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중심정맥 도관 삽입술의 성공률과 합병증 발생 빈도에 대한 전향적 연구
배창황(Chang Hwang Bae),김우건(Woo Kun Kim),박완(Wan Park),박진희(Jin Hee Park),김정균(Jeong Kyun Kim),최성준(Sung Jun Choi),이제환(Je Hwan Lee),김성배(Sung Bae Kim),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),이 대한내과학회 1998 대한내과학회지 Vol.55 No.2
N/A Objectives: The reported success rate of central venous catheterization ranged from 84% to 97.5%, and the complication rate from 0.3% to 12%. The most important contributing factor for complications reported by several authors was the physician's experience. We investigated the success and complication rates of central venous catheterization prospectively. We also evaluate the factors that contributed to complications at our institution as part of our quality assurance study. Methods: Four hundred sixty five central venous catheterizations were conducted at the medical intensive care unit and the general ward of the hemato1ogy/ oncology department of Asan Medical Center in Korea, from June to November, 1997. We surveyed the date and place of the procedures, lD numbers, age and sex of the patients, the training level of physicians, the types of catheters, initial puncture sites, success or failure, and complications. We grouped the purpose of procedures into 5categories, such as hemodynamic monitoring, fluid therapy, chemotherapy, total parenteral nutrition, and others, Results: The initial success rate, defined as the initial performer being able to insert the catheter without changing the skin puncture site, was 78.5%. The overall success rate for initial performers, including those who required multiple skin puncture sites, was 82.8%. The total success rate, including changing the performers (up to 4performers), was 96.1%. The overall complication rate was 5.2% including pneumothorax (2.8%), hemothorax (0.2%), subcutaneous hematoma (1.1%), catheter tip malposition (0.9%), and air-embolism (0.2%). There were no differences in the complication rates with regards to the sex and age of the patient, initial puncture sites, the physician's training level between 1st and 2nd year residency, and vein localization. However, the complication rate differed significantly in relation to the number of initial punctures. Patients with 1-3 punctures had a complication rate of 4.3%, while patients with 4 or more punctures had a complication rate of 18.5%. Conclusion: The overall complication rate was 5.2% and pneumothorax occured in 2.8%. We expect that we can decrease the number of complications by taking over the procedure if the initial performer fails on the first or second attempt and by attempting the skin puncture not more than 4times at initial trial.
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박진희(Jin Hi Park),서철원(Cheol Won Suh),김우건(Woo Kun Kim),이무송(Moo Song Lee),배창황(Chang Hwang Bae),민영주(Young Joo Min),최성준(Seong Jun Choi),김태원(Tae On Kim),장대영(Dae Young Zang),이제환(Je Hwan Lee),김성배(Sung Bae Kim 대한내과학회 1998 대한내과학회지 Vol.54 No.3
N/A Background: It has been well known that normal leukocyte counts in blood can vary depending on age, gender, other environmental factors and ethnic differences. However, the normal white blood ce11 counts in Koreans has not been settled yet. Over past several years, a large number of patients were referred to the Hematology Clinic of Asan Medical Center (AMC) for evaluation of leukopenia, and most of them were found to have no medical problems other than leukocyte counts less than 4.000/mm3. We performed this study on persons who visited Health 3creening Center to analysis of leukopenic patients and also to establish the normal value of white blood cell counts in Korean. Method: We studied 31,307 persons (19,540 men, 11,767 women, aged 15-90), who visited to Health Screening Center of AMC during the period from January through December 1995. We have carried out retrospective analysis of complete medical record of 2,406 patients (838 men, 1,568 women, aged 20-81) who were found to have leukocyte counts less than 4,000/mm3. And we tried to establish the normal values of leukocyte counts and differential counts of 24,079 adults (15,807 men, 8,272 women, aged 19-90), who were assessed to be healthy at Health Screening Center of AMC. Results: 1) Leukopenia (WBC<4,000/mm3) were found in 2,406 subjects (7.7%) among 31,307 persons screened. 2) Among them, 77 subjects (3%) had medical illness; 39 of them had chronic B or C viral hepatitis, 24 of them had iron deficiency anemia, and other diseases were detected in remaining 14 patients. But other hematologic diseases or significant infectious diseases were not detected. Follow-up study of them has indicated no increased incidence of infection or other hematologic diseases. 3) The total white blood cell counts of 24,097 healthy Korean adults were 3,640-9,870/mm (5,900/mm3) in men, and 3,270-8,400/mm3 (5,264/mm3) in women. Neutrophil counts ranged 1,288-6,866mm3 (3,098/mm3) in men, and 1,180-5,985/mm3 (2,816/mm3) in women. Leukocyte counts were significantly lower in female, but no significant variation was found among age groups. Conclusion: Normal range of leukocyte counts and neutrophil counts of healthy Korean adults were lower than those of white populations. Thus, a new normal values of leukocyte and neutrophil counts should be established in Koreans. And many persons with leukocyte counts less than 4,000/mm3 who are otherwise healthy could be normal.
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