신경외과 중환자에서 Feeding pump 사용으로 성공적으로 경장영양을 시행한 1예

최지혜,이영재,윤소희,김예정,김수진,신현미 한국정맥경장영양학회 2015 한국정맥경장영양학회 학술대회집 Vol.2015 No.-

서론: 중환자 경장영양치료시 위 잔여량이 증가할 경우 feeding pump 사용이 효과적인 경장영양치료에 유 효한 것으로 알려져 있다. 그러나 현실적인 의료환경에서 보험급여 문제를 포함하여 여러가지 문제점으로feeding pump 사용에 제한을 받고 있다. 본 저자는 경장영양치료가 어려웠던 중환자에게서 feeding pump 사용에 의한 지속적 방법으로 경장영양공급 시행 후 효과적인 경장영양치료를 경험하였기에 보고하고자 한다. 증례: 60세 남자가 한 달 전 의식불명을 주소로 응급실을 방문하여 급성 경막하 출혈 진단 받고 감압성 두개골 절제술 시행 후 신경외과 중환자실에 입원하였다. 입원시 체중은 표준체중 백분율(%IBW)이 96.83% (58 kg, 165 cm) 이었다. 입원 2일째부터 Levin tube에 의한 경장영양치료를 시행하였으나, 경과 관찰 중 입원 4일째 호흡곤란 및 산도포화도 감소로 기관삽관을 시행한 후 기계환기를 시행하였고, Levin tube 식도 자극에 의한 인한 식도 궤양 출혈이 발생하여 금식을 시행하였으며, 표준체중 백분율 91.84% (55 kg, 165 cm)로 중등도 Protein-calorie malnutrition 영양불양상태 이었다. 입원 8일째에 경장영양액(하모닐란®) 300 cc를 하루 네 번 간헐적 feeding방법으로 투여 하였으나 9일째 호흡곤란 상태가 다시 악화되어 경장영양치료 중단 하였고 경정맥영양치료 시행하면서 상기 환자의 영양치료에 대하여 영양집중지원팀에 협진을 의뢰하였다. 영 양집중지원팀 권고에 따라 Nasogastric feeding tube에 의한 경장영양 치료를 시행하였으나 입원일 26일부터 위잔여량 증가로 충분한 영양공급 증량이 어려워 feeding pump를 사용하여 24hr continuous feeding 을 시행하였다. Feeding pump continuous feeding protocol은 다음과 같다. 25cc/hr로 시작하여 8시간마다 15 cc/hr씩 증량하였으며, 1,400 kcal(요구량의 80%충족)을 목표로 지속적으로 증량하였다. 위잔류량을 4시간마다 측정 하였고 위잔류량이 200 cc미만시 지속해서 증량하였으며, 구토, 복부팽만, 설사 등의 증상을 주의깊게 관찰하였다. 입원일 34일째 요양병원으로 퇴원이 예고되어 타기관 치료 환경을 고려하여 intermittent feeding으로 전환하여 200 cc/hr 투여 상태에서 입원 37일째 퇴원하였다. 고찰: 중환자에서 위 잔여량이 증가함에 따라 경장영양치료에 제한 있었던 환자에게서 feeding pump사용을 통하여 효과적으로 경장영양치료를 시행할 수 있었다. 향후 경장영양치료에 feeding pump의 유용성에 대하여 지속적인 연구가 필요하다고 생각된다.

초극소 저체중 출생아에서 수유 시 산소포화도 저하와 구강자극 요법의 효과

최해원,박혜원,김희영,임진아,구소은,이병섭,김기수,피수영,김애란 대한신생아학회 2010 Neonatal medicine Vol.17 No.2

Purpose: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, longterm feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. Methods: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). Results: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. Conclusion: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay. 목적: 초극소 저체중 출생아는 경구수유를 진행하는데 여러가지 어려움을 겪어, 경구수유로의 이행이 늦어진다. 본 연구에서는 초극소 저체중 출생아 중, 수유 시 산소포화도 저하가 발생하는 군과 산소포화도 저하가 없는 군 사이의 특징을 비교하고,초극소 저체중 출생아의 경구수유 이행 및 입원기간에 미치는영향에 대해 알아보았다. 또한 초극소 저체중 출생아에서 구강자극요법을 시행하는 경우, 수유 시 산소포화도 저하와 경구수유 능력의 발달, 입원기간에 미치는 효과를 알아보았다. 방법: 제 1상 연구에서는 2003년 10월부터 2009년 1월까지서울아산병원 신생아 중환자실에 입원한 125명의 초극소 저체중 출생아를 대상으로 차트 분석을 통한 후향적 연구를 실시하여, 수유 시 산소포화도 저하 여부에 따른 특성, 산소포화도 저하가 경구수유 능력 발달 및 입원기간에 미치는 영향에 대해 알아보았다. 제 2상 연구에서는 2009년 3월부터 2010년 5월까지29명의 초극소 저체중 출생아에게 구강자극요법을 시행하며 전향적으로 자료를 수집하였고, 81명의 초극소 저체중 출생아에서 후향적 코호트 연구를 통해 두 그룹을 비교 분석하였다. 결과: 초극소 저체중 출생아의 72.8%에서 수유 시 산소포화도 저하를 보였고. 그 중 37.4%에서 서맥을 동반하였다. 수유 시산소포화도 저하가 발생하는 시점은 평균 58.2일이었고, 당시평균 175.4 mL의 수유를 하고 있었으며, 대부분 위관영양과 경구수유를 병행하고 있었지만, 36.3%에서는 위관영양만 시행하고 있었다. 수유 시 산소포화도 저하가 발생한 군은 정상군 보다출생 시 재태연령이 낮고, 5분 아프가 점수가 낮았으며, 위식도역류 및 상인두 부조화가 유의하게 많았다. 또한 기관지폐이형성이 있는 초극소 저체중 출생아에서 수유 시 산소포화도의 저하가 발생할 확률은 19배 증가하였다. 수유 시 산소포화도 저하가 있는 군은 경구수유로 완전히 이행하는 시기가 늦었으며, 입원기간도 길었다. 위 결과를 토대로, 초극소 저체중 출생아에서구강자극요법을 시행하였을 때 대조군에 비해 경구수유 시작시기 및 경구수유로 완전히 이행한 시기가 빨랐으며, 입원기간이단축되었다. 결론: 초극소 저체중 출생아에서 구강자극요법은 경구수유능력 발달에 긍정적인 효과가 있으며 입원기간을 단축하는데도움이 된다.

Fed-Batch Sorbose Fermentation Using Pulse and Multiple Feeding Strategies for Productivity Improvement

Giridhar, R.,Srivastava, A.K. The Korean Society for Biotechnology and Bioengine 2000 Biotechnology and Bioprocess Engineering Vol.5 No.5

Microbial oxidation of D-sorbitol to L-sorbose by Acetobacter suboxydans is of commercial importance since it is the only biochemical process in vitamin C synthesis. The main bottleneck in the batch oxidation of sorbitol to sorbose is that the process is severely inhibited by sorbitol. Suitable fed-batch fermentation designs can eliminate the inherent substrate inhibition and improve sorbose productivity. Fed-batch sorbose fermentations were conducted by using two nutrient feeding strategies. For fed-batch fermentation with pulse feeding, highly concentrated sorbitor (600g/L) along with other nutrients were fed intermittently in four pulses of 0.5 liter in response to the increased DO signal. The fed-batch fermentation was over in 24h with a sorbose productivity of 13.40g/L/h and a final sorbose concentration of 320.48g/L. On the other hand, in fed-batch fermentation with multiple feeds, two pulse feeds of 0.5 liter nutrient medium containing 600g/L sorbitol was followed by the addition of 1.5 liter nutrient medium containing 600g/L sorbitol at a constant feed rate of 0.36L/h till the full working capacity of the reactor. The fermentation was completed in 24h with an enhanced sorbose productivity of 15.09g/L/h and a sorbose concentration of 332.60g/L. The sorbose concentration and productivity obtained by multiple feeding of nutrients was found to be higher than that obtained by pulse feeding and was therefore a better strategy for fed-batch sorbose fermentation.

FED Technology and R & D Trend

주병권 선문대학교 첨단과학기술연구소 2001 첨단과학기술연구소 논문집 Vol.5 No.-

큰 부피와 무거운 중량으로 대표되는 CRT 고유의 한계점을 극복하기 위해, 평판 표시기(Flat Panel Display)가 등장하게 되었는데, 현재 기술 및 시장성 면에서 자리를 공고히 하고 있는 LCD(Liquid Crystal Display)를 비롯하여 PDF(Plasma Display Panel), VFD(Vacuum Fluorescent Display), ELD(Electro-luminescent Display) 등이 이에 속한다. 이들 중 하나가 FED(Field Emission Display)로 최근에 이르러 그 연구 개발이 더욱 가속화 되고 있다. 이러한 FED의 기술적 배경을 거슬러 올라가 보면, 이미 1960년대 중반에 그 연구가 시도된 바 있으나, 전계 방출용 팁의 과도한 손상과 형광체 기술의 부족으로 좌절되었으며, 이후로 극히 미미한 수준의 연구만 진행되어 왔다. 그러다가 프랑스의 국립 연구소인 LETI가 독자적으로 수 년 동안 집중적으로 연구를 수행한 결과 소자의 구조, 전계 방출용 팁, 그리고 형광체 기술에 있어서 획기적인 개선을 이루었으며, 이로서 FED는 새로운 탄생을 맞이하게 되었다. 1992년 7월에 FED 전문 회사인 Pixel International(지금은 Pix Tech으로 개명되었음.)이 설립되었고, 그 해 9월에 LETI로부터 관련 특허들을 전수받아 1993년에 칼라 FED 시제품을 최초로 발표한 바 있다. 본 고에서는 2000년대 진입을 목표로 평판 표시기 시장에 강력히 도전하고 있는 FED와 관련하여, FED 동작 원리 및 장단점, FEA(Field Emitter Array) 소자 및 제조공정, FED 회사들의 연구 개발 동향 등에 관하여 간단히 피력하고자 한다.

Weed Control by Herbicides and Fertilizers Applied Separately or Combined on Kentucky Bluegrass Lawn

Deying Li(다이엥 리),Kirk Howatt(컬크 호와트) 한국잡초학회·한국잔디학회 2007 Weed & Turfgrass Science Vol.21 No.1

잔디밭 관리 시 제초제와 비료의 혼합 처리는 시간절약 및 답압감소 등 여러 가지 장점이 있다. Weed & Feed는 제초제와 비료를 혼합 조제된 제품이다. 본 실험은 캔터키 블루그래스 잔디밭에서 비료 및 제초제를 단독으로 처리할 때와 Weed & Feed를 사용할 경우 그 효과를 비교하기 위해서 시작되었다. 실험에 사용한 Weed & Feed 28-3-3에는 세 가지 제초제 - 2,4-D 0.64%, MCPP 0.31% 및 dicamba 0.03%가 혼합 조제된 약제이다. 첫 번째 처리는 5월에 실시하였고, 두 번째 처리는 6월 또는 9월에 실시하였다. 단독으로 사용한 제초제는 2,4-D(LV-4, 4EC), MCPP(4EC) 및 dicamba(Clarity, 4EC)로 Weed & Feed의 50% 및 100% 수준으로 적용하였다. 실험기간 동안 우점 잡초는 민들레였으며, 제2 우점종은 2004년에는 엉컹키, 2005년에는 왕질경이로 나타났다. 실험결과 5월과 6월에 비료와 100% 수준의 제초제를 처리할 경우 수용할 수 있는 잔디밭 품질은 각각 112.3일과 83.7일 정도 유지되엇다. 하지만 Weed & Feed를 사용할 경우에는 각각 58.7일과 83.7일로 나타났다. Weed & Feed 효과는 사용 시기에 따라 차이는 있지만 비료와 50% 수준의 제초제를 처리한 것과 유사한 효과가 있는 것으로 나타났다. 잡초 방제 시 Weed & Feed에 비해 비료와 100% 수준의 제초제를 직접 처리하는 것은 Weed & Feed를 사용하는 그 이상의 효과가 있는 것으로 나타났다. Incorporating herbicides application into fertilization has several benefits including saving time and reducing traffics on the lawn. Premixed products of fertilizers and herbicides are commonly known as Weed & Feed in the lawn-care industry. To compare Weed & Feed with separate applications of fertilizers and herbicides on a Kentucky bluegrass (Poa pratensis L.) lawn, a Weed & Feed 28-3-3, containing 0.64% 2,4-D, 0.31% MCPP, and 0.03% dicamba of active ingredients, was used in this study. The first application was in May, with the second in June or Sept. Herbicides in forms of 2,4-D (LV-4, 4EC), MCPP (4EC), and dicamba (Clarity, 4EC) were applied at rates equal to the amounts in Weed & Feed or at half of the rates. The dominant weed in both locations was common dandelion (Taraxacum officinale Weber.) in 2005 and 2004. A secondary weed was Canada thistle (Cirsium arvense (L.) Scop.) in 2004 and broadleaf plantain (Plantago major L.) in 2005. When applied in May and June, fertilizer plus full rate of herbicides treatment achieved 112.3 and 83.7 days of acceptable turf quality in 2004 and 2005, respectively. During the same period, Weed & Feed resulted in 58.7 and 24.3 days of acceptable turf quality, respectively. Our study showed that Weed & Feed was generally as effective in weed control as the same amount of fertilizer plus half rates of herbicides sprayed although results may vary due to the timing of application. Fertilizer plus full rates of herbicides provided the same or better results of weed control than Weed & Feed.

Effect of Phase Feeding on the Growth Performance and Nutrient Utilization in Finishing Pigs

Han, In K.,Kim, J.H.,Chu, K.S.,Xuan, Z.N.,Sohn, K.S.,Kim, M.K. Asian Australasian Association of Animal Productio 1998 Animal Bioscience Vol.11 No.5

This study was conducted to investigate the effects of different feeding regimen on the growth and nutrients excretion in finishing pigs. A total of 80 pigs (59.91 kg BW) and 6 pigs (85 kg BW) were employed in a growth trial and metabolic trial, respectively. Treatments were grower-grower (GG), grower-early finisher(GE), early finisher-early finisher (EE), and early finisher-late finisher (EL) diet feeding regimens for feeding trial and G, E, L diets for metabolic trial. Through whole experimental period, no significant difference was found in any of the criteria measured. Pigs fed on a GG regimen gained slightly faster than pigs fed on other feeding regimens, with no significant difference. Although there was a trend that pigs fed on a GG or GE regimen showed improved feed/gain over pigs fed on a EE or EL regimen, the difference also was not significant. In the metabolic trial, dry matter and phosphorus digestibility was not affected by diets, however, phosphorus digestibility tended to be decreased as nutrients contents was decreasing in the diets. Crude protein digestibility was significantly influenced by the nutrients contents in th diets. The data suggested that 11.7% crude protein seemed to be low for the 85 kg pigs. Though nutrients excretion was not significantly influenced by dietary treatment except phosphorus, there was a trend that pigs fed diets with low nutrient content excreted less amount of nitrogen and phosphorus than pigs fed diets with high nutrients content. There was a trend that GG or GE feeding regimen gad a favorable effect on carcass grade when only 10 lighter pigs of each treatment were subjected to statistical analysis. However, with 10 heavier pigs, EE and EL feeding regimen showed better carcass grade, though the difference was not significant. In summary, it seemed that producers generally oversupply the expensive nutrients for the finishing pigs. High nutrient diets do not always guarantee high growth rate of pigs. It rather seems that to meet nutrient requirements for the each growth phase is more important in economical pork production.

Effects of Wet Feeding of Processed Diets on Performance, Morphological Changes in the Small Intestine and Nutrient Digestibility in Weaned Pigs

Yang, J.S.,Lee, J.H.,Ko, T.G.,Kim, T.B.,Chae, B.J.,Kim, Y.Y.,Han, In K. Asian Australasian Association of Animal Productio 2001 Animal Bioscience Vol.14 No.9

This study was conducted to evaluate the effects of different methods of feeding and processing of diets on performance, morphological changes in the small intestine and nutrient digestibility of young pigs. A total of 120 pigs (Youkshire${\times}$Landrace${\times}$Duroc; initial body weight of $5.83{\pm}0.67kg$) were randomly allotted into six treatments in a $2{\times}3$ factorial design. Treatments were 1) dry feeding with a mash diet (DM), 2) dry feeding with a pelleted diet (DP), 3) dry feeding with an expanded crumble diet (DEC), 4) wet feeding with a mash diet (WM), 5) wet feeding with a pelleted diet (WP), 6) wet feeding with an expanded crumble diet (WEC). Average daily gain (ADG) and average daily feed intake (ADFI) were not significantly (p>0.05) different among treatments. However, feed conversion ratio (FCR) was significantly improved when pigs fed a pelleted diet or an expanded crumble diet. Pigs fed an expanded crumble diet showed 9.2% and 17.3% improvement in ADG and FCR compared with those fed a mash diet. The morphological changes in the small intestine were examined at the termination (4 weeks after weaning) of the experiment. Differences in morphological changes of gastrointestinal tract were not significant among treatments. Though villus height was not significantly affected by feeding method or feed processing, the villus height of weaned pigs tended to be preserved by wet feeding. The use of a pelleted diet also helped to prevent the shortening of villus height. Pigs fed a WP diet maintained the highest villus height at all parts of the small intestine. There was no significant difference (p>0.05) in nutrient digestibility among treatments. However, nutrient digestibility for pigs fed a pelleted diet had a higher than that of pigs fed mash diets. Especially, pigs fed a WP diet digested 5.3% more P each day than those fed a DM diet. Compared with the mash diet, the expanded crumble diet decreased feed cost per kg weight gain by 15%. The net profit per pig was 79% higher in the expanded crumble diet pigs than in mash diet pigs. In conclusion, this study suggests that feeding processed diets to piglets can be more beneficial in terms of FCR and production cost.

모유 수유에 대한 일반인들의 인식에 관한 설문조사

반성환,이동환,박재옥,신상만 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

OBJECT : From the late in 1970, the incidence of breast-feeding have been increased in the developed countries. But, there is a marked contrast in Korea, inspite of the campaign of breast-feeding. We researched the general opinions of general populations on breast feeding to find out a better way on successful breast-feeding and helping people's understanding. METHODS : To find out the factors influencing the incidence of breast-feeding, we made on ingury study in 234 women and their family member including their husbands during the period of April, 1995 to August, 1995. We analysed the results according to sex, age, and the status of education and marriage. RESULT People in the inquiry answered as follows : - breast feeding is to be taken for granted.(93-94%) - the reason of breast feeding is for protecting baby from disease.(81-83%) - feeding breast milk is much better than cow's milk.(82-83%) - breast feeding is good for hepling the bonding between mother and her baby.(89%) - most of them would like to follow the spouse's opinion to keep on breast feeding.(73-75%) - breast feeding could cause some inconveniences in sexual-life/(74-78%) - breast feeding woman are regarded more admiarable when compared with non-breast feeding woman.(80-84%) - breast feeding woman is less attactive.(22-23%) - the purpose of creating breast is to feed baby.(14-17%) - breast feeding in public place is permissible.(43%) - breast feeding can make breast shapeless.(22%) CONCLUSIONS : Every effort should be made so as to increase the recognition of the value of breast feeding, not only for pregnant women but also for their husbands. Both of them have to attend the breast feeding education classes given before and after childbirth. Students have to be taught about the merit and the way of breast feeding through school education. Doctors are expected to encourage people to realize the advantages of breast-feeding, participate in the campaign and never advise to give up breast feeding.

A Review of the Optimum Feeding Rates and Feeding Frequency in Korean Rockfish Sebastes schlegeli Reared at Seven Different Water Temperatures

Mizanur, Rahman M.,Bai, Sungchul C. The Korean Society of Fisheries and Aquatic Scienc 2014 Fisheries and Aquatic Sciences Vol.17 No.2

Seven feeding trials were conducted to determine the effects of feeding rate and frequency in the Korean rockfish Sebastes schlegeli at seven different water temperatures. Two feeding-rate experiments for 5-g Korean rockfish at $17^{\circ}C$ and $20^{\circ}C$; three feeding rate experiments for 16-g Korean rockfish at $16^{\circ}C$ and $24^{\circ}C$; and finally, two feeding frequency experiments for 93- and 100-g at $15^{\circ}C$ and $20^{\circ}C$ were conducted. Twenty fish averaging $5.5{\pm}0.2$ g ($mean{\pm}SD$) were randomly distributed into 18 indoor tanks containing 40-L seawater from a semi-recirculation system. Fish were fed a commercial diet for 4 weeks at water temperatures of $17^{\circ}C$ and $20^{\circ}C$. Two feeding trials were conducted to determine the optimum feeding frequency in growing Korean rockfish reared at temperatures of $15^{\circ}C$ and $19^{\circ}C$. Broken line regression analysis of weight gain (WG) indicated that the optimum feeding rates of 5-g growing Korean rockfish were 4.48% (BW/day; BW, body weight) at $17^{\circ}C$ and 4.83% (BW/day) at $20^{\circ}C$. Broken line regression analysis of WG showed optimum feeding rates of 16-g juvenile Korean rockfish of 3.41% (BW/day) at $16^{\circ}C$, 3.75% (BW/day) at $20^{\circ}C$, and 3.34% (BW/day) at $24^{\circ}C$. The biological performance, results, along with morphological indices and serological characteristics, suggest that a feeding frequency of 1 meal/day was optimal to improve WG in growing Korean rockfish grown from 93 to 133 g at a water temperature of $15^{\circ}C$, and 100 to 132 g at $19^{\circ}C$.

Effects of Early Feed Restriction on the Occurrence of Compensatory Growth, Feed Conversion Efficiency, Leg Abnormality and Mortality in Unsexed Broiler Chickens Reared in Cages

Santoso, U. Asian Australasian Association of Animal Productio 2002 Animal Bioscience Vol.15 No.9

Two experiments were conducted to evaluate the effect of early feed restriction on growth, feed conversion ratio (FCR) and mortality in unsexed broiler chickens. In Experiment 1, 350 one-day-old broiler chickens were divided into 7 groups. Each treatment group was represented by five replicates of ten broilers each. One group was fed ad libitum as the control group and the other six groups were fed 25% ad libitum (25% multiplied by amount of feed intake of ad libitum chickens at the previous day) for 4 or 6 days, 50% ad libitum for 4 or 6 days, and 75% ad libitum for 4 or 6 days. In experiment 2, 500 broiler chickens were divided into 10 groups. Each treatment group was represented by five replicates of ten broilers each. One group was fed ad libitum as the control group. Three ages of feed restriction initial timing (2, 4 or 6 days of age) and three types of feed restriction (physical restriction, meal feeding and diet dilution) were used ($3{\times}3$) in both experiments. They were feed-restricted for 6 days. Results showed that restricted broilers exhibited compensatory growth in both experiments except for diet dilution groups. In both experiments, FCR of restricted broilers was higher, whereas feed intake of them was lower during restriction period. FCR of restricted broilers was lower upon refeeding. Mortality was inconsistently affected by early feed restriction. Leg abnormality was lower in restricted broilers in both experiments. Level of feed restriction significantly influenced body weight, FCR and feed intake of restricted broilers (p<0.05), but duration of feed restriction had no effect. Type of restriction significantly affected body weight, feed intake and FCR (p<0.05). It appeared that to achieve the best result (complete compensatory growth and better FCR), broilers should be restricted at 25% ad libitum for 6 days (Experiment 1). Meal feeding started at 2 days of age would show the best performance (Experiment 2).