청소년기 선천성 심장병 환자의 성인 치료 시스템으로의 전환

문주령,이홍재 한국소아심장연구회 2004 소아심장 Vol.8 No.1

선천성심질환 청소년의 우울과 극복력의 관계분석

문주령,정연이,허준,강이석,박승우,양지혁,전태국,김명자,이흥재 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.5

목 적 : 선천성심질환 청소년의 우울정도와 극복력의 상관관계를 파악하고 우울과 관련된 변수를 확인하고자 하였다. 방 법 : 선천성심질환으로 수술을 받고 2개 대학병원 및 심장전문병원에 등록되어 추적관찰 중인 만 13-18세 청소년 231명을 대상으로 하였다. 연구 도구는 만성질환아를 대상으로 개발한 극복력 도구와 Beck의 우울척도를 8-18세에 맞게 변형시킨 Kovasc의 CDI를 사용하였다. 결 과 : 선천성심질환 청소년의 우울정도는 0-54점 가능 점수에서 평균 16.74점이었고, 극복력은 70-160점 가능 점수에서 115.84점이었다. 극복력에 따른 우울정도는 극복력과 우울은 유의한 역상관관계(r=-0.59, P<0.01)를 나타났다. 또한, 극복력의 하부 개념인 개인내적요인(r=-0.69, P<0.01), 대처양상(r=-0.39, P<0.05), 대인관계(r=-0.59, P<0.01)도 우울정도와 통계적으로 유의한 역상관관계를 보였다. 다중회귀분석 결과 선천성심질환 청소년의 우울과 관련된 유의한 변수는 부모의 양육태도(β= -0.48, P<0.01) 및 극복력(β=-0.62, P<0.01)으로 나타났다. Purpose : The purpose of this study was to investigate the relationship between depression and resilience in adolescents with congenital heart disease(CHD) and to identify the variables associated with depression. Methods : The Resilience Scale(cronbach’s α=0.92), Children's Depression Inventory(cronbach’s α= 0.72) and Maternal Behavior Research Instrument(cronbach’s α=0.88) were applied and analyzed to assess depression and resilience among 231 adolescents after surgery for CHD from three major cardiac centers in Korea. This group consist of 114 males and 117 females. The mean age was 15.8 years(range : 13-18 years). The clinical severity of illness was rated by CHD functional index and NYHA functional class. Results : The mean score for depression and resilience was 16.74(range : 0-49) and 115.84(range : 70- 132) respectively. Depression was significantly related to age(r=0.25, P<0.001) and NYHA functional class(r=0.35, P<0.001), as well as being negatively correlated with oxygen saturation(r=-0.39, P< 0.001), academic achievement(r=-0.41, P<0.001), parental attitude(r=-0.49, P<0.001) and resilience (r= -0.59, P<0.001). The results of multiple regression analysis showed that parental attitude(β=-0.48, P<0.01) and resilience(β=-0.62, P<0.01) were related to depression. Conclusion : This study demonstrated that adolescents with CHD had a higher resilience and were less depressed with an affectionate parent. With respect to medical and nursing intervention programs, it is essential to identify strengths of adolescents with CHD in order to increase their resilience. Additionally, it is also important that parenting and counseling programs be implemented for the parents of adolescents with CHD.

심장수술 받은 영아의 영양중재프로그램 개발 및 적용

문주령,민선인,양지혁,허준,정연이,조용애 한국간호과학회 2009 Journal of Korean Academy of Nursing Vol.39 No.4

Purpose: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. Methods: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. Results: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. Conclusion: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications. Purpose: Despite recent advances in the surgical and postoperative management of infants with congenital heart disease, nutritional support for this population is often suboptimal. The purpose of this study was to develop a nutritional program for the postoperative period for infants who have had cardiac surgery and to evaluate effects of the program. Methods: A quasi-experimental design with pretest and posttest measures was used. A newly developed nutritional program including a feeding protocol and feeding flow was provided to the study group (n=19) and usual feeding care to the control group (n=19). The effects of the feeding program were analyzed in terms of total feed intake, total calorie intake, gastric residual volume, and frequency of diarrhea. Results: Calorie intake and feeding amount in the study group were significantly increased compared to the control group. However, the two groups showed no significant differences in gastric residual volume and frequency of diarrhea. Conclusion: The results indicate that the nutritional program used in the study is an effective nursing intervention program in increasing feeding amount and calorie intake in infants postoperative to cardiac surgery and does not cause feeding-related complications.

체위와 측정방법에 따른 혈압의 정확도 비교 연구

송효숙,문주령,박효정 병원간호사회 2000 임상간호연구 Vol.6 No.1

Background : The accurate blood pressure monitoring in ICU is critical in the evaluation of patient's condition. There are three ways of blood pressure measurements: direct blood pressure monitoring, automatic blood pressure measurement and sphygmomanometer. Direct blood pressure monitoring in supine position has been known as the most accurate method and has the obvious advantage in the aspect of continuity. However, there have been many complications induced by arterial line. Sometimes, it is impossible for the patient in severe pulmonary or cardiac distress to maintain supine position for blood pressure monitoring. Object: The purpose of this study was to find any differences among the methods of blood pressure measurements(direct blood pressure monitoring, automatic blood pressure measurement, sphygmomanometer), and any influences of positions(supine, 30 degree semi-fowler's position, 45 degree semi-fowler's position) in the blood pressure measurements. Material & methods: Consecutive twenty patients showing normal hemodynamics and electrocardiograms(ECG) were included in the study. Measuring blood pressure with indirect methods was done on the same arm with arterial line for direct blood pressure monitoring. We measured blood pressure with direct monitoring method(HP M1006A) and simultaneously with indirect methods, automatic blood pressure measurement 1(HP NIBP M1008B), automatic blood pressure measurement 2(SE7000 NIBP), or sphygmomanometer(W.A Baum CO. ME. AJ8143), respectively. We measured the blood pressure in supine position, 30-degree semi-fowler's position, and 45-degree semi-fowler's position, respectively. Two sets of data was obtained at each position and each set of monitoring methods. The sequence of the position changes and blood pressure measurement methods were randomized. The procedures were repeated 5 minutes intervals. Statistical analysis was done with paired t-test for the accuracy evaluation of blood pressure, and repeated measured ANOVA test for the influence of position changes, using program SPSS 6.0. Results: There were no differences in the systolic pressure between direct blood pressure monitoring method and indirect blood pressure monitoring methods(p>0.17). There were no differences in diastolic pressure between HP M1006A and HP NIBP (M1008B) (p>0.2), HP M1006A and sphygmomanometer(p>0.22), respectively. There was a significant difference in diastolic pressure between HP M1006A and SE 7000 NIBP(p<0.2) at each position. There were no differences in systolic pressure & diastolic pressure along with the position changes(p>0.6) Conclusions : Direct blood pressure monitoring method can be replaced with the indirect blood pressure monitoring methods, except in the situation of requiring frequent blood sampling. Also, it is not necessary to change body position to supine position for the accurate blood pressure measurement. Diastolic pressure can be overestimated with SE 7000 NIBP.

Myofascial Trigger Point 마사지가 정상 성인의 자율신경계에 미치는 단기 효과

김명자,문주령,송효정,김주상 병원간호사회 2007 임상간호연구 Vol.13 No.1

Purpose: To investigate the effects of myofascial trigger-point(MTrP) massage to the neck, shoulder and upper back areas on autonomic tone, and to examine the psychological outcomes of MTrP massage. Methods: Forty subjects with a mean age of 27.5 years were recruited, initially matched according to age and sex, and then randomly assigned into either experimental- or control group. Subjects in the study group received MTrP massage on shoulder and upper back areas for 20 minutes while those in the control group were for the same period. A 5-minute cardiac inter-beat interval recording, blood pressure and subjective self-evaluations regarding emotional status as well as muscle tension with Visual Analogue Scale(VAS) were examine at the points of before and after MTrP massage. Autonomic function was measured, using time and frequency domain analysis of heart rate variability. Results: Analysis of heart rate variability was showed a significant increase in parasympathetic activity(p=.01) following MTrP massage therapy. Additionally, both subjective emotional status and muscle tension were improved significantly (p<.01). Conclusions: Based on the results above, We suggest that MTrP massage might have beneficial effects on parasympathetic activity, emotional state and muscle relaxation.

Analysis of Cardiovascular Risk Factors in Adults with Congenital Heart Disease

허준,문주령,송진영,강이석,박승우,장성아,양지혁,전태국 대한심장학회 2015 Korean Circulation Journal Vol.45 No.5

Background and Objectives: The objective of this study was to analyze cardiovascular risk factors in adults with congenital heart disease (ACHD). Subjects and Methods: The subjects for this study comprised 135 patients, aged 18 years and above, who visited the ACHD clinic at the Samsung Medical Center and 135 adults with a structurally normal heart who were randomly selected from the Center for Health Promotion during the same period. For the analysis, the ACHD group was further divided into an ACHD group that underwent correction by cardiac surgery and a cyanotic group. Results: The mean (standard diviation) age (years) of patients in the surgically corrected group was 48.4 (10.9) years, while that of patients in the cyanotic group was 43.1 (9.0) years and that of patients in the control group was 47.1 (10.3) years (p=0.042). The adjusted odds ratios (ORs) for past smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and metabolic syndrome were significantly higher in the surgically corrected patients than in the controls. However, the ORs for all variables excluding past smoking were significantly lower in the cyanotic group compared with the control group. After adjustment for age, gender, smoking, alcohol use, and exercise, the ORs for metabolic syndrome were 0.46 (0.35-0.57, p<0.001) and 1.48 (1.14-1.92, p=0.003) in the cyanotic and surgically corrected groups, respectively. Conclusion: Cardiovascular risk factors need to be considered in surgically corrected ACHD patients as well as in adults with a structurally normal heart. A further study with a long-term follow-up is needed for developing guidelines for prevention

수술 후 성인 Fallot 4징 환자의 임상적 고찰

장기영,김선영,문주령,허준,강이석,박승우,전태국,박표원,이흥재,Jang, Gi Young,Kim, Sun Young,Moon, Joo Ryung,Huh, Joon,Kang, I-Seok,Park, Seung Woo,Jun, Tae Gook,Park, Pyo Won,Lee, Heung Jae 대한소아청소년과학회 2003 Clinical and Experimental Pediatrics (CEP) Vol.46 No.7

목 적 : Fallot 4징 환자에 대한 수술 및 수술 후 집중 치료의 발달로 생존율이 향상되면서 교정 수술을 받은 Fallot 4징 환자의 연령이 점차 증가하였고, 이에 따라 장기 생존에 따른 여러가지 문제점들이 알려지게 되었다. 저자들은 완전 교정 수술을 받은 성인 Fallot 4징 환자에서 나타나는 주요 임상적인 문제점들을 알아보고자 하였다. 방 법 : 1994년 5월부터 2000년 7월까지 삼성서울병원 성인선천성심장병클리닉(GUCH Clinic)에 등록된 Fallot 4징 환자는 30명으로, 내원 당시 자연 생존자는 6명, 수술 후 생존자는 24명이었다, 이들중 본 조사 당시까지 완전 교정 수술을 받은 환자 28명을 대상으로 임상 기록, 심전도, 심장 초음파, 심도자 검사, 수술 기록 등을 후향적으로 조사하여 주요 임상 문제점을 알아보았다. 결 과 : 1) 본 조사 당시 평균 연령은 30.8세(16-53세)였고, 교정 수술시 나이는 15.8세(2-49세)였다. 남녀 비는 1.3 : 1이었다. 2) 완전 교정 수술 후 임상적으로 유의한 문제점들은 부정맥(11례), 폐동맥 역류(8례), 좌폐동맥 협착(6례), 잔존 심실 중격 결손(6례), 승모판막 역류(5례), 삼첨판막 역류(4례), 우심실 유출로 협착(3례), 우심실 유출로 낭성 확장(3례), 대동맥판막 역류(3례), 심내막염(1례) 및 단백 소실 장증(1례) 등이었다. 3) 부정맥이 있었던 환자군(Group I, 11명)과 부정맥이 없었던 군(group II, 17명)으로 나누어 비교하여 보았을 때, 수술 시 연령이 낮을수록 수술 후 부정맥이 적게 관찰되었고(P<0.05), 부정맥 군이 부정맥이 없었던 군에 비해 흉부 방사선 소견상 심.흉 비 0.55 이상의 심비대가 유의하게 많았다(P<0.05). 심전도에서 QRS폭이 넓을수록 심비대가 많았으며(P<0.05), 수술 후 심비대가 있는 군(심/흉 비>0.55)과 심비대가 없는 군으로 나누어 비교해 보았을 때는 심비대가 있는 군에서 QRS폭이 넓었고 (P<0.05), 의미 있는 폐동맥 역류와 삼첨판막 역류가 많이 관찰되었다(P<0.05). 4) 재수술은 총 28례 중 8례에서 시행되었다. 재수술의 원인으로, 잔존 심실 중격 결손만 있었던 경우가 3례, 우심실 유출로 협착이 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착과 폐동맥 역류가 동반된 잔존 심실 중격 결손이 1례, 우심실 유출로 협착, 감염성 심내막염으로 인한 삼첨판막 우종 및 잔존 심실 중격 결손이 1례, 좌폐동맥 협착이 1례, 우폐동맥 협착(추정)이 1례 있었다. 결 론 : Fallot 4징은 교정 수술 후 대부분의 환자가 별 문제없이 정상적인 생활이 가능하지만 본 조사에서처럼 여러 가지 문제점들-부정맥, 폐동맥 역류, 잔존 심실 중격 결손, 우심실 유출로 협착, 폐동맥분지 협착, 감염성 심내막염 등-이 발생할 수 있으므로 장기적인 예후를 좋게 하기 위해서는 정기적이고도 지속적인 관찰과 조기 교정이 필요하다고 생각된다. Purpose : This study was performed to find the chief clinical problems associated with the ages of adult patients of tetralogy of Fallot(TOF) who had undergone total correction. Methods : Of the 30 patients who were registered at the Grown-Up Congenital Heart Disease (GUCH) Clinic of Samsung Medical Center for TOF, a retrospective investigation was carried out on 28 patients who underwent total correction. Results : Mean age at retrospective study was 30.8(range : 16-53) years old. Age at total correction was 15.8(range : 2-49) years old. Problems after corrective surgery were assessed. They were arrhythmia, pulmonary valve regurgitation, left pulmonary artery stenosis, residual ventricular septal defect, mitral valve regurgitation, tricuspid valve regurgitation, right ventricle outflow tract obstruction, aortic valve regurgitation, infective endocarditis and protein losing enteropathy. After repair of TOF, such arrhythmias as atrial arrhythmia and AV conduction disturbances were observed in some patients. Cardiomegaly was found significantly in the subjects with arrhythmia(P<0.05), and arrhythmia was less observed in patients who underwent surgery at a young age. Eight patients required a reoperation; the main indications were residual ventricular septal defect, right ventricle outflow tract obstruction and peripheral pulmonary artery stenosis. Conclusion : The majority of the patients seemed to live normal lives after Tetralogy of Fallot repair. However, as residual anatomic and functional abnormalities exist postoperatively, continued careful follow-up is needed to detect and correct structural and functional abnormalities.

Natural Course of Adult Ebstein Anomaly When Treated according to Current Recommendation

김형윤,장신이,문주령,김은경,장성아,송진영,허준,강이석,양지혁,전태국,박승우 대한의학회 2016 Journal of Korean medical science Vol.31 No.11

The objectives of this study were to assess the clinical outcomes of adults with Ebstein Anomaly (EA) according to their treatment modalities. All adult EA patients diagnosed between October 1994 and October 2014 were retrospectively evaluated by medical record review. Total 60 patients were categorized into 3 groups according to their treatment strategy, i.e. non-operative treatment (Group I, n = 23), immediate operative treatment (Group II, n = 27), and delayed operative treatment (Group III, n = 10). A composite of major adverse cardiac and cerebrovascular events (MACCE) and factors associated with MACCE were assessed in each treatment group. MACCE occurred in 13.0% patients in Group I, 55.6% patients in Group II and 50% in Group III (P = 0.006). Event free survivals at 5 years were 90% in Group I, 52.7% in Group II, 50.0% in Group III (P = 0.036). Post-operatively, most patients showed improvement on clinical symptoms. However, event free survival rate was lower in patients with operation compared to those with non-operative treatment (58.7% vs. 90.9%; P = 0.007). Major arrhythmic event occurred more frequently even after surgical ablation (50.0% vs. 20.0%; P = 0.034). Re-operation was more frequent in patients underwent delayed surgery compared to those with immediate surgery (50.0% vs. 18.5%; P = 0.001). Current guideline to decide patient’s treatment strategy appeared to be appropriate in adult patients with EA. However, surgical ablation for arrhythmia was not enough so that concomitant medical treatment should be considered. Therefore, attentive risk stratification and cautious decision of treatment strategy by experienced cardiac surgeon are believed to improve clinical outcome.

기혼 선천성 심질환자의 지각된 건강상태, 성생활만족도, 삶의 질

윤미선,전명희,박영례,최경숙,문주령 한국자료분석학회 2010 Journal of the Korean Data Analysis Society Vol.12 No.3

Recently advanced medical care enables the patients with congenital heart disease to survive longer till grown up than before. This study surveyed how much the quality of life of the adult patients with the perceived health status can be explained by perceived health status, and sexual satisfaction. One hundred thirteen patients registered in 5 hospitals located in and near to Seoul, Korea were interviewed using questionnaire. To analysis the relationship of the quality of life with perceived health status and sexual satisfaction, Pearson correlation and multiple regression were used with SPSS WIN 12.0. The quality of life showed positive correlation with perceived health status(r=5.25, p=.000) sexual satisfaction(r=.321, p=.003). Quality of life is explained 26.6% by the perceived health status, and sexual satisfaction. This study results suggest that in order to improve the quality of life for the grown up patients, sensitive nursing considerations specific to not only health status but also sexual satisfaction be created. 본 연구는 기혼 선천성 심질환자의 일반적 특성과 지각된 건강상태, 성생활만족도, 삶의 질 정도를 파악하고 삶의 질 영향요인을 분석하여 선천성 심질환자의 삶의 질 향상을 위한 간호중재 프로그램 개발에 기여하기 위한 서술적 상관관계 연구이다. 연구대상자는 선천성 심질환을 진단받은 평균 44.2세의 기혼 선천성 심질환자 113명이다. 선천성 심질환자의 지각된 건강상태는 평균 3.15, 성생활만족도는 3.03, 삶의 질 정도는 3.81이었고 이들 요인은 각기 선천성 심질환자의 일반적 건강관련 특성에 따라 유의한 차이가 있었다. 지각된 건강상태는 성생활만족도 및 삶의 질과 순상관관계(r=.267, p=.005; r=.525, p=.000)이며, 성생활만족도는 삶의 질과 순상관관계(r=.321, p=.003)를 보였다. 기혼 선천성심질환자들의 삶의 질에 영향을 미치는 요인은 지각된 건강상태( =.440, p=.000)와 성생활만족도( =.208, p=.038)로 26.6%의 설명력을 나타냈다. 결론적으로 기혼 선천성 심장질환자의 지각된 건강상태, 성생활만족과 삶의 질은 규칙적 운동, 적은 의료비 지출, 독립적 활동 수준, 수술치료가 가능한 경우에 높으므로, 본 연구결과를 토대로 진단, 수술, 장기적 관리 등 시기별 삶의 질 영향요인 파악 연구와 심장기능단계별 맞춤형 간호중재 프로그램 개발이 필요하다.

Outcomes of Pregnancy in Women with Congenital Heart Disease: A Single Center Experience in Korea

송영빈,박승우,김준형,신대희,조성원,최진오,이상철,문주령,허준,강이석,이흥재 대한의학회 2008 Journal of Korean medical science Vol.23 No.5

Pregnancy outcomes in patients with congenital heart disease have not been fully assessed in Korea. Forty-nine pregnancies that occurred in 34 women with congenital heart disease who registered at our hospital between September 1995 and April 2006 were reviewed. Spontaneous abortions occurred in two pregnancies at 6+1 and 7 weeks, and another two underwent elective pregnancy termination. One maternal death in puerperium occurred in a woman with Eisenmenger syndrome. Maternal cardiac complications were noted in 18.4%, pulmonary edema in 16.3%, symptomatic arrhythmia in 6.1%, deterioration of New York Heart Association (NYHA) functional class by ≥2 in 2.0%, and cardiac death in 2.0%. Independent predictors of adverse maternal cardiac events were an NYHA functional class of ≥3 (odds ratio [OR], 20.3), right ventricular dilation (OR, 21.2), and pulmonary hypertension (OR, 21.8). Neonatal complications occurred in 22.4% of pregnancies and included preterm delivery (16.3%), small for gestational age (12.2%), and neonatal death (2.0%). Independent predictors of adverse neonatal events were pulmonary hypertension (OR, 6.8) and NYHA functional class ≥3 (OR, 23.0). Pregnancy in women with congenital heart disease was found to be significantly associated with maternal cardiac and neonatal complications. Pre-pregnancy counseling and multidisciplinary care involving cardiologists and obstetricians are recommended for women with congenital heart disease contemplating pregnancy.