http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
화상 정도 및 CAPS 점수에 따른 타액 코티졸의 변화 양상 비교
김진나,김지욱,최인근,전욱,서정훈,김경자,이병철,Kim, Jin-Na,Kim, Jee Wook,Choi, Ihn-Geun,Chun, Wook,Seo, Cheong Hoon,Kim, Kyung Ja,Lee, Boung Chul 대한불안의학회 2012 대한불안의학회지 Vol.8 No.2
Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.
화상 환자에서 신속 순차 시각 제시를 이용한 주의깜빡임에 관한 예비연구
김대희,전보라,서정훈,조용석,임해준,허준,김도헌,전욱,김종현,정명훈,최인근,이병철,Kim, Dae Hee,Jun, Bora,Seo, Cheong Hoon,Cho, Yongsuk,Yim, Haejun,Hur, Jun,Kim, Dohern,Chun, Wook,Kim, Jonghyun,Jung, Myung Hun,Choi, Ihngeun,Lee, Boung Ch 대한생물정신의학회 2010 생물정신의학 Vol.17 No.2
Objectives : Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. Methods : We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. Results : Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the 'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. Conclusion : We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.
송종훈(Jong Hoon Song),김도헌(Do Hern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.1
Purpose: The most common cause of death in massive burn patients is burn wound sepsis. Therefore we have been using allograft skin for preventing burn wound sepsis. Methods: Included in this study were 71 subjects who had sustained extensive burns from December 2003 through February 2006. 1. Early selective Escharectomy was performed for full thickness burn areas. 2. Allograft skins were grafted on excision area. 3. An autograft was performed for areas with a formation of granulation tissue after the allograft skin had come away. 4. A modified sandwich grafting technique (1:4∼6 meshed autograft with Cultured Epithelial Autografts) was performed in large sized burns. 5. Acellular dermal substitute was concurrently used to prevent burn scar contraction on joint areas. Results: Seventy one subjects were included (Fresh allograft: 9 cases, Cryo-preserved allograft: 42 cases, Glycerol preserved allograft: 20 cases). The average burn area was 41.8 (20∼92) %TBSA (Total Body Surface Area). The mean area of the allograft skin used was 26.9 (8∼70) %TBSA. The grafted allograft skins usually came away 3 weeks later. Four cases of initial take failure were occurred. All of these cases were pediatric patients using cadaver skin. Nine patients were dead from heart failure, severe inhalation, respiratory failure, pneumonia in old age, renal failure etc. There was no definite wound sepsis. Cultured Epithelial Autografts (CEAs) were used in fourteen cases. In twentyfive cases, acellular dermal substitute was simultaneously used. Conclusion: Early selective escharectomy, allograft skin coverage, acellular dermal substitutes and wide meshed autograft with CEA application would be immensely helpful techniques in patients with extensive burns.
중증 화상 환자의 CRRT 시행 시 임상양상과 적절한 적용기준
변광(Kwang Byun),송종훈(Jong Hoon Song),최규성(Gyu-seong Choi),김도헌(Do Hern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.1
Purpose: Acute renal failure is not a rare event in severe burns and the prognosis of a burn patient becomes remarkably unfavorable with the onset of renal insufficiency. Several studies have reported that the incidence of ARF in severe burns is 0.5∼30% and the mortality rate is 73∼90%. This study analyzed the clinical features of severe burns requiring continuous renal replacement therapy (CRRT) to determine the adequate indication for CRRT. Methods: Thirty-nine patients requiring CRRT out of 492 burned patients who were admitted to the burn intensive care unit in the Burn center, Hangang Sacred Heart Hospital from January 2003 to December 2004, were reviewed. CRRT was indicated when azotemia, fluid overload, acidosis, or hyperkalemia were observed. The APACHE Ⅱ score, BUN, creatinine, creatine kinase, bicarbonate and base excess were analyzed at admission and at the initiation of CRRT for the survival group and non-survival group. Results: The incidence of ARF requiring CRRT in severely burned patients was 7.9%. The average of burn area was 51.1%. The mean delay in initiating CRRT was 16.6 days and the mean duration of CRRT was 7.0 days. There was no difference between the survival group and the nonsurvival group in the data obtained upon admission, but there was a significant difference in the BUN level at the initiation CRRT. Therefore, the BUN level at the initiation CRRT has corelation with the mortality. Conclusion: CRRT is helpful for treating severely burned patients who have ARF, particularly those with accompanying with hemodynamic instability. This study showed that the BUN level at the initiation of CRRT associated with mortality. Therefore, the BUN level is an important criterion for initiating CRRT in these patients. However, a prospective randomized control study will be needed to accurately define BUN level.
조용석(Yong Suk Cho),임해준(Haejun Yim),김도헌(Dohern Kim),허준(Jun Hur),전욱(Wook Chun),김종현(Jong Hyun Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.6
Central diabetes insipidus (DI) is caused by failure of ADH release from the posterior pituitary gland. Common causes of central DI in critically ill patients include traumatic brain injury, anoxic encephalopathy, meningitis, primary or metastatic brain tumor and brain death. Inhalation burn injury with thermal injury can cause profound brain damage according to the degree of gas inhalation. This results in pituitary failure with diabetes insipidus (DI) and secondary adrenal insufficiency. We recently experienced 3 cases of central diabetes insipidus with inhalation burn injury, aggravated polyuria and abnormal serum or urine osmolarity. Severe burn injury is not easy to treat in and of itself, moreover, if central diabetes insipidus is combined it is difficult to manage appropriately. Therefore, if we suspected central diabetes insipidus, early aggressive control would lower mortality and morbidity. We report therapeutic experience in these cases with a review of the literature.
우시욱 ( Si Uk Woo ),최규성 ( Gyu Sung Choi ),김도헌 ( Do Hern Kim ),허준 ( Jun Hur ),전욱 ( Wook Chun ),이재정 ( Jae Jung Lee ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2
Background: During the past several decades, advances in burn treatment, including the improvement in fluid ressusitation, the evolvement of antibiotics, and the early excision of the wound, have increased the survival rate of burn patients. How ever sepsis and organ dysfunction are major causes of death after burn trauma. This study focused on finding the demography of burn mortality and the cause of death and on characterizing the time course of severe burn injury. Method: From January 1, 2002, to December 31, 2002, 543 patients were treated at the Burn Unit of General Surgery, Han Gang Sacred Heart Hospital after burn trauma. Among them, 112 patients expired. We reviewed their medical records and analyzed their demography, the cause of death, and the survival period, retrospectively. Results: Among the 112 patient, the cases of death are most common in the male patients aged 40 to 49. The most common cause of burn was flame (94.6%). They expired from sepsis (63.39%), pulmonary complication (13.39%), burn shock (13.39%) and acute renal failure (6.25%). Unill 72 hours after the burn injury, burn shock was the most common cause of death, between the 3rd day and the 7th day, pulmonary complications were the most common cause and after the 7th day, sepsis was. Conclusions: Even nowadays, many burn patients expire from burn shock and sepsis. Rapid transportation to a specialized burn center, judicious fluid ressusitation, wound care for wound healing, and prophylaxis of secondary infection can save more massive-burn victims.
흡입화상이 동반된 중증화상환자에서 사망률 예측의 조기 인자로서 혈중젖산과 염기부족에 대한 연구
조용석(Yong Suk Cho),양형태(Hyeong Tae Yang),임해준(Haejun Yim),김도헌(Dohern Kim),허준(Jun Hur),김종현(Jong Hyun Kim),전욱(Wook Chun) 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.2
Purpose: The aim of this study was to elucidate whether plasma lactate (PL) and base deficit (BD) are useful early parameters to predict the prognosis of burn patients with inhalation injury. In addition, one of the main objectives was to evaluate if PL and its change, BD and its change due to fluid resuscitation, adds additional information. Methods: A retrospective review was performed on 151 patients admitted to our burn intensive care unit who were suspected to have inhalation burn injury, and then were confirmed by fibreoptic bronchoscopy between 1 Jan 2008 and 31 Dec 2008. All patients received proper fluid and electrolyte resuscitation, pain management, nutritional support, wound care and surgical debridement of dead tissue by burn surgeon. Results: Initial PL, PL1 (24 hours later) and initial BD show statistical differences between survivors group and non-survivors group. A better chance of survival occurs when resuscitation results in normal PL values within 24 h. Moreover, an outcome predictor of shock and effective resuscitation could be defined by evaluating the changes of BD on Day 1. Normalization of the BD within 24 h is associated with a better chance of survival. Conclusion: Measuring PL, BD and their changes may help to identify burn patients either for adequacy of treatment, or selection of other therapeutic options. Therefore titration of burn resuscitation to normalize PL and BD levels may be a reasonable method to improve burn mortality.