소아 흉통의 원인질환에 따른 임상양상

장국찬,김은영,노영일,양은석,문경래,박영봉 朝鮮大學校 附設 醫學硏究所 2008 The Medical Journal of Chosun University Vol.33 No.2

목적: 소아에서의 흉통은 흔히 접하게 되며 일반적으로 좋은 경과를 보인다. 가장 흔한 원인으로 특발성, 골격계이상, 위장관계 질환 등이 다양하게 언급되고 있으며 감별진단이 쉽지 않아 여러 검사를 시행하게 된다. 자세한 병력청취와 진찰이 진단에 가장 중요하다고 하지만 통계적 의의를 보고한 바는 드물다. 이에 흉통 원인을 분류하고 각각의 임상양상을 파악하여, 병력 청취와 진찰소견의 감별진단에 대한 유용성과 시행 검사들의 의의를 알아보고자 하였다. 방법: 2004년 3월 부터 2007년 8월 까지 조선대학교 병원 소아청소년과에 흉통을 주소로 방문한 환아 77명을 대상으로 하였다. 연령, 성별, 흉통의 위치, 지속시간, 양상, 빈도, 방문까지 걸린 시간, 동반증상, 유발인자의 각 항목과 원인 질환과의 관련성을 분석하였다. 흉부방사선, 심전도, 심초음파, 24시간 Holter, 운동부하 심전도, 상부 위장관 조영술, 24시간 pH 검사, 위내시경, 심근효소를 검사 하였다. 결과: 평균 나이는 10.2±2.8세로 6세에서 11세까지가 48명(62.3%)으로 가장 많은 분포를 보였고 남아 42명(54.5%), 여아 35명(45.5%)이었다. 흉통의 위치는 좌측이 32명(41.6%), 양상은 콕콕 찌르는 것이 27명(35.1%)으로 가장 많았고 지속시간은 1분미만이 36명(46.8%), 1-5분 사이가 28명(36.4%)으로 대부분 5분 미만이었다. 흉통 원인은 특발성이 27례(35.1%)로 가장 많았고, 위장관 질환 23례(29.9%), 늑골 연골염 12례(15.6%), 심혈관 질환 7례(9.1%), 정신신체화 질환 6례(7.8%), 폐질환 2례(2.6%)였다. 여아에서 연령이 높을수록 정신신체화 질환의 빈도가 높았다(P= 0.046). 흉골 하부 통증을 호소한 17명 중 13명(76.5%)이 위장관 질환으로 통계적으로 유의하였다(P= 0.023). 정신 신체화 질환은 6명에서, 위장관 질환도 20명(86.9%)에서 흉통지속시간이 5분 미만이었으나 통계적 의의는 없었다. 흉통 양상 중 타는 듯한 양상을 호소한 7명중 6명에서 위장관 질환이 원인이었으나 통계적 의의는 없었다. 선택 시행 검사 중 심초음파는 32명중 3례(9.4%), 24시간 Holter 검사는 13명중 5례(35.7%), 24시간 pH 검사는 28명 중 16례(57.1%)에서 이상소견을 보였다. 결론: 소아 흉통 환자 중 연령이 높은 여아에서는 정신 신체화 장애를, 흉골 하부 통증을 호소한 경우는 위장관 질환을 먼저 생각하는 것이 좋다고 판단된다. 흉통원인으로 위장관 질환의 빈도가 높고 시행검사들의 진단율을 볼때, 소아 흉통 환아 에서는 상부 위장관 조영술 등 위장관 질환의 검사를 기본적으로 시행하는 것이 좋을 것으로 생각된다. Purpose: Chest pain in children is usually benign. Chest pain in children results from a wide variety of causes. Differential diagnosis of causes is not easy and then many diagnostic approach is trying. Careful history and physical exams must guide the assessment of children with chest pain. The purpose of this study intends to evaluate children with chest pain and usefulness of careful history, physical examination and several diagnostic examinations. Methods: From March 2004 to August 2007, 77 patients presented with chest pain were enrolled. we evaluated age, sex, characteristics of chest pain (location, duration, description, frequency), accompanying symptoms, increasing reasons and relationship with cause of chest pain. Chest x-ray and ECG were checked in all patients. Cardiologic and gastrointestinal evaluations were checked when considered necessary. Results: The male and female ratio was 0.55:0.45, mean age 10.2 ± 2.8 year. Common ages of chest pain were 10 to 12 years old (38case, 49.3%). The location was on the left precordium in 32cases (41.6%) of the patients. The most common diagnostic findings of chest pain were idiopathic(27cases, 35.1%), gastrointestinal disorder (23cases, 29.9%), costo chondritis (12cases, 15.6%), cardiovascular disorder (7cases, 9.1%), psychosomatic disorder(6cases, 7.8%) and pulmonary disorder (2cases, 2.6%). Older children in female were more likely to have a psychosomatic cause (P= 0.046). The patients complained chest pain on substernal area were 17cases and 13cases (76.5%) were diagnosed as gastrointestinal disorder (P= 0.023). Positive findings of echocardio graphy, 24hr Holter ECG and 24hr pH monitoring were present in 3 (9.4%), 5 (35.7%) and 16 (57.1%) of the patients respectively. Conclusion: Gastrointestinal disorders are common causes and positive diagnostic rate of gastrointestinal evaluation is relatively high in children with chest pain. Old girls are more likely to have a psychosomatic disorder and substernal pain is the reliable sign to be considered as a gastrointestinal disease in children with chest pain. Hence, Diagnostic approach of gastrointestinal disease such as upper GI should be performed basically in mostly children with chest pain.

2급 응급구조사의 성인외상환자에 대한 처치의 적절성 평가

장문수,어은경,김상현,김창섭,송근정,박한규,유지영,최동섭 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

In Korea, EMT have two classified subgroup of first and second degree : EMT-P, and EMT. For the beginning, authorization of the first EMT was made in this year through the EMT educational program. There are 8 items which EMT can perform the treatment without the supervision by a physician. But there was no previous report of pertinent assesment of treatment performed by the EMT. There upon authors have conducted review of assessment done by the EMT in EC setting, and proposed the following treatment application can be used by EMT at the field of accident. The study materials include adult trauma patient older than 15 years, and sustained trauma within 48 hours before visiting Ewha University DongDaeMoon Hospital Emergency Deparment. The duration of study was from Apr. 1 1995 to Aug. 31 1995. the study was conducted by 5 certified EMT. The EMT's performance was evaluated by the attending Emergency Medicine physician. The result were as followings ; 1. Among the total 5532 ED visiting patients during the study period, 1267 were adult trauma patients who recieved treatment within 48 hours of injury. 2. Among 1222 out of 1267 patients have completed performed survey. 3. Male to female ratio was 2.6 : 1, age distribution was from 15 to 87 years old and mean age was 34.6 years old. 4. The MOI showed : MVA (33.1%), blunt trauma (29.9%), slip down (16.8%), penetrating injury(15.4%), and miscellaneous (5.7 %), burn (3.1%), falling down injury(2.9 %), bite injury(1.1%) in order. 5. There were 437 cases of survey completed by the EMT. For assessment of mental status of 3 different method : AVPU, 5 scale mental status and GCS, were correlated with EM physician with 99.1%, 98.6%, 97.7 %, respectively. 6. For 320 out of 437 cases of survey completed, 319 patients recieved treatment by the EMT within 30 minute and 1 patient between 30 to 60 minute of an ED arrival. 7. For those 437 cases of survey completed, 266 patient (60.9%) had adequate treatment and 54 patients (12.4%) had inadequate treatment. 67 patient (15.3%) did not received treatment but it was adequate inway, and 50 patients (11.9%) did not received treatment even though patient required treatment. In cases of adult trauma patients, EMT's mental status assessment was correlated with EM physician's assessment. But treatment done by EMT without the supervision of EM physician was adequate only in 76.2 %. Therefore, continuous education and assessment of treatment performed by EMT in needed to improve field treatment by EMT future.

항암요법을 받은 폐암환자의 삶의 질

장군자,박점희,류은경,김현미 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 항암요법을 받은 폐암환자의 삶의 질 정도를 파악하여 효과적인 암환자 간호를 하기 위한 기초자료를 제공하기 위해 본 연구를 시도하였다. 대상 및 방법 : 1995년 10월 1일부터 1996년 3월 31일까지 대구시내 소재 1개 대학교 병원에 입원하여 폐암을 진단받은 후 항암요법을 받은 환자 97명을 대상으로 하여 구조화된 질문지를 이용하여 자료를 수집하였으며, 자료의 분석은 SAS program을 이용하여 실수, 백분율, 최소값, 최대값, 평균, 표준편차, t-test 및 ANOVA, 단계적 중회귀분석을 하였고, 도구의 신뢰도는 Cronbach's α값을 구하였다. 결과 : 항암요법을 받은 폐암환자의 삶의 질 평균은 4.67이었고, 영역별로는 신체적 영역 3.90, 정신적 영역 4.23, 사회경제적 영역 5.65였다. 인구학적 특성에 따른 삶의 질은 연령과 교육수준에서, 질환특성에 따른 삶의 질은 신체적 활동정도에서 유의한 차이가 있었고, 항암제 종류와 항암치료횟수에 따른 삶의 질은 유의한 차이가 없었다. 결론 : 항암요법을 받은 폐암환자의 삶의 질 정도는 4.67로 다른 암진단을 받은 환자들에 비해 낮은 편으로 폐암에 대한 간호학적인 지식의 축적과 효과적인 간호중재에 대한 계속적인 연구, 항암요법이 폐암환자의 삶의 질에 미치는 영향에 대해서 더 많은 연구가 필요하다고 생각된다. This study was designed to investigate the quality of life in lung cancer patients with chemotherapy. Ninety seven patients with chemotherapy were sampled from one university hospital located in Taegu. The data were analyzed by percentage, mean, t-test. ANOVA. and stepwise multiple regression analysis, using the SAS program. The results were as follows; The mean score of quality of life was 4.67/10. The mean score of psychological dimension was 4.23/10. The mean score of socio-economic dimension was 5.65/10. The general characteristics related to quality of life were age. education level. A cancer characteristics related to quality of life was performance state. There was no statistically significant difference between chemoagents, chemotherapy frequency and quality of life.

防風類의 比較檢討

김미경,김미정,김은영,류건영,이은미,장원희,황선희 曉星女子大學校 藥學大學 學生會 1988 曉星藥誌 Vol.4 No.-

간호중재분류체계(NIC)를 이용한 중환자실 간호중재 분석

권경남,장희정,황운순,김은주,이미경 영남이공대학 산업기술연구소 2000 産業技術硏究 Vol.12 No.-

The purpose of this research was to identify nursing interventions performed by the ICU nurses from 2 university hospital in Taegu. For this research, I used the Nursing Intervention questionnaire developed by the Iowa Intervention Project and translated by korean specialists and professor concerned to the same field. In order to obtain the data, a special group of professor, head nurse, charge nurse, researcher was instituted. The special group work validataed 205 nursing interventions with agreement of more than 50% becuse the NIC(433 nursing intervention) survey process was too time-consuming and not appropriate for all labels. The data were collected from June 1 to 30, 1999 and analysed with SAS program. The obtained results are as follows; (1) 94 interventions were performed at least daily. (2) The most frequently used nursing interventions were Parenteral Medication Administration, Aspiration Precautions, Pressure Ulcer Prevents, Positioning, Airway Management, Cough Enhancement in rank. In conclusion, this research using NIC has helped to figure out the component to the ICU care in korea. The use of this results will contribute to enhance quality assessment and improve standard of ICU nursing.

대동맥 판막 치환술 후 반복되는 Acinetobacter baumannii 균혈증의 원인이 된 대동맥염 1예

정용필,김성철,송은희,장은영,김은경,김윤지,성흥섭,김미나,최상호,우준희,김양수 대한감염학회 2007 감염과 화학요법 Vol.39 No.3

감염성 대동맥염은 흔하지 않지만 매우 위중한 질병으로 Salmonella so.와 S. aureus가 주된 원인균이다. 아직까지 병원내 감염의 주요 원인균인 Acinetobacter baumannii에 의한 감염성 대동맥염은 보고된 바가 없었다. 저자들은 대동맥 판막 치환술을 시행받은 76세 남자 환자에서 적절한 항생제 투여에도 반복되는 A. baumannii 균혈증의 원인이 감염성 대동맥염으로 진단되었던 1예를 경험하였기에 보고하는 바이다. Infectious aortitis is an uncommon yet, life threatening disease. Early surgical treatment and prolonged antibiotic therapy is crucial to survival. Salmonella sp. and Staphylococcus aureus are the most common organisms isolated. There is no case report of infectious aortitis caused by Acinetobacter baumannii, which has recently emerged as a major cause of health care-associated infections. Here, we describe a 76-year-old male with infectious aortitis who experienced recurrent bacteremia due to A. baumannii in spite of adequate antimicrobial therapy after aortic valve replacement.

임상실습 교육개선을 위한 간호학생의 간호활동시간 분석

이애경,김정애,주미경,정안순,장은정,김정수,강정희,이정애 경복대학 2001 京福論叢 Vol.5 No.-

신규간호사의 능력은 간호학생 때의 다양한 임상경험에 기초를 둔다. 따라서, 간호대학의 교수, 병원 지도자, 임상지도자는 간호학생들이 다양한 지식을 획득하고 간호기술을 경험할 수 있도록 도와주는 중요한 역할을 한다. 이 연구의 목적은 이러한 간호학생들의 임상실습에서 수행하는 간호활동과 간호활동 시간을 분석하고자 하는데 있다. 연구결과 간호학생 1인당 직접간호활동 시간은 185.5분(직접간호비율은 56.7%)으로 141.65분(간접간호 비율은 43.3%)인 간접간호활동 시간보다 많았다. 직접간호활동 시간 중 활력징후 측정이 51.9분으로 가장 많은 시간을 차지하였고, 간접간호활동 시간 중에는 차트보기가 22.98분으로 가장 많은 시간을 차지하였다. 전반적으로 기본적인 임상간호 수행기술에 소요되는 시간이 고도의 숙련된 간호기술을 수행하는데 드는 시간보다 많은 것으로 나타났다. 따라서, 본 연구결과를 토대로 간호대학의 지도자와 병원의 지도자 및 임상지도자가 함께 임상실습 교육과정의 지침서와 평가서를 평가할 필요가 있다고 제언하는 바이다. The competence of newly graduated nurses is based on various clinical experiences gained when they were students. Therefore, professors in nursing schools, directors in hospitals or preceptors must play a critical role in assisting them to obtain various knowledge and experienced nursing skills. The purpose of this study is to investigate nursing care activities and nursing care hours practiced by nursing students in clinical experience. The results of this study showed that the direct nursing care hours per each nursing student are 185.5 mins(direct nursing care rate 56.7%) and it is higher than indirect nursing care hours, 141.65 mins(indirect nursing care rate 43.3%). The hours of checking vital signs are the longest(51.9mins) among the direct nursing care activities, and the hours of reviewing chart are the longest(22.98mins) among the indirect nursing care activities. In general, the time of performing basic clinical nursing technique was higher than that of performing high skilled nursing technique. And nursing observation was higher than that of directly performing task. So, we suggest based on the results of this study as follows. It is needed for nursing instructors in nursing schools and hospitals together to evaluate the guidelines and check-list of clinical practice courses.

17β-Estradiol의 심근 보호작용에 대한 연구 ; 재관류 부정맥을 유발한 동물실험

홍정석,김원,조규종,이미우,장성은,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Although reperfusion certainly prevents tissue ischemia from possible cardiac death, several lines of evidence suggest that reperfusion may paradoxically aggravate the frequency of serious reperfusion-induced lethal arrhythmias. It has been reported that acute administration of estrogen at physiological concentrations reduced with myocardial ischemic injury in women with coronary heart disease. In studies with canines, acute administration by either the intra-muscular or the intra-coronary route similarly prevented ischemia and reperfusion dysrhythmias and also reduced the infarct size because the estrogen increased the distal coronary perfusion pressure, scavenged free radicals and had other effects during both ischemia and reperfusion. However, the canine heart is notoriously well collateralized. 17β-estradiol induces very little vasorelaxation in cat coronary rings, suggesting that increased ischemic myocardial blood flow dose not contribute to the protective effect. In the present study, employing a cat model of regional cardiac ischemia, we examined whether reperfusion rendered after acute administration of 17β-estradiol could lower the incidence of reperfusion-induced lethal arrhythmia and the death rate. Method: Adult mongrel male cats(n=31, 2.7∼4.5 kg) were anesthetized under positive-pressure artificial ventilation with room air. Electrocardiograms were recorded. The animals of the control group(n=15) were subjected to 20-minute left anterior descending coronary artery(LAD) occlusion followed by abrupt reperfusion. The animals in the experimental 17β-estradiol(2 or 20 ㎍/kg) group were subjected to ischemia/reperfusion insult following drug treatment: 17 β -estradiol was applied intravenously within the 60 seconds just before LAD ligation followed by abrupt reperfusion. The Fisher's exact test was used to compare the data from different animal groups(p<0.05). Results: The number of arrhythmias(ventricular premature beat, ventricular tachycardia and ventricular fibrillation) emerging during the reperfusion phase were not statistically different from that in the control group. The death rate in the 17β-estradiol 20㎍/kg group was lower from that in the control group(P value = 0.039). Conclusion: Acute administration of 17β -estradiol at a supraphysiological concentration might produce cardioprotective effects, not by modificating the coronary blood flow into the threatened myocardial region, but by other mechanisms that directly or indirectly increase the intrinsic myocardial ischemic tolerance in the cat during the reperfusion phase.

전문대학 간호과 통합교과과정 개발에 관한 연구

김영희,김정수,김정애,방숙명,배경진,이애경,장은정,정안순,주미경,최나영 경복대학 1998 京福論叢 Vol.2 No.-

교과과정의 조직은 체계적이고 뜻이 있는 순서로 학생들을 가르치기 위해 지식을 어떻게 조직화할 것인지와, 과목들 사이에서 공통된 내용은 통합시켜 중첩되는 일이 없도록 조정할 필요가 있다. 이에 현재 본 대학 간호과에서 운영되었던 97학년도의 17개 전공과목들의 교과과정의 내용을 비교, 분석하여 중복을 줄이며 순차적 지식의 습득을 도모하는 새로운 통합교과과정의 틀을 개발, 제시함으로써 보다 나은 전문직 간호교육이 이루어지도록 하고자 하였다. Most curricula are considered how to teach the student in systematic and meaningful orders. And it is necessary to coordinate the duplicate contents in major subjects in nursing. So this study was designed to set up a new comprehensive curriculum through comparing and ananlyzing each seventeen major subjects in Nursing Department of Kyung-Bok College. Therefore, the purpose of this study is to present the new comprehensive curricula for promoting the efficiency and effectiveness in diploma degree course of nursing education.

특발성 자발성 신장 파열 1예

윤재철,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Primary aldosteronism is a syndrome characterized by hypertension, hypokalemia, suppressed plasma renin activity, and elevated serum aldosterone levels. Conn first described it 1955 in association with adrenal cortical adenoma(Conn's syndrome). Today, it can be divided into at least six distinctive sub-groups. The diagnosis of primary aldosteronism is usually suspected when the patient presents with poorly controlled hypertension with hypokalemia. The main issues in the evaluation of primary aldosteronism are to differentiate an adenoma from hyperplasia and to localize the adenoma. Basic hormonal studies and computed tomographic(CT) scanning can be used effectively for that differentiation. An adenoma is one of a few potentially curable forms of hypertension, and it is best treated by removing the adrenal tumor. We experienced a case of a typical adrenal adenoma. The patient was a 37-year-old male who had experienced in both his legs over a period of several days a weakness due to hypokalemia. He was diagnosed using basic hormonal studies and adrenal CT scanning. After, he received laparoscopic adrenalectomy and was discharged with improved condition.