로 보인다. Background/Aims: The aim of this study was to identify the ability of Glasgow-Blatchford score (GBS) and pre-endoscopic Rockall score (pre-E RS) to predict the occurrence of hypotension in patients with non-variceal upper gastrointestinal bleeding who are initially normotensive at emergency department.Methods: Retrospective observational study was conducted at Asan Medical Center emergency department (ED) in patients who presented with non-variceal upper gastrointestinal bleeding from January 1, 2011 to December 31, 2013. Study population was divided according to the development of hypotension, and demographics, comorbidities, and laboratory findings were compared. GBS and pre-E RS were estimated to predict the occurrence of hypotension.Results: A total of 747 patients with non-variceal upper gastrointestinal bleeding were included during the study period, and 120 (16.1%) patients developed hypotesion within 24 hours after ED admission. The median values GBS and pre-E RS were statistically different according to the occurrence of hypotension (8.0 vs. 10.0, 2.0 vs. 3.0, respectively; p<0.001). In the receiver operating characteristic curve analysis of hypotension development, the area under the curve of GBS and pre-E RS were 66% and 64%, respectively. The sensitivity and the specificity of GBS using optimal cut-off value were 81% and 46%,respectively, while those based on the pre-E RS were 74% and 46%, respectively.Conclusions: GBS and pre-E RS were both not sufficient for predicting the occurrence of hypotension in non-variceal upper gastrointestinal bleeding. Development of other scoring systems are needed.(Korean J Gastroenterol 2016;67:16-21)
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