태연혈(太淵穴)의 유침 시간에 따른 체온 변화 -적외선체열촬영(赤外線體熱撮影)을 중심으로-

이봉효 ( Bong Hyo Lee ),이경민 ( Kyung Min Lee ),박지하 ( Ji Ha Park ),김민서 ( Min Seo Kim ),김산들 ( San Deul Kim ),박병규 ( Byeong Gyu Park ),양현동 ( Hyun Dong Yang ),예성호 ( Sung Ho Yea ),이호정 ( Ho Jung Lee ),최재원 ( Jae 경락경혈학회 2012 Korean Journal of Acupuncture Vol.29 No.2

Objectives: This study was performed to find the desirable remaining time of needle in the acupuncture treatment. Methods: The 21 volunteers were given acupuncture at LU9 vertically and needles were remained for 2 min, 10 min, 15 min, 30 min, respectively. The thermographic change induced by acupuncture was measured with Digital Infrared Thermographic Image at the following acupoints: LU11, LU10, LU9, LU8, LU5, LU1, and PC7. The statistical significance of thermographi change was evaluated using paired t-test and post hoc Wilcoxon test. Results: The most significant changes after acupuncture were produced when needles were remained for 10 min or 15 min. LU11, LU5, LU1, and PC7 were the point at which all of the remaining time produced significant change commonly. At LU11, the biggest change was produced when needle was remained for 15 min, while at LU5, LU1, and PC7, the biggest change was produced when needle was remained for 30 min, and the smallest change was produced when needle was remained for 10 min at all of acupoints of LU11, LU5, LU1, and PC7. The unbalance between left side and right was decreased the most largely in 15 min group. Conclusions: The results of this study suggest that the desirable remaining time of acupuncture needle might be 15 min.

불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

철과 망간이 동시에 코팅된 반응성 매질을 이용한 용존 Fe(2) 제거

민상윤(Sang Yoon Min),장윤영(Yoon Young Chang),양재규(Jae Kyu Yang) 大韓環境工學會 2011 대한환경공학회지 Vol.33 No.2

본 연구에서는 산화망간과 산화철이 단독 및 복합 코팅된 반응성매질인 망간코팅사(MCS), 철코팅사(ICS) 그리고 철-망 간코팅사(IMCS)를 이용하여 용존 Fe(II)의 산화 및 제거능을 평가하였다. 반응성매질에 KMnO₄와 NaOCl를 추가적인 산화제로 이용하였을 때의 Fe(II) 제거능을 반응용액의 pH, 반응시간, Fe(II) 농도변화에 따라 조사하였다. 반응성매질 및 추가적인 산화제 없이 Fe(II) 용액만을 사용한 경우, pH 5 이하에서는 Fe(II)의 느린 산화에 의해 제거율이 낮았으나 이후에는 빠른 산화 및 침전반응에 의해 제거율이 증가하였다. ICS만을 사용하였을 때 ICS 표면에 의한 Fe(II)의 제거는 극히 제한적인 것으로 나타났다. 망간 산화물이 코팅된 IMCS와 MCS를 사용한 경우 낮은 pH에서도 Fe(II)가 산화망간에 의해 산화되었으며 용액으로부터 효과적으로 제거되는 것으로 나타났다. Fe(II)는 IMCS만 단독으로 사용했을 때와 NaOCl을 산화제로 사용했을 때 제거율에서 큰 차이가 나지 않았다. IMCS와 산화제를 이용하여 Fe(II)을 제거할 경우, 용액의 pH가 증가함에 따라 이들의 산화능이 증가하였고 이로써 전체 제거율의 증가를 가져왔다. Fe(II)의 제거에 관한 반응속도 실험결과 유사-1차 반응 보다는 유사-2차 반응 식으로 더 잘 표현되었으며 KMnO₄를 추가적인 산화제로 이용한 경우 Fe(II)는 14,286 mg/kg·hr의 높은 초기 제거율(h)을 보였다. KMnO₄ 주입 시 반응시간 10분 안에 제거평형에 도달하였고 NaOCl의 경우는 6시간 후에 거의 제거평형에 도달하는 것으로 나타났다. IMCS에 의한 Fe(II)의 최대 제거량 값을 구하기 위해 pH 4에서 Langmuir 등온식에 적용한 결과 1,088 mg/kg의 제거량을 보였다. Evaluation of the removal efficiencies of Fe(II) by reactive sand media coated with manganese (MCS), iron (ICS) and both of iron and manganese (IMCS) was investigated as functions of solution pH ranging from 2 to 9, reaction time and concentration of Fe(II) in a batch reactor using each reactive medium and additional oxidants such as KMnO₄ and NaOCl. When only Fe(II) was present in solution without any reactive medium, removal of Fe(II) was quite low below pH 5 due to a slow oxidation of Fe(II) and/or negligible precipitation but greatly increased above pH 5 due to a rapid oxidation of Fe(II) and subsequent precipitation of oxidized Fe species. ICS showed negligible efficiency on the removal of Fe(II) through adsorption. However, an efficient removal of Fe(II) was observed at low solution pH in the presence of IMCS or MCS through rapid oxidation and subsequent precipitation. Removal efficiency of Fe(II) by IMCS in the presence or absence of NaOCl was quite similar. Removal rate of Fe(II) by IMCS and additional oxidants gradually increased as the solution pH increased. From the kinetic experiments, removal pattern of Fe(II) was better described by pseudo-second-order equation than pseudo-first-order equation. A rapid removal of Fe(II) using IMCS in the presence of KMnO₄ was observed in the first 10 min. The initial removal rate of Fe(II) using KMnO₄ was 14,286 mg/kg·hr. In case of using NaOCl, the removal of Fe(II) occurred rapidly in the first 6 hrs and then reached the near-equilibrium state. Removal of Fe(II) on IMCS was well expressed by Langmuir isotherm and the maximum removal capacity of Fe(II) was calculated as 1,088 mg/kg.

제 2형 콜라겐에 의해 경구관용 유도된 DBA/1 mice에서의 세포면역반응

양형인 ( Hyung In Yang ),김완욱 ( Wan Uk Kim ),민도준 ( Do Jun Min ),박성환 ( Sung Hwan Park ),홍연식 ( Yeon Sik Hong ),이상헌 ( Sang Heon Lee ),조철수 ( Chul Soo Cho ),김호연 ( Ho Youn Kim ) 대한류마티스학회 2000 대한류마티스학회지 Vol.7 No.4

Objective: To investigate the dosage of bovine type II collagen (BnCII) for the induction of oral tolerance in CIA animals, and to verify the changes of immune response and TGF-β production of mesenteric lymph node cells in tolerized CIA animals. Methods: Oral tolerance was induced by feeding of variable doses (5㎍, 10㎍, 20㎍ and 40㎍) of BnCII to DBA/1 mice 4 times per week during 2 weeks, and control mice were given ovalbumin (1000㎍), before immunization. We examed clinical assessment; incidence of arthritis, severity of arthritis, arthritic limb by visual analysis. IgG antibodies to BnCII were measured by ELISA, T cell responses to BnCII and PHA were quantified by antigen (CII)-induced 3H-thymidine incorporation into lymphocytes of mesenteric lymph node, draining lymph node, and spleen. TGF-β in supernatants obtained from lymph node culture medium was measured by ELISA. Results: Arthritis limbs were observed in 100% of control at 5 weeks after subcutaneous BnCII injection. The incidences of CIA in all tolerized group were significantly lower than that in control 5 weeks after immunization (control 100% vs. 5㎍ feeding group: 50%, 10㎍ feeding group: 50%, 20㎍ feeding group: 50%, 40㎍ feeding group: 55.5%, P<0.01). In comparison to control, mean articular indices were lower in all tolerized groups (control 5.13: 5㎍ feeding group 3.50, 10㎍ feeding group 2.75, 20㎍ feeding group 2.87, 40㎍ feeding group 2.63, P<0.05). Arthritic limbs were also significantly lower in tolerized groups (control 58.3: 5㎍ feeding group 20.8, 10㎍ feeding group 16.7, 20㎍ feeding group 20.8, 40㎍ feeding group 20.8, P<0.05). The titers of IgG antibody to CII were lower in tolerized group than that in control [tolerized group; median 10 (min. 0, max. 48), control; median 33 (min. 8.6, max. 101), P<0.05]. The proliferative responses to BnCII were significantly suppressed in tolerized (control 8010±2319cpm, tolerized group 4500±2060cpm, P<0.01). High TGF-β production was noted in tolerized group (control; 28pg/ml, BnCII feeding group; 73pg/ml). Conclusion: Oral tolerance in DBA/1 mice was successfully induced from low doses of BnCII (5㎍) and suppressed T and B cell function in conjunction with increased TGF-β production may play an important role for the induction of CII induced oral tolerance in DBA/1 mice.

C -11 및 F - 18 표지 콜린의 합성과 체내동태에 관한 연구

전권수,유국현,김상욱,임상무,홍성운,서용섭,양승대,안순혁,허민구 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.3

Objectives: Recently, [methyl-(11)^C]-(β-Hydroxyethyl)trimethylammonium ([(11)^C]choline) has been discovered to be a very effective tracer in imaging various human tumors using positron emission tomography. Because of the short half-life of C-11, it is very difficult to use in a routine imaging procedure and needs a frequent synthesis of [(11)^]choline. This can be supplemented by the substitution of [(11)^Ccholine with [methyS-18]fluorocholine. Here, we would like to report cell uptake and biodistribution of [(11)^Ccholine and [(18)^F]fluorocholine as a basic study. Methods [(11)^C]Choline was prepared by the treatment of [(11)^C]CHzI with N,N-dimethylaminoethanol and [18F]fluorocholine was synthesized from reaction of CHzBr[18F]F with N,N-dimethylaminoethanol. The radiochemical purity was checked by high performance liquid chromatography (HPLC). The biodistribution of [(11)^C]choline and [(18)^F]fluorocholine was determined in balb/c mouse at 5 min, 20 min, 40 min and 80 min. The cell uptake wa measured using glioma (9L) and colon adeocarcinoma (SW620). Results: The radiochemical purity was more than 98% after purification. In the liver, uptake did not change over time the uptake was 20/ID/g for [C]choline and 13%ID/g for [(18)^F]fluorocholine. In the kidney, radioactivity decreased over tirne the uptake was 15%1D/g for [(11)^Ccholine and 20%ID/g for [(18)^F]fluorocholine, 80 min post-injection. The cell uptake of [(11)^Ccholine was 4.93% for glioma (9L) and 18.69F for colon adenocarcinoma (SW620). For [(18)^F]fluorocholine, 1.77% for glioma (9L) and 2.77% for colon adenocarcinoma (SW620). Conclusion: [(11)^CCholine and [(18)^F]fluorocholine showed a different cell uptake tendency, depending on cancer cell line. (Korean J Nucl Med 200135:185-191)

Simple Sequence Repeat Primer에 의한 딸기의 Genomic DNA 분석

양덕춘,최성민,김무성,민병훈 경희대학교 생명자원과학연구원 2002 硏究論文集 Vol.22 No.-

본 연구는 진핵세포에 널리 산재되어있는 repeat sequence를 primer로 사용하여 딸기의repeat sequence 좌위를 증폭시켜서 분석하고 이를 같은 종일지라도 지역간의 차이로 인한 환경의 변화 또는 재배방법의 차이에 의해서 일어나는 변이를 분석하는 방법에 활용할 수 있도록 하기 위하여 수행하였다. GGC repeat sequence의 딸기 genomic DNA에 존재여부를 판명하기 위하여 (GGC)_(6) probe를 DIG을 사용하여 labeling하여 딸기 genomic DNA에 hybridization한 결과 확실한 spot이 나타났다. 또한 repeat sequence로 이루어진 UBC SSR primer 100개중에서 4가지 서로 다른 primer에서 선명한 band를 확인할 수 있어서 딸기의 genomic DNA내에 여러 종류의 repeat sequence가 있는 것으로 판단되었다. 따라서 각 품종별 표지로서 이용성을 알아보고자 PCR을 수행하였는 바 (ACC)_(6)와 (CCG)_(6)의 primer에서는 다른 band에 비해 매우 확실한 밴드를 형성하였다 이러한 PCR product의 염기서열분석을 위해 우선 대량증식을 위한 PCR의 적정 조건은 primer 10p㏖, DNA 50ng으로서 수행하는 것이 DNA의 증폭에 좋았다. 증폭된 1 Kb DNA 절편을 이용하여 염기서열을 조사하였던 바, 808bp의 서열을 알아냈고 그 반복염기서열은 효모와 사람에 존재하는 유전자이었으며 Cdontella sinensis와의 유의성 검정결과 ACC 반복염기에 62% 동일성을 나타내었다. This study was carried out to investigate genetic variation caused by environmental change or cultural method difference, which was performed by amplifying repeat sequence loci of strawberry widely dispersed in eukaryotic cell. DIG labeled(GGC)_(6), probe was used to test if GGC repeat sequence exists in strawberry genomic DNA, resulting in clear spot on the filter. Among the 100 UBC SSR primers which contain repeat sequence, four different primers amplified clear DNA fragments, suggesting that the repeat sequence exist in the genome of strawberry. PCR was also performed to test whether these primers could be used for a marker among strawberry cultivars. (ACC)_(6), (No. 861) and (CCG)_(6) (No. 865) primers showed very clear bands compared to the other primers. The amplified 808 bp of 1 kb DNA was sequenced, and database search using the sequence information showed that the repeat sequence was the gene existed both in yeast and human, and a significant sequence homology to Odontella sinensis was found.

품질 경영 시스템 구축을 위한 FMEA 모듈

양성민,김승완 경성대학교 공학기술연구소 2001 공학기술연구지 Vol.8 No.-

This study is concerned with the Failure Mode Effect Analysis(FMEA) for small and medium industries. The purpose of this study is to develop a FMEA module to apply to other quality management systems. It includes a fail mode data base, a design FMEA sub-module, a process FMEA sub-module, a Risk Priority Number(RPN) evaluation sub-module, and a FMEA chart. Appling this module, it is expected higher productivity and reliability in the manufacturing industry.

구급일지를 통한 병원 전 환잔 분류 및 처치의 적절성 평가 연구

민순식,김재광,이근,박철완,양혁준,류일,현성열,이훈규,정환모,김윤 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. Methods: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician,s log and newly devised protocols recorded by paramedics or nurses. Results: 1) Male to female ratio was 1: 0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6±1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients.4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment. performance of treatment, and adequate treatment were as follows: oxygen supply.38.1/41.6/93.8 ; wound dressing. 19.3/71.8/92.9 ; immobilization of the cervical spine, 15.8/56.3/92.9 ; application of a spinal board. 12.9/42.3/72.7 ; application of a splint, 9.9/50.0/60.0 ; manual maintenance of an airway. 9.9/55.0/63.6 ; and CPR, 4.5/66.7/0. 5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG. intubation, medical administration. defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3% ; endotracheal intubation, 8.9% ; medical administration, 8.9% ; defibrillation. 3.5%; and pacing. 1.5% Conclusion: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.