대전·충남지역의 생활폐기물 발생량의 실태 및 관리방안

김환덕,이상민 목원대학교 1999 통계학술논집 Vol.14 No.-

상복부 개복술 환자의 체온 변화에 관한 연구

김환덕,우수영,이병준,허철회,김문철,조강희 인제대학교 1999 仁濟醫學 Vol.20 No.1S

수술과 마취중 환자의 체온변화는 정도의 차이는 있으나 체온의 하강을 초래하는 것이 대부분이나 경우에 따라서는 체온상승으로 나타나기도 한다. 마취와 수술과정은 정상적인 환자의 항상성 온도조절기능을 변화시키고 커다란 온도적 스트레스를 환자에게 주게 된다. 수술 환자의 열 손실은 대류, 복사, 전도 등으로 일어날 수 있는데 특히 상복부수술시와 같이 체강의 개방으로 인한 체온의 손실이 심하다. 본 저자들은 상복부 개복술을 시행하는 위암 수술을 받는 환자를 대상으로 가열과 가습하지 않은 흡입가스를 사용한 마취와 수술 동안 식도체온계를 사용하여 시간에 따른 환자의 식도심부체온의 변화를 관찰한 결과 체온은 시간이 경과함에 따라 하강하기 시작하여 최저 평균 체온 35.3℃까지 0.9℃ 하강하였고 최저체온까지 평균 119분이 걸렸고 체온하강의 범위는 0.2∼2.8℃로 차이가 심하였다. 따라서 모든 환자가 시간이 경과하면서 체온이 수술과 마취중에는 떨어지며 저체온증을 나타낼수 있으므로 가능한 한 모든 방법을 사용하여 체온을 유지하도록 노력하여야 환자의 빠른 회복을 기대할 수 있을 것이다. It is well known that the body temperature changes during the operation and anesthesia and tend mostly to drop. During the operation, general anesthesia and surgery effect to several factors of the home ostatic thermoregulation that control the body temperature. To understand the body temperature change in the general anesthesia and operation, which exposure the abdominal cavity, authors followed up the esophageal core temperature of the patient. The esophageal core temperatures were measured in 50 patients undergoing total or subtotal gastrectomy for stomach cancer in Seoul Paik Hospital in 10 minutes interval. The esophageal core temperatures were dropped to the range of 35.3 ±0.9℃ (mean±SD), which took 119±47 minutes(mean±SD). There were individual varieties of temperature change(0.2∼2.8℃ ) and elapsed time(30∼190minutes) among patients. It is important for the anesthesiologist to preserve the body temperature during perioperative period of the patient, especially in prolonged operations and surgeries which opens body cavities like the abdominal cavity.

요실금 환자에서 자가지방삽입술 후 발생한 지방폐색전증 1예

이승홍,김경태,김환덕,허철회,김문철,조강희 인제대학교 1998 仁濟醫學 Vol.19 No.1

폐색전증은 그원인이 다양하고 진단이 어려워 치명적인 결과를 초래하는 질환으로 저자들은 요실금환자에서 시행되고 있는 자가지방 삽입술 도중 그 예가 많지 않은 지방폐색전증을 경험하였기에 문헌고찰과 함께 보고한다. Pulmonary fat embolism is a common and lethal complication in patients with fractures of the long bones or pelvis and with during hip arthroplasty. But we experienced a rare case of pulmonary fat embolism during autologous fat injection operation for stress urinary incontinence . A 44 year old woman was a ASA class I and previously healthy exccept syndrom of stress urinary incontinence(S.U.I) and underwent autologous fat injection operation. Soon after the transfer of the patient to the recovery room, she suddenly developed hypotension, bradycardia and acute respiratory failure with cyanosis. The diagnosis of pulmonry fat embolism was made by clinical symptoms and signs, the large differences of arteial carbon dioxide and end tidal carbon dioxide and right heart failure by transesophageal echocardiogram. We performed reintubation and cardiopulmonary resuscitation but the patient had failed to recover and then the next day after the operation, she finally died.

갈색세포종의 마취관리 3예 보고

김경태,이승홍,김환덕,허철회,김문철,조강희 인제대학교 1998 仁濟醫學 Vol.19 No.1

갈색세포종은 부신수질이나 paravertebral sympathetic chain을 따라 분포하는 chromaffin세포에서 발생하는 내분비질환이다. 악성인경우는 약5% 미만으로 작지만 Catecholamine의 과분비를 특징으로 다양한 임상증상이 나타나 마취유도, 기관내삽관, 체위변동, 종양조작시에 심혈관계의 혈역학적 변화로 심각한 합병증을 초래할 수 있다. 저자들은 갈색세포증 마취관리 3예를 문헌적 고찰과 함께 보고한다. Three patients underwent anesthesia for pheochromocytoma resection involving adrenal gland and extra-adrenal space. All three cases were diagnosed as pheochromocytoma by abdominal computed tomography, urinary VMA level and I-MIBG scan. Anesthesia was managed with glycopyrrolate and midazolam for premedication, pentothal sodium for induction, isoflurane-nitrous oxide-oxygen for maintensive, vecuronium for muscle relaxation, and nitroprusside for controlling severe hypertensive episode. We experienced marked fluctuation in blood pressure removal the surgical manipulation of the pheochromocytoma. Severe hypotension followed removal of tumor, which was correccted by vasoconstrictor(phenylephrine), rapid blood transfusion and infusion of crystalloids. Postanesthetic recovery course was uneventful and the patients discharged in good healthy condition.

응용통계학과 졸업생들의 전공과목 성적에 관한 통계분석

김유라,이상민,김환덕,장삼수 목원대학 응용통계학과 1994 통계학술논집 Vol.9 No.-

개심술환자에서 섬유소용해를 억제하기 위한 Tranexamic Acid 의 In Vitro 최소유효량 결정과 In Vivo 투여효과에 관한 연구

김경태,조강희,김문철,김성주,이승홍,우성,김환덕,허철회 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.6

Backgroud : Prophylactic administration of tranexamic acid(TA) reduces bleeding and transfusion requirement after open heart operations. This study was performed to determine the relationship between inhibition of fibrinolysis and TA blood concentration. Method : In phase I, recombinant tissue plasminogen activator[r-tPA(0, 50, 100, 150 ng/ml)] was added to the blood of volunteer and induced fibrinolysis. In phase II, 4 thromboelastography(TEG) models of severe fibrinolysis in which TA was added to achieve blood levels(0, 0.72, 1.44, 2.88 mg/ml) were compared to determine the lowest effective dose. In phase III, the lowest dose(0.72 mg/ml) was mixed with the blood and evaluated on TEG in open heart operation. In phase IV, a placebo group and study group receiving TA in an loading dose of 5 mg/kg before bypass following infusion of 2 mg/kg/hour. Used analysis is Mann Whitney U test and Wilcoxon rank signed test. Result : In phase I, fibrinolytic inhibition at A30/MA(r=0.752) and A60/MA(r=0.735) were linearly correlated with the blood r-tPA concentration. In phase II, severe fibrinolysis(r-tPA 100 ng/ml) was reversed completely at all doses of TA. In phase III, the fibrinolysis index at 10 min. after starting bypass, aorta declamping, and 1 hour after operation were improved when the patient's blood was treated with TA(0.72 mg/ml). In phase IV, blood treated with TA showed less fibrinolysis and better TEG results than the placebo group. Conclusions : A small dose of TA(5 mg/kg), which was determined by an in vitro model of fibrinolysis on TEG, was effective in preventing changes in fibrinolytic index during cardiopulmonary bypass in open heart surgery. (Korean J Anesthesiol 1998; 34: 1193∼1201)

개에서 혈액희석에 의한 급성 정상혈량성 빈혈이 조직 산소화에 미치는 영향 : 전신 산소소모량, 동맥혈 actate, 동맥혈 케톤체비 및 위점막내 산도의 비교 A Comparison of Systemic Oxygen onsumption, Arterial Lactate, Arterial Ketone Body Ratio and Gastric Intramucosal pH

김영재,조강희,박주열,신치만,구영권,김환덕 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3

Background : The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. Methods : Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. Results : Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. Conclusions : By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution. (Korean J Anesthesiol 1999; 37: 478∼488)