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간경변증 환자에서 24 시간 심박동수변이를 이용한 자율신경 장애 측정
김철우(Chul Woo Kim),권재구(Jae Goo Kwon),채민수(Min Su Chae),안혜숙(Hye Sook Ahn),조영중(Young Jung Cho),이창원(Chang Won Lee),장덕환(Duk Whan Jang),이무용(Moo Yong Rhee),김학산(Hak San Kim),이홍순(Hong Soon Lee),유수웅(Soo Woong Yo 대한내과학회 1997 대한내과학회지 Vol.53 No.3
N/A Objective: Heart rate variability(HRV) is helpful to diagnosis autonomic disturbance and sympathetic-parasympathetic imbalance in patients with myocardial infarction and diabetes mellitus. Patients with liver cirrhosis demonstrate reduced blood pressure despite increased heart rate and increased cardiac output, indicating a fall in peripheral vascular resistance. Autonomic disturbance may contribute to this phenomenon. The aim of the present study is to evaluate the degree of autonomic disturbance and the circadian rhythm of autonomic nervous system by estimating HRV with 24 hour-Holter recorder, Methods : 24 hour-HRV with Del Mar Avionics 563 Holter recorder and cardiovascular reflex tests were carried out on 32 patients with liver cirrhosis and 20 control subjects. We evaluated the presence of autonomic disturbance, and assessed quantitatively the autonomic disturbance. Results: 1) Among cardiovascular reflex tests, Valsalva test, standing test and deep breathing test were showed a significantly decreased response in liver cirrhosis compared with control groups. 2) The standard deviation of 24hours average R-R intervals were showed a significantly decrease in liver cirrhosis than control groups(P<0.0001). The HRV of low frequency(LF. P<.D.001), high frequency(HF, P<0.0001) and total power spectral density (P<0.0001) in liver cirrhosis were statistically lower than control. 3) The LF/HF ratio of patients with liver cirrhosis was showed higher than control at night Conclusion: Non-invasive assessment of 24 hour-HRV has a few advantages in the diagnosis and degree of autonomic disturbance, evaluation of diurnal variation of autonomic tone.
신진,전용덕,최원규,안병진,문석준,김철우,권재구,백인석,강효종,채민수 대한신장학회 1996 Kidney Research and Clinical Practice Vol.15 No.4
Doxylamine is an antihistamine commonly used as an over-the-counter medication to relieve insomnia and frequently involved in overdoses. Its overdoses are dominated by anticholinergic effects, including central and peripheral effects in clinical course. Recently it was revealed that doxylamine has a direct toxic effect on muscle, while the exact mechanism is not clear yet. We report a case of young adult who was complicated by rhabdomyolysis and acute renal failure after ingestion of about 6250mg of doxylamine for suicide attemps. He was camed to emergency department due to generalized tonic clonic seizure. He developed a elevated muscle enzyme and showed generalized, multiple uptake in damaged muscle with image of Tc-99m MDP bone scan. He was treated with hydration, urine alkalinization and supportive care during hospitalization. On considering the cause of this rhabdomyolysis, we could not regard the seizure as a main cause in view of plasma creatine kinase level and suppose that direct toxic effect of doxylamine may play a role to some extents. In all case of where such overdosages are suspected, we should make consideration of obtaining creatine kinase level in tbe early periods to prevent the possibility of rhabdomyolysis and subsequent acute renal failure, especially in the presence of dehydration and acidosis.
이창원(Chang Won Lee),장덕환(Duk Whan Jang),백인석(In Seok Baek),김장원(Jang Won Kim),배순철(Soon Chul Bae),김철우(Cheol Woo Kim),권재구(Jae Koo Kweon),최락경(Rak Kyeong Choi),이무용(Moo Yong Rhee),이홍순(Hong Soon Lee),유수웅(Soo Wo 대한내과학회 1997 대한내과학회지 Vol.52 No.4
N/A Objectives: Signal-averaged electrocardiography (SAECG) has been found to be a useful noninvasive technique for identifying patients at risk for life-threatening ventricular tachycardia. Delayed and fragmented activation of abnormal myocardial tissues causes the occurrence of high frequency low amplitude (HFLA) electocardiographic signals or late potentials. Generally, there are two methods in analyzing signal-averaged electrocardiography. Late potentials in the time domain analysis do not provide sufficient diagnostic power with regard to life-threatening Ventricular tachycardia. Buckingham et al. (1989) reported a time-domain sensitivity of 62%, a specificity of 75%. Spectral turbulence analysis (STA) of the signal-averaged ECG is the most recent frequency domain technique to improve the time domain sensitivity and specificity. So, We designed the study to compare the efficacy of Time Domain Analysis and Spectral Turbulence Analysis among five groups (Normal control, QRS widening, Postmyocardial infarction, Frequent VPC's with group beats, Nonsustained ventricular tachycardia). Methods: 88 patients were selected from the patients who had been admitted between January 1994 and October l994, at National Medical Center. Patients were divided into five groups, which were respectively, Group A: Normal control group (n=33), Group B: QRS widening group (n=14), Group C: Postmyocardial infarction group (n=10), Group D: Frequent VPC's with group beats (n=22), Group E: Nonsustained VT group (n=9). We compared Spectral Turbulence Analysis and Time Domain Analysis of Signal-Averaged Electrocardiogram by 24 hours-Holter monitoring. Results: 1) In normal control group(Group A), 9.1%(3 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence An- alysis. 2) In QRS widening group (Group B), 71.4%(10 patients) were positive by Time Domain Analysis, but, all were negative by Spectral Turbulence Analysis. 3) In postmyocardial infarction group (Group C), 309o were positive by Time Domain Analysis, and 10% were positive by Spectral Turbulence Analysis. 4) In frequent VPC's group (Group D), 22.7% (5 patients) were positive by Time Domain Analysis, and, 4.5%(1 patient) was positive by Spectral Tur-bulence Analysis. 5) In Nonsustained VT group (Group E), 33.3% (3 patients) were positive by Time Domain Analysis, and 11.1% (1 patient) was positive by Spectral Turbulence Analysis. Conclusions: In Time Domain Analysis, abnormal results were presented at Group R (QRS widening group) by 71.4%, which was markedly higher than other groups. But, in Spectral Turbulence Analysis, abnormal results were not presented at Group A and Group B. In Group A and Group B, Spectral Turbulence Analysis shows less false positive results than Time Domain Analysis.