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곽영란 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.1
In the heart, ventricular end diastolic volume (EDV) before ejection (preload) is directly related to the amount of stroke volume. Generally, the filling pressures such as central venous pressure or pulmonary artery occlusion pressure are used as an indirect indicator of preload. Since cardiac compliance dose change,however, the filling pressure may not be an accurate indicator of the cardiac preload. As substitutes, volumetric parameters like right ventricular EDV or global end diastolic volume were developed and reported to be superior to the filling pressure in the assessment of preload. Preload responding volume resuscitation, however, is different according to the patient’s condition. Whether any improvement is to be expected from volume resuscitation depends on whether the heart operates on the steep portion in its function curve. Under mechanical ventilation, because of the influence of positive pressure on vena caval and pulmonary venous return, arterial blood pressure and pulse pressure are maximum during inspiration and minimum a few heart-beats later, i.e., during the expiratory period. These periodic changes become prominent under the hypovolemic condition. Recently, various monitors continuously measuring pulse pressure variation (PPV) or stroke volume variation (SVV) using analysis of arterial wave is widely used as a dynamic guidance for volume resuscitation in mechanically ventilated patients. The ability of those variables to predict fluid responsiveness is better than those of filling pressure or EDV. Thus, PPV and SVV could be beneficially used to guide fluid therapy, while the safety limit of fluid therapy should be based on filling pressure.
체외순환 없는 관상동맥우회술 시 성별이 술 후 예후에 미치는 영향
곽영란,김창석,최용선,방서욱,신병훈,심재광 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4
Although female gender is associated with higher prevalence of perioperative morbidity and mortality than male gender in conventional coronary artery bypass surgery (CABG) using cardiopulmonary bypass, the impact of gender as an independent risk factor for morbidity and mortality following off-pump CABG (OPCAB) is controversial. Therefore, we prospectively investigated the impact of gender on intraoperative variables and postoperative outcome and complications in OPCAB. Methods: One hundred patients (69 males and 31 females) undergoing OPCAB by a single cardiac surgeon during 5 months period were prospectively enrolled. Preoperative patient's characteristics, intraoperative hemodynamics and medications and postoperative outcome and complications were recorded during hospital stay. Results: There were no significant differences in preoperative characteristics including age, NYHA class and incidence of concomitant diseases between the male and female groups, except body surface area which was less in the female group. There were no significant differences in intraoperative hemodynamics and use of cardiotonic drugs between the groups. Frequency and amount of blood transfusion were greater, and length of ventilatory care and stay in intensive care unit were longer in female group. Other postoperative outcomes were similar between the groups. Conclusions: Gender did not significantly affect postoperative outcome, except use of blood products, length of ventilatory care and stay in intensive care unit in OPCAB. These results may be attributable to comparable preoperative patient's characteristics between the groups.
곽영란,오경옥 충남대학교 의과대학 지역사회의학연구소 1983 충남의대잡지 Vol.10 No.1
This study analyzed the emotional state of anxiety and depression of female patients with hyperthyroidism. The following scales were used; the self-rating anxiety scale, the self-rating depression scale of w. w. K. zung, and general health questionnaire of Goldberg. The subjects were 50 patients with hyperthyroidism at the outpatient department of internal medicine, 50 patients with neuro psychiatrics in Chungnam National University Hospital and 50 normal females, from July to September, 1982. The results were as follows; 1. In the comparision of hyperthyroidism, Neurosis and normal among three groups, the result was that the first was neurosis, the second was hyperthyroidism, and the last was normal in total average score, and it seemed to me significant difference. 2. In SAS, Fear, Restlessness and Insomnia were more significant symptoms of neurosis group than those of hyperthyroidism group. 3. In SDS, Depressed Affect, Constipation, Confusion, Psychomotor Agitation, Hopelessness, Indecisiveness, Personal Devaluation and Emptiness were more significant symptoms of neurosis group than those of hyperthyroidism group. 4. There was no differance of quality in anxiety and depression between hyperthyroidism and neurosis on the basis of age, marital status and education.