고혈압이 조절 안 되는 원인과 대책

박종훈 ( Chong Hun Park ) 대한내과학회 2009 대한내과학회지 Vol.76 No.4

어떤 고혈압 환자에서는 부작용 없이 목표 혈압에 도달하기 어려운 경우도 있을 수 있다. 그러나 단순히 고혈압 약물을 증량하기 전에 살펴보아야 할 요소와 단계가 있다. 혈압 측정 시 혈압이 정확하게 측정되었는지 백의 고혈압이나 백의 효과는 없는지 확인한다. 환자가 자신의 적정한 혈압조절과 유지를 위한 마음가짐을 가지고 있으며 치료에 적극적으로 참여하기 위해 의사와 의사소통이 잘되고 있는지 생각해보고 항고혈압 약물을 잘 복용하도록 한다. 약물요법뿐만 아니라 체중조절 식이염분의 제한, 알코올 절제와 같은 비약물 요법도 충분히 노력할 가치가 있음을 인식하도록 한다. 이차 고혈압의 원인이 되는 질환에 대한 병력청취와 이에 대한 진단검사를 한다. 혈압을 상승시킬 수 있는 약물을 같이 복용하고 있지 않은지 체크한다. 복합적인 다수의 항고혈압 약제를 복용 중에는 혈관확장제의 과다사용으로 인해 용적과부하 또는 교감신경계의 이차적 항진이 일어났는지 살펴보고 충분한 이뇨제 사용과 적절한 베타차단제를 사용한다. 이뇨제는 반감기, 작용기전, 신기능 상태를 고려하여 적절히 선택하고 알도스테론 차단제도 고려한다. 그러나 무엇보다도 필요한 요소는 환자의 혈압조절에 대한 순응도를 높이기 위한 전반적인 배려일 것이다. Resistant hypertension is defined as when the blood pressure cannot be reduced to below 140/90 mmHg in patients who are adhering to an adequate and appropriate triple drug regimen that includes a diuretic, in near full doses. Before changing or increasing the antihypertensive medication, several factors should be checked. A careful evaluation of the patient`s adherence to therapy and adequate measurement of blood pressure are needed to exclude pseudoresistance secondary to poor medical adherence or white coat hypertension. Patients should be asked regularly about medications or substances that could interfere with blood pressure control. Successful treatment requires the identification of causes and a reversal of life style factors contributing to treatment resistance. Diabetes, chronic kidney disease, nonsteroidal anti-inflammatory drugs, high salt intake, obesity, and alcohol abuse are frequent causes of uncontrolled hypertension in Korea. The diagnosis and appropriate treatment of secondary hypertension is also needed. When multiple medications are used, vasodilators are the most commonly used antihypertensive drugs that cause subsequent fluid retention or sympathetic tone elevation. Adequate, effective, and sufficient diuresis and catecholamine suppression are needed for patients who do not respond to several vasodilators. (Korean J Med 76:398-401, 2009)

Y₂O₃-카본 복합체의 전기전도성에 미치는 소결온도의 영향

최관영,오윤석,김성원,김형순,박종훈,이성민,Choi, Kwan-Young,Oh, Yoon-Suk,Kim, Sung-Won,Kim, Hyung-Sun,Park, Chong-Hun,Lee, Sung-Min 한국세라믹학회 2012 한국세라믹학회지 Vol.49 No.2

The $Y_2O_3$ ceramics have been widely used as plasma resistant materials in the semiconductor industry. In this study, composites made of plasma resistant $Y_2O_3$ and electrically conductive carbon have been produced. The electrical properties of this composite were measured with respect to the size, volume fraction of the conductive carbon phase, and sintering temperature. When micro-sized carbon was used, the composites were insulating up to 5 wt% addition of the carbon. However, when nano-sized carbon of around 60 ~100 nm was used, the composites became conductive over threshold volume fraction of carbon, which increased with increasing sintering temperature. This behavior of electrical conductivity of the composites was discussed in terms of the percolation theory. The percolation threshold of the conductivity seemed to be affected by the grain growth and coalescences of dispersed conductive carbon phases with grain growth of matrix $Y_2O_3$.

심에코도상 EPSS 와 방사성동성원소 심장주사상 심박출계수와의 비교 : 좌심실기능부전 환장에서

고창순 ( Chang Soon Koh ),이영우 ( Young Woo Lee ),서정돈 ( Jung Don Seo ),박종훈 ( Chong Hun Park ),이상훈 ( Sang Hoon Lee ) 대한내과학회 1982 대한내과학회지 Vol.25 No.3

심실내 전도장애 환자에서의 99mTc-RBC Gated Blood-Pool Scintigraphy 을 통한 Phase Image Analysis

이강욱(Kang Wook Lee),곽병수(Byeng Su Kwak),최시완(Si Wan Choi),강승식(Seung Sik Kang),박기남(Ki Nam Park),전은석(Eun Seok Jeon),박종훈(Chong Hun Park) 대한핵의학회 1994 핵의학 분자영상 Vol.28 No.1

N/A It is known that the normal His-Purkinje system provides for nearly synchronous activation of right (RV) and left (LV) ventricles. When His-Purkinje conduction is abnorrnal, the resulting sequenee of ventricular contraction must be correspondingly abnormal. These abnormal mechanical consequences were difficult to demonstrate because of the complexity and the rapidity of its events. To determine the relationship of the phase changes and the abnormalities of ventricular conduction, we performed phase image analysis of Tc-RBC gated bJood pool scintigrams in patients with intraventricular conduction disturbances (24 complete left bundle branch block (C-LBBB), 15 complete right bundle branch block (C-RBBB), 13 Wolff-Parkinson-White syndrome (WPW), 10 controls). The results were as follows; 1) The ejection fraction (EF), peak ejection rate (PER), and peak filling rate (PFR) of LV in gated blood pool scintigraphy (GBPS) were significantly lower in patients with C-LBBB than in controls (44.4 +- 13.9% vs 69.9 +- 4.2%, 2.48 +- 0.98 vs 3.51 +- 0,62, 1.76 +- 0.71 vs 3.38 +- 0.92, respectively, p<0.05). 2) In the phase angle analysis of LV, Standard deviation (SD), width of half maximum of phase angle (FWHM), and range of phase angle were significantly increased in patients with C-LBBB than in controls (20.6+ 18.1 vs S.6+ I.8, 22. 5+ 9.2 vs 16.0+ 3.9, 95.7+ 31.7 vs 51.3+5.4, respectively, p< 0.05). 3) There was no significant difference in EF, PER, PFR between patients with the WolffParkinson-White syndrome and controls. 4) Standard deviation and range of phase angle were significantly higher in patients with WPW syndrome than in controls (10.6+2.6 vs 8.6+1.8, p<0.05, 69.8+11.7 vs 51.3+5 4, p < 0.001, respectively), however, there was no difference between the two groups in full width of half maxirnurn. 5) Phase image analysis revealed relatively uniform phase across the both ventriles in patients with normal conduction, but markedly delayed phase in the left ventricle of patients with LBBB. 6) ln 13 cases of WPW syndrome, the site of preexcitation could be localized in 10 cases (77%) by phase image analysis. Therefore, it can be concluded that phase irnage analysis can provide an accurate noninvasive method to detect the mechanical consequences of a wide variety of abnormal

한국형 출혈열환자의 핍뇨기 심전도 소견

박종훈,안원전 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

Electrocardiograms obtained from 33 cases of oliguric phase of Korean Hcnorrhagic fever were analysed and serum potassium, calcium and phosphorous levels were measured also. The ECG tracings were abnormal in 25 cases. (75.8%) The abnormalities were sinus bradycardia, QT prologation, sinus tachycardia, non specific ST-T change and low voltage in the decreasing order of frequency. Sinus tachycardia was relatively high frequency compared with other studies. Total case of QT prolongation was 9 cases and among them 7 cases were associated with associated with significant hypocalcemia. We summerized that transient hemodynamic changes or electrolyte disturbance may be one of the causes of inns rate change or QT prolongation.

만성 판막질환에 관한 임상적 관찰

박종훈 충남대학교 의과대학 지역사회의학연구소 1984 충남의대잡지 Vol.11 No.2

Clinical observations were made on 37 patients of chronic valvular heart disease admitted to chungnam National University Hospital during period of Jan. 1983-Oct. 1984. The obtained results were as follows; 1. Seventeen patients were male and twenty patients were female. The incidencies of each valvular heart disease were mitral stenoinsufficiency (MSI) 14 cases (37.8%), mitral stenosis (KS) 12cases (32.4%), mitral insufficiency (MI) 5 cases (13.5%) and combined valvular disease (CVD) 6 cases (16.2%). 2. The main subjective symptoms were dyspnea, cough, orthopnea, palpitation, hemoptysis and chest pain. One of major complications, embolism was noticed at 4 cases(10. 8%). 3. The abnormalities of electrocardiographic findings were observed as follows; atrial fibrillation 24 cases (64.9%), left ventricular hypertrophy 7 cases(18. 9%), right ventricular hypertrophy 5 cases(13. 5%), left atrial enlargement 4 cases(10.8%), VPB's 3 cases(8. 1%) and incomplete RBBB 1 case(2.7%). 4. In echocardiographic study; Left ventricular dimensions or volumes were increased in MSI+MI group or CVD group, while no significant increase was nos found in MS group. Left atrial dimension was increased in MS group, MSI+MI group or CVD group respectively.

고혈압환자 운동처방의 실제

박종훈 대한고혈압학회 1997 대한고혈압학회지 Vol.3 No.2

좌심실 장축 운동의 기능적 의의 (Ⅰ)

박종훈,전은석,구대회 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

To assess the functional significance of long axis movement which would reflect the fiber orientation of the ventricular muscle, we examined the mitral annulus motion and compared it with standard minor axis movement. M-mode echocardiogram were performed in 24 healthy individuals and 17 mitral valve replaced (MVR) patients with simultaneous EKG and phonocardiogram recordings. The results were as follows : 1. In the controls, the onset of shortening of long axis preceeds that of minor axis (phase difference : 20±3msec, mean± SEM) but in MVR patients this phase difference was reversed (-33±8msec). It means that the spherical shape changes which can be observed in normal controls during isovolumic contraction period were lost in MVR patients. 2. In MVR patients, the time intervals from A2 to the end of shortening of long axis were significantly delayed compared with normal controls (54±3 VS 90±8 msec, P<0.01). 3. In MVR patients, the delayed shortening of long axis was observed in amplitude as well as in time. In summary. we observed the regional nonuniformity between long axis and short axis in normal control and interpreted that it could play a role in modulating ventricular function which was lost in MVR patients.

고혈압의 처방

박종훈 약업신문사 2000 의약정보 Vol.2000 No.3

Color Doppler 혈류영상법을 이용한 승모판 및 대동맥판폐쇄부전의 평가

박종훈 충남대학교 의과대학 지역사회의학연구소 1986 충남의대잡지 Vol.13 No.1

The new color flow mapping Doppler technology provide a dynamic method for studying the spatial distribution of blood flow in the heart, unlike any noninvasive or invasive technique previously available. The aim of this observation is a grading of mitral insufficiency or aortic insufficiency by color Doppler flow mapping. The subjects were 11 cases of mitral insufficiency and 14 cases of aortic insufficiency confirmed by cineangiography. In all 11 cases of mitral insufficiency, regurgitant flows through miral valves were observed dy color Doppler flow mapping and there was significant correlation between the grades of left ventricular angiography and color Doppler flow mapping. Among 14 cases of aortic inssufficiency, regurgitant flows through aortic valves were observed in 11 cases by color Doppler flow mapping. There was significant correlation also between the grades of ascending aortogram and color Doppler flow mapping. In 3 cases of aortic insufflciency combined with mitral stenosis, aortic regurgitant flows were masked by mitral stenotic jets. Although some limitations of aliasing or signal to noise problems in deep structures are present, It appeares that this now technology will provide substantial opportunity in evaluating valvular regurgitaions.