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RISS 인기검색어
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- 저자 : 이유선(Yeu Seon Lee) (검색결과 2 건)
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강정아(Jeong A Kang),이유선(Yeu Seon Lee),정승현(Seung Hyeon Jeong),이정우(Jeong Woo Lee),김보영(Bo Yeong Kim),임대승(Dea Seung Im),이민수(Min Soo Lee),김정희(Jeong Hee Kim),정준용(Jun Young Jeong),최시완(Si Wan Choi),정진옥(Jin Ok J 대한내과학회 2002 대한내과학회지 Vol.63 No.2
목적: 우리나라는 이형성 협심증의 발생 빈도가 높음에도 불구하고 임상상과 예후에 대한 연구가 부족한 실정이다. 이에 본 조사는 이형성 협심증으로 진단을 받은 환자를 대상으로 그 빈도와 임상상 그리고 예후에 대해 연구 조사하였다. 방법: 1995년 1월부터 2000년 7월까지 흉통을 주소로 충남대학교병원 순환기 내과에 입원하여 관상동맥 조영술를 시행한 결과 관상동맥의 내경의 협착이 50% 미만이며 에르고노빈(ergonovine)8, 9) 유발 검사로 이형성 협심증으로 진단된 178명을 대상으로 하였다. 결과: 1) 관상동맥질환자 중 이형성 협심증 환자의 빈도는 13.2%로 높았다 2) 이형성 협심증의 위험인자는 흡연이 가장 많았다. 3) 이형성 협심증의 임상상은 대부분 불안정형 협심증의 양상이었고, 13.2%의 환자는 급성심근경색의 임상상을 보였다. 4) 흉통의 발생 시간대는 대부분 새벽이었고, 흉통의 지속시간 평균 11분으로 일반 협심증보다 길었다. 5) 흉통이 없을 때 검사한 심전도는 대부분에서 정상이었고, 운동부하 심전도검사는 76%에서 음성소견을 보였다. 6) 이형성 협심증의 진단에 에르고노빈 유발 관상동맥 조영술은 안전하고 유용한 검사이다. 7) 이형성 협심증의 치료에 칼슘길항제와 나이트레이트제제는 효과적인 약물이다. 8) 이형성 협심증의 예후는 비교적 양호하나 임의로 약물이 중단된 상태에서 심장사 할 수 있다. 따라서 이형성 협심증 환자는 흉통 발생에 대비한 나이트레이트의 준비가 필요하다. 결론: 본 조사에서는 관상동맥질환자의 13.2%가 이형성 협심증 환자였고, 이들은 약물 치료에 대한 효과와 예후가 비교적 양호하였다. 그러나 2.8%의 환자에서 심정지나 심장사가 발생하여 흉통 발생시에 적절한 나이트레이트제제의 사용이 필요하겠다. Background: Coronary artery spasm plays an important role in the pathogenesis of variant angina. However the precise mechanism (s) and the clinical characteristics of variant angina remain to be elucidated. We investigated the clinical characteristics and diagnostic features of variant angina. Methods: The clinical characteristics and coronary angiographic findings were analyzed in 178 patients with angiographically documented coronary artery spasm, which developed spontaneously or was provoked by the admistration of intravenous ergonovine maleate. All patients were followed for at least 1 year or more or until their death. Results: One hundred and eleven patients complained of chest pain which developed especially at night and in the early morning. One hundred and thirty three patients (74.7%) were smokers. The electrocardiographic findings at the time of admission showed no changes in 147 cases (82.6%), testes showed ST segment elevation in 22 cases (12.4%), ST segment depression in 2 cases (1.1%), T wave inversion in 7cases (3.9%). The treadmill test was performed in 135 cases, ST segment elevation was noted in 6 patients (4.4%) and ST segment depression in 18 patients (13.3%). All of the other results were within normal range. The ergonovine provovative tests for coronary spasms were safe and effective. The right coronary artery was the most prevalent site of coronary artery spasm. Drug treatment was applied initially to all patients, but only 115 patients (64.5%) received the follow-up. Of these three died from cardiac arrest. The rate of cardiac death was low (1.7%) in patient, which made it difficult to know the risk factors for the cardiac deaths. Two (1.1%) had cardiac arrest. They didn't take any medication. Patients with variant angina usually responded well to nitrates and calcium antagonists. Thus nitrates and calcium antagonists are useful in preventing attacks and abolished attacks of variant angina. Conclusion: In this study, 13.2% of coronary artery disease was variant angina. The effectiveness of drug therapy and the prognosis of the patients was quite good in the group. But when chest pain happens, the adequate use of nitrate agents is needed because of cardia arrest or cardiac death in 2.8% of the patients. (Korean J Med 63:195-202, 2002)
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혈액 투석 환자에서 중심정맥 협착에 대한 스텐트 삽입술 : Wallstent Placement
임대승,노상필,이유선,정승현,김보영,이정우,강정아,김정희,이민수,정준용,최시완,정진옥,성인환,이강욱,신영태 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.1
Stenosis of central vein is a common complication arising after percutaneous subclavian vein catheter insertion performed for temporary vascular access in chronic renal failure patients undergoing hemodialysis. There are several treatment methods for the condition like percutaneous angioplasty(PTA), stent insertion, and surgery, but recent trend is toward PTA and stents. Among the patients diagnosed with chronic renal failure from March 1993 to May 2002 and undergoing hemodialysis through AV fistula, the 14 Patients in whom central vein stenosis arose were selected for the study. A total of 28 percutaneous interventions(5 PTA and 23 stent placement) were performed, and restenosis rate and the time taken till the restenosis in de novo lesions and instant lesions were compared. All 28 cases were operated successfully. The 14 cases that received both anigioplasty and stent placement initially. (de novo lesion : 14 cases), Among the 10 cases with de novo lesion that followed up more than 1 year, 3 cases are currently undergoing hemodialysis without restenosis, and the remaining 7 cases have recurred stenosis with the mean time to restenosis of 10.9 months. In the 7 cases in whom stenosis recurred, 11 interventions were done(instent lesion: 11 cases). 4 of these were using only ballon angioplasty with 100% restenosis rate and the mean time of 3 months until restenosis. The remaining 7 cases were using both balloon angioplasty and stent placement, also with 100% restenosis rate but with the mean time of 12 months until restenosis, which was later than the group receiving only balloon angioplasty. In treating the patients with central vein stenosis, stent placement seems to be more advantageous over PTA in terms of restenosis rate and the mean duration of patency. In the case of instent lesion, inserting the stent for the second time after stenosis recurred lengthened the duration of patency compared to performing balloon angioplasty alone.
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