심폐소생술의 최신지침 소개

우건화 대한흉부외과학회 2003 Journal of Chest Surgery (J Chest Surg) Vol.36 No.6

심폐소생술 지침은 과거에 미국심장학회 지침과 유럽소생학회 지침으로 크게 양분되어 있었으나, 2000년 8월에 국제심폐소생술 위원회에 의한 공동 지침으로 ‘심폐소생술과 응급심장 처치에 관한 지침 2000’이 완성되었다. 현재까지 심폐소생술로써 환자의 생존율에 괄목할 만한 향상이 없으므로 보다 새로운 지식으로써 적절히 임상에 적용하는 것이 최선의 방법이라 할 수 있다. 새 지침의 특징은 알고리듬의 단순화와 과학적인 결과를 바탕으로 하였으며, 성인 심정지 환자의 기본소생처치에서 심장 마사지:인공 호흡을 15:2로 통일하고 일반인에게는 경동맥 촉지법과 하임리히법을 가르치지 않는다는 것이다. 흡입 산소농도에 따라 호흡 흡입량의 차이를 두었으며, 기관 삽관의 튜브 크기를 8.0 mm로 통일하였고, 심실빈맥/심실세동의 알고리듬에서 epinephrine대신에 vasopressin을 사용할 수 있게 하였으며, 자동 제세동기의 사용을 권장하였다. 또 급성 관상동맥 증후군에서는 병원 도착 전에 심전도를 중요시하고 혈전용해제를 조기에 사용할 수 있게 하였으며 급성 허혈성 뇌졸중에서도 병원 도착 전에 적절한 평가와 빠른 혈전용해제 사용이 추가되었다.

경피적 폐생검술에 의해 흉벽에 전이된 폐암 -1례 보고-

우건화,김동원,곽영태,이신영,U, Geon-Hwa,Kim, Dong-Won,Gwak, Yeong-Tae,Lee, Sin-Yeong 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.4

경피적 폐생검술은 폐 및 늑막 질환의 진단에 보편적으로 흔히 시행되며 이에 의한 합병증의 발생 빈도는 매우 낮다. 이중 매우 드물지 만 치명적 일 수 있는 합병증 중의 하나는 경피적 폐생검술 후 바늘의 경로를 통한 암세포의 흉벽으로의 전이이다. 환자는 59세 된 여자로 편평상퍼 세포 폐암으로 진단되어 우측폐 상엽절제술을 시행한 후 외래 추적 관찰 6개월째 수술 전 시행한 경피적 폐생검 부위에 종괴가 촉지되어 폐암의 흉벽 전이로 판단하고종 괴를 포함하여 주변 근육들과 함께 확대 절제하였고 이후 방사선 치료 및 항암제 치료를 병 행하였다. 본 인제대학교 의과대학 흉부외과학교실 상계 백병 원에서는 1 례의 폐암 환자에서 경피적 폐생검술 후 암세포가 흉벽으로 전이되 어 외과적으로 치험하였기에 보고하는 바이다. Percutaneous transthoracic fine needle biopsy is a popular technique in the diagnosis ot'pulmonary and pleural diseases and its complication rate is very low. One of the rarest but potential complications is that of implantation of malignant cells along the needle tract and subsequent development of a chest wall mass . We experienced a case of chest wall implantation of lung cancer after percutaneous transthoracic fine needle biopsy. The patient was a 59 year old female who had undergone right upper lobectomy for squamous cell carcinoma of the lung (T,N,Mo). 6 months after operation, a loculated mass was palpated at the right posterior .chest wall where the percutaneous transthoracic fine needle biopsy had been performed before operation. We carried out wide excision of this mass and confirmed squamous cell carcinoma histopathologically.

신혈관성 고혈압의 외과적 치료 결과

우건화,김창호 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.4

본 인제대학교 서울백병원 흉부외 과에서는 지난 8년간 술전 적극적 인 항고혈압제 투여에도 불구하 고 혈압 조절에 실패한9명의 신혈관성 고혈압 환자를 수술 치험하였다. 수술방법은9명중8명에서는 자가복재 정맥을 이용한 대동맥 신동맥간우회술을시행하였으며,나머지 1명은내장골동맥을이용한 신동맥 재건술을 시행하였다. 술후 9명의 환자중 사망한 예는 없었으며, 수술전후 비교한 혈압 수치의 선정 기준은, 술전에는 환자의 여러 차례 측정된 혈압중 대표적 인 혈압수치로 선정하였고, 술후혈압은 최종적으로 외래 추적 관찰한 혈 압수치를 선정 하였다. 술후 장기 추적한 걸과 9명의 환자 모두에서 혈압 호전을 보여 좋은 수술 결과를 얻었기 에, 중증 신혈관성 고혈압환자에 있어서 수술적 치료가 가장 효과적이고 유용한 치료법으로 생각 되는 바이다. During the past eight years, we have encountered 9 patients, aged between 2 and 61 years, with renovascular hypertension. The renovascular hypertension In this series included Takayasu's disease with renal artery stenosis, arteriosclerosis of renal artery, fibromuscular dysplas a of renal artery Aortd-renal bypass was performed In 8 patients, iliac-to-renal bypass in 1 patient. 9 patients have been followed form 2 months to 5.1 years. Postoperatively, all patients'hypertension was improved. Only 2 patients need to take small dose of antihypertensive medication after discharge. These data indicated the good results of renovascular reconstruction for the patients with renovascular hypertension.

흉부외과에 대한 일반인의 인식도 설문조사 연구

우건화,오상준,김창호,U, Geon-Hwa,O, Sang-Jun,Kim, Chang-Ho 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.2

흔히 일반인들은 종합병 원에 대한 인식이나 신뢰도가 개인병원이나 규모가 좀 작은 준종합병원에 비해 높은 편이나 그 자체 내에 포함되어 진료하고 있는 소속분야에 대한 상식선은 상당히 낮은 편이다. 저자는 이런 상황을 감안하여 본인이 속해있는 "흉부외과"라는 특수 진료과목에 대한 우리 나라 성인의 인식도와 진료과목에 대해 인지하고 있는 정도와진료및 수술, 어떠한 질병을 다루고 있는지에 대한 통계를 도표로 정리하여 분석해 보았다. 흉부외과에 대한 물음에 따른 상황을 균형 점검하여 현시점에서 "흉부외과"라는 의료진들의 현실영역과 일반인들이 알고 있는 내용을 비례하여 점검하고자 이들의 현실적인 사고를 제시한다.자 이들의 현실적인 사고를 제시한다. In general, common people have more understanding of and confidence in the university hospital than the private and the smaller semi-general hospital. But they know little about an appropriate field that is a part of the university hospital And takes care of them. Taking these situations into consideration, we, writers made analyses of statistics by putting into the form of diagrams. Stati tics are about these questions. 1. How much Korean adults know about nly major, a special treatment field-Thoracic & Cardiovascular surgery (T.C.S). 2. How much Korean adults know about the detailed parts of the T.C.S. 3. How much korean adults know about how medical treatment and operations are performed, and which diseases are concerned with the T.C.S. At this point, to compare the medical team's practical province in the T.C.S. surgery with the contents of 'common people's knowledge of the T.C.S., we made a balanced-check of many situations according to questions about the T.C.S. We present common people's actual answers.

미숙아에서 시행된 동맥관 개존증 결찰술 10례에 대한 고찰

우건화,이홍섭 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.2

최근 3년 6개월동안, 재태 연령 37주 미만의 미숙아 동맥관 개존증 환아 10명에서 생후 평균 30일경 결찰술을 시행하여, 수술시 사망은 없었으며, 수술후 2개월간의 수술과 관계없는 만기 사망 1례를 제외한 나머지 9례 모두에서 2∼26개월의 추적관찰기간동안 양호한 경과를 보였기에, 중증의 증세를 보이는 미숙아 동맥관 개존증에 있어서 수술적 결찰술이 가장 근치적이고 유용한 치료법으로 생각되는 바이다. Over a 3 year period, 10 premature infants with less than 37 weeks of gestational age underwent ductal ligation for patent ductus arteriosus. No patient died during operations which were done at a mean age of 30 days. One late death at 2 months after operation was not directly attributed to operative procedure. Follow-ups were done in 9 survived patients from 2 to 26 months. Results suggest that surgical ligation is a feasible and effective method for treating symptomatic premature infants with patent ductus arteriosus.

흉부외상 환자에서 응급 전산화 단층촬영의 효용성에 관한 분석

우건화,김원율,김경환,김홍용,이기재 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background. Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography(CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest injuries are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. Methods. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. Results. Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings, Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3% and 45.1% respectively), whereas 65.7%(44/67) of patients had thoracostomy only by CXR. Conclusion. Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.

응급센터에서의 박리성 대동맥류에 대한 임상적 고찰

우건화,김원율,김홍용 대한응급학회 1998 대한응급의학회지 Vol.9 No.2

Dissecting aortic aneurysm is an emergency condition which requires prompt diagnosis and management. From January 1992 to December 1996, 54 patients were admitted to our department. Patients were categorized according to the Stanford classification of aortic dissection and investigation of the clinical records utilized the retrospective method. Male constituted the majority, accounting for 38(70.4%) of the total number of patients, whereas females accounted for 16(29.6%). Mean age was 52.1±2.2 years old (range: 25∼82). Clinical findings included chest pain in 46 cases(85.2%), renal failure in 11(20.4%), aortic insufficiency in 10(18.5%) and stroke in 9(16.7%). Predisposing factors were hypertension in 48 cases(88.9%), Marfan's syndrome in 5(9.3%) and diabetes mellitus in 1(1.8%). 21 patients(type A:12, type B:9) underwent surgical treatment. There were three(2 in type A and 1 in type B) deaths in the surgical treatment group and nine(5 in type A and 4 in type B) deaths in the medical treatment group. These results reflect our current policy in the management of dissecting aortic aneurysm.

풍진바이러스 감염에 의한 뇌염

김수진,우건화,김낙훈,이베안,최성혁,홍윤식 대한응급의학회 2003 대한응급의학회지 Vol.14 No.1

We experienced 5 cases of acute rubella encephalitis, a serious complication of rubella. The patients presented with convulsions and a deteriorated mental state, both of which occurred with a vanishing maculopapular rash and a lowgrade fever. The cerebrospinal fluid analysis showed pleocytosis and increased protein and normal glucose levels. We diagnosed the rubella encephalitis by detection of IgM in the serum. Rubella encephalitis is known to be a serious complication of rubella, and with poor prognosis. The mortality rate may reached as high 20%. Our cases recovered without any sequelae.

응급센터에서 검상하 심낭루조성술을 이용한 급성 외상성 심장압전에 대한 처치

김홍용,우건화 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2

The development of cardiac tamponade is an acute, life-threatening emergency. Once the diagnosis has been established, an immediate decompression by a safe and effective method is required. We experienced two consecutive successful outcome for the treatment of traumatic cardiac tamponade with drainage using the subxiphoid pericardiostomy in emergency department. The causes of cardiac tamponade were blunt chest trauma due to car accident and falling. The patients were treated with emergency drainage by the subxiphoid pericardiostomy without procedure-related complications. We believe that subxiphoid pericardiostomy is a safe and effective method for the management of traumatic cerdiac tamponade in emergency department. The ability to perform this technique safely using local anesthesia and the capacity to obtain a direct visualization make this technique superior to both needle pericardiocentesis and pericardiectomy in the acutely ill patient.

둔상에 의한 흉골골절 104 례의 임상적 평가

오상준,김홍용,우건화 대한외상학회 2000 大韓外傷學會誌 Vol.13 No.1

Background: Sternal fracture, once thought of as an uncommon phenomenon, has occurred with increasing frequency, paralleling the incidence of motor vehicle accidents. The tremendous force necessary to cause sternal fracture and this bone's prominent position overlying major intrathoracic and mediastinal structures, have important implications in the assessment and the treatment of patients. Methods: Data on blunt trauma victims admitted to our hospital were retrospectively analyzed to determine the significance of sternal fractures and possible associated injuries. One hundred four patients with sternal fractures due to blunt trauma were admitted from January 1990 to December 1999. Result: The frequency was about 4.2% of nonpenetrating chest traumas. The ratio of males to females was 2.1: 1. The most common cause of sternal fractures was TA (80 cases). The most common fracture site was the sternal body (83 cases). Abnormal ECG findings were sinus bradycardia (8 cases), sinus tachycardia (6 cases), complete or incomplete RBBB (3 cases), specific S-T change (3 cases), 1st degree A-V block (1 case), LVH (1 case), PVC (1 case), atrial fibrillation (1 case), and Low voltage (1 case). CK-MB was increased in about 14.4% of the sternal fractures. Patients were treated with conservative treatment (100 cases) and open reductions & steel-wire fixations (4 cases). The complications after treatment were atelectasis (4 cases), empyema (2 cases), ARDS (1 case). One patient died at the emergency center. The causes of death were lung contusion and ARDS. Conclusion: Although sternal fractures do not occur frequently, and are mostly treated with conservative treatment, they should be carefully observed because of critical associated injuries.