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임상연구 : Tissue Factor 유전체 자리 다형성과 체외 순환을 요하는 심장 수술 후 섬유소용해와 출혈의 연관성에 관한 예비연구
윤승주 ( Seung Zhoo Yoon ),김종성 ( Chong Seong Kim ),이용헌 ( Yong Hun Lee ),허원석 ( Won Seok Heo ),김성협 ( Soong Hyop Kim ),이종환 ( Jong Hwan Lee ),임영진 ( Young Jin Lim ),장인진 ( In Jin Jang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: Fibrinolysis, which commonly occurs following cardiopulmonary bypass (CPB), may be related to the excessive bleeding (EB) and morbidity after CPB. It is known that tissue factor (TF), which is triggered by CPB, plays an important role in the initiation of fibrinolysis during and after CPB, however, EB and fibrinolysis after CPB show inter-individual variance. Therefore, in this study, TF -603A/G polymorphism was evaluated to determine if it is associated with fibrinolysis and/or EB and morbidity following CPB. Methods: RT-PCR was used to determine the TF genotype of each patient. In addition, the amount of blood loss that occurred during the first 24 hours following surgery was documented, and EB was diagnosed when more than 1 L of blood was lost during the first 24 hours following surgery. The D-dimer levels were measured at; a) Time 1; prior to initiation of CPB, b) Time 2; 2 hours after CPB, and c) Time 3; 24 hours after CPB. The oxygen index (OI) was calculated at; 1) OI1; upon admission to the ICU, b) OI2; 24 hrs after admission to the ICU, and c) OI3; 48 hrs after admission to the ICU. The intubation time and the length of the ICU stay were also documented. Results: The serum D-Dimer level of the TF -603AA group (n = 72) measured at time 3 was higher than that of the TF -603GG/GA group (n = 25) measured at the same time. In addition, the incidence of EB and the intubation time of the TF -603AA group were higher than those of the TF -603GG/GA group. Finally, the OI3 of the TF -603AA group was lower than that of the TF -603GG/GA group. Conclusions: The G allele that is associated with TF -603A/G polymorphism may be protective against fibrinolysis following CPB, therefore, it may also be protective against EB and morbidity following CPB. (Korean J Anesthesiol 2007; 53: 720∼6)
증례보고 : 총대동맥활치환술 이후 혈액투석을 받은 환자에서 발생한 헤파린 기인성 혈소판 감소증 -증례보고-
정희진 ( Hee Jin Jeong ),김재광 ( Jae Kwang Kim ),최주연 ( Ju Yeon Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박경운 ( Kyoung Un Park ),박재현 ( Jae Hyon Bahk ),안혁 ( Hyuk Ahn ),김종성 ( Chong Sung Kim ),김용락 ( 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Heparin-induced thrombocytopenia (HIT) is an immunologically mediated complication of heparin therapy resulting in the consumption of platelets and a catastrophic thromboembolism. Both the clinical and laboratory features are important for a diagnosis of HIT. There have been 3 case reports of suspected HIT in Korea. However none have satisfied the laboratory features. We experienced a case of HIT, which satisfied both clinical and laboratory features, in a patient who received heparin during continuous veno-venous hemodiafiltration (CVVHD) used to treat acute renal failure that developed after a total aortic arch replacement with a cardiopulmonary bypass. The decreased platelet count and obstruction of extracorporeal filter of CVVHD by the blood clot was observed while receiving unfractionated heparin. The serum from the patient contained the anti heparin-platelet factor 4 antibody, and the condition was thus diagnosed as HIT. Argatroban, which is a direct thrombin inhibitor, was used to treat the thrombosis. (Korean J Anesthesiol 2006; 50: 600~4)
증례보고 : 제7응고인자 결핍증 수술환자에서 재조합 활성화 제7인자의 임상 경험
김성환 ( Sung Hwan Kim ),임경지 ( Kyung Ji Lim ),윤승주 ( Seung Zhoo Yoon ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
A 33-yr old female patient with coagulation factor VII deficiency was scheduled for laparoscopic oophorectomy under the diagnosis of ovarian teratoma. Plasma concentration of factor VII of this patient was 9 IU/dl (normal range; 60-140 IU/dl) and the prothrombin time INR (International Normalization Ratio) was 1.79 (normal range; 0.8-1.2) on the day before the operation. Total 1,200μg (30μg/kg) of recombinant activated factor VII (rFVIIa) was administered just before the start of the laparoscopic procedure, which was accomplished safely without severe hemorrhage or other complications. Postoperative course was uneventful. In addition, this article provides the clinical implication of rFVIIa in terms of hemostasis management in hemophiliacs and surgical patients. (Korean J Anesthesiol 2007; 52: 609~11)
증례보고 : 체외순환 없는 관상동맥 우회술 중 발생한 승모판막 전방이동에 의한 좌심실 유출로 폐쇄로 인한 저혈압
설태경 ( Tai Kyung Seol ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ),김종성 ( Chong Sung Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Systolic anterior motion of the mitral valve (SAM) is well known in the concentric left ventricular hypertrophy or post mitral valvuloplasty. However, SAM has not been reported in Off-pump coronary artery bypass surgery (OPCAB). Preoperatively, SAM in combination with a left ventricular outflow tract obstruction leads to severe cardiovascular destabilization. Moreover, a diagnosis of SAM is very important because the administration of conventional therapy to hypotension can aggravate SAM. We report a patient with un-identified left ventricular wall hypertrophy or mitral valve regurgitation, who was diagnosed with SAM by TEE during OPCAB. This report describes the diagnostic and therapeutic strategies for the perioperative management of SAM. (Korean J Anesthesiol 2007; 53: 242~5)
임상연구 : 경막외 마취를 이용한 각성하 관상동맥우회술
김진태 ( Jin Tae Kim ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),최주연 ( Ju Yeon Choi ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Recently, awake coronary artery bypass graft (ACAB) with spontaneous ventilation has been performed under thoracic epidural anesthesia (TEA) without general anesthesia. We report our first experiences of 12 cases of ACAB with full median sternotomy under TEA. Methods: Between March and September 2005, 12 patients underwent ACAB under TEA. The thoracic epidural catheter was placed at the level of T1 and/or T8 vertebral body according to surgical plan. Seven to fifteen milliliter of 2% lidocaine and sufentanil 1.66μg/ml was administered through the epidural catheter. Results: There were 11 male and 1 female patients, aged 67 ± 7 years. In 10 (83.3%) patients, pneumothorax was observed during surgical intervention. During the operation, 5 patients needed to be received general anesthesia because of respiratory distress caused by pneumothorax (n = 3), bowel protrusion (n = 1) or bleeding (n = 1). Mean length of stay in intensive care unit and hospital stay were 1.5 ± 1.2 days and 6.3 ± 1.7 days, respectively. Conclusions: Our initial experience confirms the feasibility of performing ACAB under TEA. However, high rate of conversion to general anesthesia and development of pneumotorax should be considered. Therefore, the actual and potential risks of ACAB under TEA should not be underestimated. (Korean J Anesthesiol 2006; 51: 421~5)
임상연구 : 머리의 자세가 우측 쇄골하 중심정맥도관의 위치에 미치는 영향
류호걸 ( Ho Geol Ryu ),이상진 ( Sang Jin Lee ),권정은 ( Jung Eun Kwon ),최주연 ( Ju Youn Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Confirmation of central venous catheter position with chest X-ray is recommended, but frequently omitted in clinical practice. It was suggested that the head posture during right subclavian catheterization affects the incidence of catheter malposition in infants. We evaluated the influence of the head posture on catheter position during right subclavian catheterization in adults. Methods: Two-hundred and seventy four patients scheduled for thoracic or neuro-surgery requiring central venous catheterization were enrolled. Patients were divided into 3 groups depending on the head posture during catheter insertion: the neutral group (n = 109), the turn away group (n = 72), and the turn toward group (n = 93). The catheter position was confirmed with postoperative chest X-ray. Results: Central venous catheterization was failed in 5 patients. There were no differences in the incidence of catheter malposition and the complications among the 3 groups. Conclusions: The head posture during right subclavian catheterization did not affect catheter malposition and immediate complication rates. (Korean J Anesthesiol 2007; 52: 627~9)