말기 암 환자의 마지막 24시간 동안 진통제 사용의 분석 : 내과의사와 외과의사의 비교

최윤선,김종민,이영미,임종국,이태호,홍명호,Choi, Youn-Seon,Kim, Jong-Min,Lee, Young-Mee,Lim, Jong-Kuk,Lee, Tai-Ho,Hong, Myung-Ho 한국호스피스완화의료학회 1998 한국호스피스.완화의료학회지 Vol.1 No.1

목적 : 암은 우리나라 사망원인의 첫째이며 말기암환자에서 보이는 신체증상 중 통증은 의료인이 반드시 조절을 해주어야 한다. 암환자의 90%이상에서 통증조절이 가능하며, 말기 암환자의 임종 24시간 전 $33{\sim}60%$에서는 의식이 명료하여 진통제의 경고, 투여가 가능하다. 마지막 24시간 동안의 진통제 사용실태와 내과계와 외과계 의사에따른 통증조절 방법의 차이를 조사함으로서 보다 계획적이고 적극적인 통증 조절 중요성의 중요성을 강조하고자 본 연구를 시행하였다. 방법 : 1994년 7월 1일부터 1995년 6월 30일까지 모대학병원에 입원하여 암으로 사망한 환자 160명을 대상으로 의무기록지, 간호기록지를 조사하는 후향적 코호트 방법을 시행하여 인구통계학적 자료와 사망 24시간전의 의식상태, 통증여부, 암의 종류 등을 조사하였다. 대상자를 내과의사와 외과의사에 의해 치료받은 군으로 나누어 임종전 24시간 동안 투여한 진통제의 용량, 투여방법, 투여종류, 필요시 마타 투여된 진통제의 평균 횟수를 비교 분석하였다. 진통제의 용량은 경구몰핀 등가량으로 환산해서 계산하였다. 결과 : 1) 전체 160명 중 남자가 102명(63.8%)명, 여자는 58명(36.2%) 이었고 평균연령은 56.4세였다. 2) 평균입원 27.8일이었으며 원발부위에 따른 암의 종류는 위암 42명(26.3%), 폐암 29명(18.1%), 간암 29명(18.1%), 췌장암 10명(6.2%), 대장암 9명(5.6%), 자궁경부암 6명(3.7%), 유방암 5명(3.1%)의 순이었다. 3) 160명 중 125명(78.13%)이 통증을 호소했고 진통제를 투여받은 환자는 내과계 103명중 66명(64.08%), 외과계 57명 중 31명(54.39%)이었다. 97명 중 50명(51.55%)에서 경고, 투여가 가능했다. 4) 임종 24시간 전에 86명(53.75%)에서 의식이 명료했다. 5) 규칙적으로 투여된 진통제의 종류는 경구용 모핀이 34명(내과계 24명, 외과계 10명)으로 제일 많았고, 주사용 모르핀이 26명(내과계 20명, 외과계 6명), 경구용 코데인이 8명 (내과 5명, 외과 3명)의 순이었다. 비정기적으로 통증조절을 위해 투여된 약물로는 주사용 모르핀이 16회, 데메롤 근주가 12회, nubain 근주가 9회의 순이었다. 6) 규칙적으로 투여된 진통제의 평균량은 내과계에서 115.41 OME에서 외과계 52.7 OME 보다 많았으나(P<0.05), 환자 요구시마다 투여된(p.r.n.) 진통제의 양은 외과계가 66.64 OME 로서 내과계 23.49 OME 보다 유의하게 많았다(P<0.01). 7) 통증호소시에 투여한 진통제의 횟수에 있어서도 내과계 평균은 0.62회, 외과계는 1.88로 유의한 차이가 있었다(P<0.001). 8) 보조진통제의 사용은 내과계에서 57명(55.34%), 외과계에서 25명(43.86%)이 사용했다. 결론 : 임종 24시간 전에 과반수 이상이 의식이 명료했으며 내과의사가 외과의사보다 적극적으로 통증조절을 하고 있으나 많은 의사들이 규칙적인 통증조절보다는 비정기적인 투약과 진통제의 비경구투여를 선호하였다. Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

주유소 조명 실태와 개선 방안

주윤석(Yoon-Suck Joo),이동호(Dong-Ho Lee),임종국(Jong-Kuk Lim),여인선(In-Seon Yeo) 한국조명·전기설비학회 1998 한국조명·전기설비학회 학술대회논문집 Vol.1998 No.-

This paper investigates the illuminance level at the existing gas stations and compares the results with the KS and IESNA standards. The measured illuminance level in the pump island area is found to be high up to 3 times the recommended value in KS and somewhat lower than one in IESNA standard. From this result we conclude that significant degree of energy saving can be possible from proper maintenance program, and careful consideration must be paid in the design process. And the KS standard need to be examined more thoroughly against other nation"s standards.

바위솔 추출물의 항산화활성 및 암세포 증식억제

김충현(Chung Hyun Kim),박재호(Jae Ho Park),임종국(Jong Kuk Lim),이건주(Kon Joo Lee),정규영(Gyu Young Chung),정형진(Hyung Jin Jeong) 한국약용작물학회 2003 한국약용작물학회지 Vol.11 No.1

The antioxidative activities and biological properties in the EtOAc extracts and purified extracts of Orostachys japonicus were measured by assay of DPPH, xanthine/xanthine oxidase and mammalian cells(2-12). Scavenging of DPPH radical and inhibition of xanthine/xanthine oxidase of EtOAc extracts were showed the highest activity in the arable land and in September. The S-4 fraction showed the highest activity among the silica-gel column chromatography fractions. LH-4 fraction showed higher activity than the other fractionsins in assay of DPPH and xanthine/xanthine oxidase. Fatty acids and phenolic compounds were identified by GC/MS and main compounds were 1,2,3-benzenetriol, alpha-androsta-7.14-diene in LH-4 fraction. The activities of POD and SOD in samples havested on different habitats were high such as arable land > intermountain > seashore. That of POD and SOD in crude extracts of late stage were higher than early stage. Isozyme bands of crude extracts samplinged in all habitats and all growing stage were higher than early stage. Isozyme bands of crude extracts samplinged in all habitats and all growing stages showed two bands and the signal intensity showed strongly according to passage of growing stage. The purified extracts of LH-4 fraction showed excellent inhibition effect in proliferation of HL- 60 cells and markedly suppressed colony formation in mouse fibroblast cells. Dose response between partially purified extracts(400ppm) and negative control did not produced statistically significant reduction in colony formation.

灌漑用 貯水池의 餘水吐 容量에 關한 水文學的 硏究 : 忠淸南道 中心으로 In Chung Cheong Nam -do District, Korea

林鍾國 안성산업대학교 1979 論文集 Vol.11 No.-

本 硏究는 忠淸南道內 灌漑用 貯水地의 Spillway 容量을 診斷하여 앞으로 設計 水文量을 設定함에 寄與코저 하는 것이다. Spillway 諸元은 dam 計劃 樹立 당시의 事業 計劃書에 依하여 收集되었으며 照會가 可能한 忠淸南道內의 貯水地 19個所를 選定하였다. 計劃 洪水量과 計劃 降雨量의 크기를 分析하고 그것에 對應할 確率年의 大小로서 Spillway 用量을 判斷하였다. 灌漑用 dam의 Spillway 計劃 規模는 確率年 T=70-600年이 採擇되고 있으며 Spillway 計劃 規模는 貯水地의 常時 滿水位를 基準으로 하여 設計 越流深만으로서 安全하게 人命과 資産의 被害를 막을수 있어야 한다는 관점에서 볼때 아래와 같이 要約된다. 1. 旣存 Spillway 容量은 確率年 70∼600年에 해당되는 規模이나 其間의 餘水吐 破壞 實例나 都市化 現家의 高潮되어 갈 취세로 볼때 確率年의 設定이 增大되어야 할것이다. 2. 同一한 計劃 降雨量(例 r=360㎜/day)에 대하여 計劃 洪水量(Qp=52-133 CMS)은 변동목이 크므로 計劃 洪水量의 增加에 따라 確率年도 커져야 할 것으로 判斷하였다. This study is assess the Spillway Capacities of irrigation Reservoirs and determine the design capacity in Chung Cheong nam-do district. The basic data of spillway were collected by the fundamental reports of 19 reservoirs in Chung Cheong Nam-do district The assessment of the Spillway Capacity was analized by the frequency analysis of rainfall data and flood discharge. The design magnitude of the Spillway capacity for irrigation dam was adopted by T=70 ~ 600 yrs and it should be fulfilled only by the overflow depth above the ordinary full water Level in order to prevent form disaster. (1) The present Spillway Capacity had designed by the return period 70 ~ 600 yrs, but Consider the precedent Spillway destruction or the urbanizing the return period must be increased. (2) Because the Variation of flood discharge (Qp=52 - 133CMS) for the same rainfall intensity (exr=360 m/dey) is Considerable, as increasing the designed flood discharge, the return period must be also extended.

낭만주의적 문학인식 : 루카치, 벤야민, 코메렐, 아도르노를 중심으로 Lukacs, Benjamin Kommerell und Adorno

임종국,변학수 한국독일어문학회 1995 독일어문학 Vol.3 No.-

民間飛行場의 FLEXBLE PAVEMENT에 關한 硏究

林鍾國 안성산업대학교 1983 論文集 Vol.15 No.-

Results of the study are summarized as follows: 1. On the method of making decision in run-way length, corps of engineers are used the method of modifying length on its and administration of federal aviation are used the efficiency diagram on take-off and landing. 2. In designing of flexible pavement, results of comparing the method of corps engineers with the method of administration of federal aviation are as follows: corps engineers adminstration of federal aviation Width(runway) 150ft 150ft Longitudinal slop 1.5% 1.50%~2.0 Sectional slop 1.0~1.50% 1.50% Classification of subgrad Unified soil soil classification Classification by F.A.A 3. The depth (thickness) of flexible pavement in civilian airport is calculated by the designing loads depend upon these kinds of airplanes, subgrad or subbase, by the traffic volume. In making decision of the depth (thickness) on the flexible pavement, essential factor is the designing loads depend upon these of airplanes. 4. Corps engineers was used the formula of C.B.R. testing and administration of federal aviation was used the diagram or table for a designing. The construction of civilian airport expected forward so much that the research for a technical development of the flexible pavement in runway is required continually.

灌漑用 貯水池의 餘水吐 容量에 關한 水文學的 硏究 : 金南地方 中心으로

林鍾國 안성산업대학교 1982 論文集 Vol.14 No.-

This study is assess the spillway capacities of irrigation reservoirs and determine the design capacity in Jeon-Nam district. The basic data of spillway were collected by the fundamental reports of 70 reservoirs in Jeon-Nam district. The assessment of the spillway capacity was andlized by the frequency analysis of rainfall data and flood discharge. The design magnitude of the spillway capacity for irrigation dam was adopted by T=40-1000 yrs and it should be fulfilled only by the overflow depth above the ordinary full water level in order to prevent from disastes. 1) The present spillway capacity had designed by the return period of 40-1000 yrs, but consider the precedent spillway destruction or the urbanizing the return period must be increased. 2) Because the variation of flood discharge (Qp=8.5-222 CMS) for the same rain-fall intensity (ex r=300mm/day) is considerable, as increasing the designed flood discharge, the return period must be also extended. 3) The overflow depth must be increased and should be hold free board which are taken above proposed high water lever.

道路鋪裝의 維持修繕에 관한 硏究

林鍾國 안성산업대학교 1984 論文集 Vol.16 No.-

道路鋪裝의 破損과 維持修繕의 工法에 관련된 사항을 調査分析한 結果를 要約하면 다음과 같다. 1. 貨物車輛의 94%가 過積車輛이며 貨物車輛이 鋪裝에 미치는 破損率은 81%에 달하였다. 2. 不等沈下와 施工이음을 中心으로 하여 鋪裝破損이 發達되었으며 局部的인 龜裂이 龜甲狀의 全面的 cracking으로 發生하였다. 3. 高速道路의 鋪裝은 經濟的 事情을 고려하여 初期 投資를 적게하기 위하여 段階的 工法을 適用하였다. 그러므로 供用年數 5年을 計劃施工 되었으나 2∼3年을 앞당겨 追加鋪裝 工事를 실시하게 되었다. 4. Overlay두께는 Wave.D 1.5mmdlfEo 4∼15cm이용하여야 하겠고 切削打換은 15∼20cm두께로 Asphalt混合物을 계속 적용하도록 努力하여야 한다. 5. Patching을 할때 1cm의 餘盛의 塡充과 轉壓을 잘 하여야 하겠고 表面處理法에서 使用하는 碎石은 5∼13mm, 5∼2.5mm이며 Asphajt유제는 5mm의 두께로 세심한 施工을 하여야 한다. 鋪裝道路에 있어서 維持 修繕工法은 계속 硏究 開發하여야 하겠고 補修機械의 開發과 過積車輛의 根絶을 위하여 汎國民的 意識改革 次元에서 캠페인運動을 推進하여 나가야 할 것이다. This study was related on the engineering method of maintenance and repairing in breakages of the wearing surface for a paved load. The results are summarized as follows. 1. In wearing surface(asphalt-pavement) for a paved load, rate of breakage by the freight was reached to 81 percent, there to the rate of over-load truck to the total freight found out 94 percent. 2. In asphalt-pavement broken cracks were developed from the centeral point of differential settlement or construction joint to the asphalt inside. Also, local breakage was occurred on the whole surface as a turtle deck. 3. he construction of wearing surface for highway has to considering about the economics, so for the purpose of reduced the initial investment of construction. The annually step method was applied on analyses of inspected data. In the construction of wearing surface for a paved load, originally, the year of public useing in it was planned for five years, but repairable construction was required before two or three years from the planned. 4. When the waving depth on asphalt-pavement is reached 1.5 millimeters, the depth of overlay has to about 4-15 centimeter and the depth of asphalt paving mixture has to compact in cutting section by 15-20 centimeters. 5. When the patching is required, should be careful in the filled up and compaction of surplus banking by one centimeter. In the surface treatment, it is required that the size of construction meterials is used for crushed stone 5-13 or 5-2.5 millimeter and the depth of emulsified asphalt is required 5 millimeters. The method of maintenance and repairment for the wearing surface (asphalt-pavement) of a paved load has to study and develop of repairing mechines continuously. In order to eradicate driving with over-load trucks in a paved load, it is required to innovation of consciousness in a pannational campaign.

八會血 應用의 經穴學的 硏究

金容佑,朴寅圭,林鍾國 圓光大學校 韓醫學硏究所 1992 원광한의학 Vol.2 No.1

Shu(수) point is the communication channel of meridian-viscera and body surface. It is used for the point acupuncture and moxibustion that the solid and hollow organs and meridians are closely related with each other. Also, that is point where the channel energy(脈氣) of meridian and viscera organs communicate inward and outward. Hence, the knowledge on the meridian and its points are essential for acupunture and moxibustion therapy. Especially, Palhoae point(八會穴) is one of the special points chiefly used for the remedy of faver. In this study, the use of Palhoae point(八會穴) is examined through the literatural survey.

두통과 우울성향 및 가족기능과의 관계 : 서울 모 여자 고등학생을 대상으로

이병환,임종국,윤도경,최윤선,조경환,홍명호,장정애,박종석 대한가정의학회 2002 Korean Journal of Family Medicine Vol.23 No.4