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말초 정맥혈과 동맥혈에서 측정된 가스 분석 지표간의 상관성 및 일치성
정영보,김진주,김재혁,임용수,조진성,현성열,성애진,양혁준 대한응급의학회 2011 대한응급의학회지 Vol.22 No.1
Purpose: To determine the correlation and agreement between perpheral venous and arterial values in emergency department patients Methods: The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. Prospective comparison of paired peripheral venous and arterial values were evaluated from October, 2009 to February, 2010. Peripheral venous and arterial samples were taken as simultaneously as possible when patients who were deemed by the attending doctor to require an peripheral arterial sample presented in the emergency department. Collected information included age, sex,vital signs, emergency department initial diagnosis, lactate,pH, base excess, bicarbonate, pO2, and pCO2. Statistical methods were Shapiro-Wilk test, Spearman rho test, linear regression analysis, and Bland-Altman plots. Results: Among the 546 patients, 50 were excluded and 496 were included. The majority (59.5%) of patients were male. Correlation constant (rho) of pH and lactate were 0.907 and 0.901, respectively. Mean difference and CI (confidence interval) of pH were -0.04 and -1.34~1.56,respectively. Mean difference and CI of lactate were 0.11mmol/L and -0.15~0.07 mmol/L, respectively. Conclusion: Moderate correlation and agreement between perpheral venous and arterial pH, lactate, base excess, and CO2 was evident. Especially, peripheral venous pH, lactate correlated very well and had reasonable agreement with peripheral arterial values to serve as substitutes.
심정지 후 자발순환이 회복된 소아에서 치료적 저체온 요법을 시행한 3례 보고
김진주,정영보,임용수,조진성,류일,양혁준,현성열 대한응급의학회 2010 대한응급의학회지 Vol.21 No.3
Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.