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성인 입원 환자에서의 영양치료 관련 합병증: 국내 다기관 연구
설은미 ( Eun-mi Seol ),권계숙 ( Kye Sook Kwon ),김정구 ( Jeong Goo Kim ),김정태 ( Jung-tae Kim ),김지훈 ( Jihoon Kim ),문선미 ( Sun-mi Moon ),박도중 ( Do Joong Park ),박정현 ( Jung Hyun Park ),박제훈 ( Je Hoon Park ),박지영 ( Ji Y 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.1
Purpose: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. Methods: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. Results: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m<sup>2</sup>. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. Conclusion: NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.
문준호(Jun-Ho Moon),신진화(Zhen-Hua Xin),김갑부(Gab-Boo Kim),문선미(Sun-Mi Moon),김영욱(Young-Uk Kim) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.1
일반적으로 지반의 강도가 강한 지반은 입도분포가 양호하다고 예상할 수 있다. 그러나 Gap입도로 이루어진 지반으로 입도분포가 불량하더라도 지반의 강도가 강한 경우가 있다. 본 연구에서는 이와 같은 사실에 근거하여 인위적으로 조성한 Gap 입도시료와 입도분포가 균일한 시료, 양호한 시료를 직접전단시험을 통하여 지반의 강도정수를 구하고 이를 비교 분석하였다. 또한 13mm 골재와 19mm 골재를 이용한 평판재하시험으로 확대 적용하여 현장 적용성과 입도에 따른 강도 변화의 재현성을 확인하였다. 실험 결과 입자크기비와 내부마찰각이 상관관계가 있음을 확인 할 수 있었고, 특정한 입자 크기비의 범위에서 전단저항각이 상당히 커지는 것을 알 수 있었다. 또한 평판재하시험으로 극한지지력을 산정한 결과 입도조정법이 강도증가율에 크게 영향을 미치는 것을 알 수 있다. 따라서 위의 직접전단 시험을 통한 시험적 검증과 평판재하시험을 통한 재현성 확인을 통해 입도분포가 좋지 않음에도 간단한 입도 조정만으로 지반의 강도 증진을 유도할 수 있었다. In this study, an artificially formed Gap graded soil, designed to increase its shear strength, was analyzed to determine the strength parameters through direct shear tests. Uniform and fine grain size samples were compared to the Gap graded soil to investigate the increase in the shear strength. Plate loading tests were conducted using 13mm and 19mm aggregates to confirm the reproducibility of the strength enhanced samples for site application. This test confirmed that the particle size ratio and the internal friction angle are correlated to the shear strength, and the shear resistance angle significantly increased in the specific particle size ratio range. The calculation of the ultimate bearing capacity by the plate load test demonstrated that the grain size adjustment method greatly influences the strength increase rate. Therefore, the findings were verified and it was confirmed that a high shear strength is achievable despite the existence of a poor particle size distribution.