일부 지역 초등학생의 정서 ․ 행동문제와 적응유연성

조삼순(Cho Sam Soon),홍미순(Hong Mi Soon) 전남대학교 간호과학연구소 2013 Nursing and Health Issues(NHI) Vol.18 No.1

Ⅰ. 서 론 Ⅱ. 연구방법 Ⅲ. 연구 결과 Ⅳ. 논 의 Ⅴ. 결론 및 제언

증례보고 : 척추마취하 치핵 절제술 종료 직후에 발생한 스트레스성 심근병의증

최락민 ( Rak Min Choi ),윤진선 ( Jin Sun Yoon ),노재훈 ( Jae Hoon Noh ),강경오 ( Kyoung Oh Kang ),김민석 ( Min Suk Kim ),조삼순 ( Sam Soon Cho ),전희정 ( Hee Jung Jun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

A 48-year-old healthy woman was admitted in our hospital for elective hemorrhoidectomy. She developed sudden headache and chest pain, and showed sinus bradycardia, arrhythmia and hypotension forty minutes after spinal anesthesia with 0.5% hyperbaric bupivacaine. An EKG showed ST depression and an transthoracic echocardiogram performed in PACU demonstrated mild LV dysfunction with hypokinesia of LV inferolateral wall. An coronary angiography on postoperative day 1 revealed normal coronary vessel and akinesia of LV inferior wall. Levels of CK-MB and Troponin I were mildly elevated. With medical therapy, the patient`s symptoms improved and recovered without any complication. (Korean J Anesthesiol 2009;56:470~3)

당뇨병 환자의 자율신경기능 이상은 관상동맥 우회술시 혈역학적 변화에 영향을 주는가 ?

최인철,전희정,심지연,조삼순,권은하 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.3

Background : In this study, we examined diabetic patients scheduled for elective coronary artery bypass surgery to determine whether there is an association between autonomic dysfunction and intraoperative hemodynamic instability, and if perioperative autonomic function tests are effective predictors for diabetic patients at greatest risk for hemodynamic events during the intraoperative period. Methods : We examined 52 patients, 25 without diabetes (nonDM group) and 27 with diabetes (DM group). Preoperative autonomic function tests included are the valslava maneuver (valsalva ratio, valsalva index, strain response), change in heart rate with deep breathing 0/E ratio), change in heart rate (30: 15 ratio, stress response) and diastolic blood pressure (L-S(d)) while standing. Anesthesia was established with midazolam, fentanyl, isoflurane and vecuronium. Several hemodynamic variables such as heart rate (HR), mean arerial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), systemic vascular resistance index (SVRI), pulmo- nary vascular resistance index (PVRI), cardiac output (CO), and cardiac index (C0 were obtained at the following times: before induction; after induction; after intubation; after skin incision and after sternotomy. Results: The DM group had a significantly diminished response compared with the nonDM group in the valsalva ratio, valsalva index, 30: 15 ratio, and L-S(d). The remaining tests (I/E ratio, strain response, stress response) showed similar but nonsignificant diminished trend response in the DM group. Most patients had one or more abnormal test results in this group (76%), whereas in the control group most patients did not show any abnormal test results (74.1%). The comparison of hemodynamic response between the DM group and non-DM group reveal a significant difference between times within each group but not between groups. Conclusions: This study indicates that increased hemodynamic instability during the intraoperative period is not an obligatory association with diabetes and autonomic dysfunction and is not detected by preoperative autonomic function tests in patients with coronary artery disease and diabetes mellitus when anesthesia is induced and maintained with a large dose of opiod and anesthetic agent which has minimal hemodynamic effects, (Korean J Anesthesiol 2000; 38:440~449)

포도당 용액이 쥐의 적출된 좌골신경전도에 미치는 영향

박재홍,최윤,전희정,이청,조삼순 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.5

Background: When performing spinal anesthesia, glucose is frequently added to control the extent of the anesthesia by increasing the specific gravity of the local anesthetic solution. It is not clearly known whether the added glucose directly affects the nerve blockade or not. The purpose of this study is to examine the effect of glucase solution on isolated nerve fibers in vitro. Methods : Compound actioa potentials (CAPs) of A-fiber range were recorded from isolated nerves of adult Sprague-Dawley rats (300 ― 400 gm), Tonic (0.5 Hz) and phasic (30 Hz) supramaximal stimuli were repeatedly applied to one end of the nerves and the recordings were made on the other end. Nerves were perfused with modified Krebs solution for 45 minutes initially to get baseline data and then perfused with test solutions containing different concentrations of glucose (2.5%, 5%, 7.5%) for 30 minutes. The same experiments were repeated with mannitol at the same osmolality as the glucose. Results : Glucose produced a decrease in he amplitude of CAPs in a dose-dependent manner (79.2 ± 3.4, 50.3 ± 3.7, 34.6 ± 4.0 for 2.5%, 59o, 7.5% glucose solutions, respectively). At each of the same concentration levels, the degree of nerve conduction blockade did not have any significant difference within the glucose groups and mannitol groups. Conclusions: Glucose, in clinically employed concentration range, directly depressed peripheral nerve conduction in vitro, probably via osmotic effect. (Korean J Anesthesiol 2000; 3S: 871~876)

고양이에서 출혈성 쇽 유발후 투여한 THAM 과 Sodium Bicarbonate 가 소화관 점막 산소환에 미치는 영향

최인철,박평환,최수주,서병태,김종욱,조삼순 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.4

Background: In hypovolemic shock, multiple organ failure is caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. Therefore, much attention has been paid to the gut mucosa oxygenation in shock resuscitation. The current guidelines on cardiopulmonary resuscitation restrain the use of sodium bicarbonate due to paradoxical intracellular acidosis. Because THAM, CO₂ - consuming agent, does not produce CO₂ and induce intracellular acidosis, THAM has been known as a effective buffering agent. This study was purposed to investigate the effect of THAM and sodium bicarbonate on the gut mucosa oxygenation in cats which were in hemorrhagic shock and resuscitation. Methods: 18 anesthetized cats were subjected to hemorrhage to decrease the mean arterial blood pressure to 35-45 mmHg and this blood pressure was maintained for 120 minutes. After 90minutes, we infused 1.945% hypertonic saline, 2.8% sodium bicarbonate and 0.3M THAM as same volume and osmolality. Mean arterial pressure(MAP), mesenteric arterial-venous pH differences[pH(a-v)], mesenteric venous oxygen tension(PvO₂), mesenteric arterial-venous carbon dioxide tension differences[P(v-a)CO₂], mesenteric arterial-venous lactate differences[Lactate(v-a)] were measured 1, 5, 15, 30 minutes after drug infusion and 30, 60 minutes after reperfusion. Results: There were no statistical significances in MAP, pH(a-v), PvO₂, Lactate(v-a) among the three groups. There were significant differences in P(v-a)CO₂ and ETCO₂ between sodium bicarbonate group and THAM group. Conclusions: This study suggest that THAM and sodium bicarbonate do not have significant effects on the tissue oxygenation and hemodynamic improvement in hypovolemic shock. We suppose that THAM does not produce carbon dioxide but may correct intracellular acidosis.

고양이에서 저산소혈증후 대기 혹은 100 % 산소소생시 뇌에너지 대사의 변화:생체내 31P 자기공명분광법을 이용한 연구

이정희,이대근,박평환,최수주,임태환,김종욱,조삼순 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

Background: This study was purposed to study the effect of reoxygenation with room air as compared to FiO₂ 1.0 in a feline model subjected to hypoxemia followed by reoxygenation. Changes in the brain energy metabolism were investigated by P magnetic resonance spectroscopy(P MRS). Methods: Twelve cats were employed for this study and divided into two groups(6 cats each). Both groups were subjected to hypoxemia for 1 hr with FiO₂ 0.07 followed by reoxygenation for 2hrs. For group I, the reoxygenation was done by FiO₂ 1.0 and for group 2, by room air. Brain intracellular pH and the ratio of Pcr/Pi(phosphocreatine/inorganic phosphate) were calculated from the spectra acquired every 15 mimutes of the hypoxemia and reoxygenation periods. Results: The intracellular pH of the baseline were 7.07±0.01 and 7.04±0.01 for group 1 and group 2, respectively, and dropped to 6.89±0.04 and 6.83±0.06 during hypoxemia. For both groups, the intracellular pH returned to baseline values after 30 minutes of reoxygenation. The of Pcr/Pi of the baseline were 2.41±0.21 and 2.47±0.15, for group 1 and group 2, and dropped to 0.77±0.10 and 0.70±0.11, respectively, during hypoxemia and recovered to the baseline values after 30 minutes of reoxygenation for both groups. For both pH and the ratios of Pcr/Pi, the differences between the groups were statistically insignificant. Conclusion: From this study, we can conclude that reoxygenation by room air is as effective as FiO₂ 1.0 in the feline model of hypoxemia investigated by P MRS.