Intra-abdominal hypertension

경규혁(Kyu Hyouck Kyoung) 대한외과학회 2014 대한외과학회 학술대회 초록집 Vol.2014 No.11

내재된 둔상으로 인한 좌측 총 장골동맥 파열에 따른 출혈성 심정지 (질 내 경로를 통한 자위 행위로 인한 손상 의심): 증례보고

경규혁 ( Kyu Hyouck Kyoung ),김미진 ( Mi Jin Kim ),최병호 ( Byung Ho Choi ),홍정석 ( Jung Seok Hong ),홍은석 ( Eun Seog Hong ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

A 34-year-old woman experienced a sudden cardiac arrest after complaining of abdominal pain. The cause of that serious event was a hidden hemorrhagic shock. On computed tomography of her pelvic area, we found that her left common iliac artery had been ruptured. No bone fractures were observed. Her angiography showed neither atherosclerosis nor an aneurysm of the artery. Because spontaneous ruptures of the common iliac artery are rare, we suspected, based on her husband’s statement, that a hidden blunt trauma to the artery had occurred via an endo-vaginal route due to dildo masturbation. Unfortunately, she died without recovery, in spite of our having controlled the bleeding by using an angiographic endovascular stent-graft. [ J Trauma Inj 2014; 27: 211-4 ]

둔상에 의한 외상성 좌심실 파열환자를 성공적으로 치료한 예

경규혁 ( Kyu Hyouck Kyoung ),정성호 ( Sung Ho Jung ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Blunt cardiac rupture is uncommon and is associated with significant mortality. Patients with blunt cardiac rupture usually have combined injury and do not always show signs of cardiac tamponade, which delays the diagnosis of cardiac rupture and increases mortality. We report a case of cardiac rupture diagnosed and treated by using only thoracic exploration based on clinical impression, with radiologic studies, including even echocardiography, showing negative results.

급성신부전이 발생한 중증 외상 환자에서 저분자량헤파린 투여 후 발생한 심각한 출혈 합병증

경규혁 ( Kyu Hyouck Kyoung ),김운원 ( Woon Won Kim ),박성진 ( Sung Jin Park ),김기훈 ( Ki Hoon Kim ),김진수 ( Jin Soo Kim ),박종권 ( Jong Kwon Park ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84. (J Korean Soc Traumatol

외상환자의 초기 호흡 부전에 대한 흡입산화질소의 적용

김병성 ( Byoung Sung Kim ),경규혁 ( Kyu Hyouck Kyoung ),박호종 ( Ho Jong Park ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.3

Purpose: Nitric oxide (NO) is a vasodilator and inhaled NO (iNO) is used in acute respiratory distress syndrome (ARDS) to improve alveolocapillary gas exchange. The mechanism to improve oxygenation is likely to redistribute blood flow from unventilated areas to ventilated areas. Though improvement of oxygenation, iNO therapy has not been shown to improve mortality and considered as only rescue therapy in severe hypoxemia. We conducted the study to investigate an efficacy of iNO in trauma patients with severe hypoxemia. Methods: We reviewed the trauma patients who underwent iNO therapy retrospectively from 2010 to 2014. Degree of hypoxemia was represented as PaO2/FiO2 ratio (PFR) and the severity of patient was represented with sequential organ failure assessment (SOFA) score. Patients were divided into the survivor group and non-survivor group according to the 28-day mortality. Results: A total of 20 patients were enrolled. The mortality of 28-day was 40%. There were no significant differences between survivor and non-survivor group in age, sex, severity of injury, PFR and SOFA score. There was significant difference in initiation time of iNO after injury (p=0.047). Maximum combinations of sensitivity and specificity for timing of iNO therapy were observed using cut-off of 3-day after injury with a sensitivity of 88% and specificity of 75%. Conclusion: Though iNO therapy does not influence the mortality, iNO therapy may decrease the mortality caused by respiratory failure in the early phase of trauma. [ J Trauma Inj 2015; 28: 104-107 ]

흉부 둔상으로 발생한 외이도 출혈이 동반된 외상성 질식 증후군

이제호 ( Je Ho Lee ),경규혁 ( Kyu Hyouck Kyoung ),김정원 ( Jeong Won Kim ),양희준 ( Hui Jun Yang ),홍은석 ( Eun Seog Hong ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.4

Traumatic asphyxia, also called ``Perthes syndrome``, is characterized by subconjunctival hemorrhage, cervicofacialpetechiae and cyanosis resulting from venous hypertension caused by an abrupt, severe, compressive force to the thoracoabdominal region. A 37-year-old male patient who was transferred to the emergency room due to chest trauma by overturning of a forkcrane. His head, neck, and shoulders showed severe ecchymosis, and his upper chest was cyanotic. There was bilateral subconjunctival hemorrhage and bilateral ear bleeding without tympanic rupture. Perthes syndrome is a rare condition and we treated a patient with typical and atypical symptoms; thus we report this case of Perthes syndrome.

혈역학적으로 불안정한 골반 골절 환자에 있어서 외상팀 유무에 따른 생존율 비교

김지완(Ji Wan Kim),홍석경(Suk-Kyung Hong),경규혁(Kyu Hyouck Kyoung),최지호(Ji Ho Choi),김정재(Jung Jae Kim) 대한정형외과학회 2012 대한정형외과학회지 Vol.47 No.3

목적: 혈역학적으로 불안정한 골반 골절 환자에 있어서 외상팀 치료를 시행한 시점을 전후로 시기를 나누어 각 시기별 치료 결과의 차이를 알아보고자 한다. 대상 및 방법: 혈역학적으로 불안정한 골반 골절 환자를 대상으로 외상팀 가동 시작인 2009년 3월 이전을 1기, 가동 이후를 2기로 하여 구분하였다. 의료진의 진료 시작까지 소요된 시간, 지혈을 위해 시행한 치료 방법 및 소요 시간, 수혈량, 사망률을 조사하였다. 결과: 진료 시작까지 소요된 시간은 1기의 경우 5시간 48분, 2기의 경우 57분으로 줄어들었으며, 환자가 응급실에 도착한 이후 지혈을 위한 처치 시행까지 소요된 시간은 1기의 경우 14.4시간, 2기의 경우 4.2시간이었다. 수혈량은 1기의 경우 41.1 unit인 반면, 2기의 경우 13.2 unit로 1/3 수준으로 감소되었다. 1기에서 7명의 환자 중 4명(57.1%)이 사망하였던 반면, 2기에는 7명 중 1명(14.3%)만이 사망하였다. 결론: 혈역학적으로 불안전한 골반 골절이 있는 외상 환자의 경우 외상팀의 진료는 환자의 치료 방침을 결정하는 데 시간을 단축시키고 적극적인 지혈 치료를 통해 수혈량을 감소시켜 사망률을 현저히 감소시킬 수 있었다. Purpose: To compare the clinical results of hemodynamically unstable patients diagnosed with pelvic ring injury according to the presence of a trauma team. Materials and Methods: Patients with hemodynamically unstable pelvic fracture were enrolled in the study and were divided into two groups: Group Ⅰ, patients who were managed before March 2009, when there was no trauma team; and Group Ⅱ, patients who were managed after March 2009, when emergent trauma team began to work. Data were collected regarding the time the trauma team began patient management, the treatment modality used to control bleeding, transfusion requirement, and patient mortality. Results: The time when the trauma team began patient management was fi ve hours and 48 minutes in Group Ⅰ and 57 minutes in Group Ⅱ. The time to definitive treatment in order to control bleeding in Group Ⅰ and Group Ⅱ was 14.4 hours and 4.2 hours, respectively. The amount of the transfusion was 41.1 unit in Group Ⅰ and 13.2 unit in Group Ⅱ patients. In Group Ⅰ, four patients (57.1%) died, although only one of the seven patients in Group Ⅱ (14.3%) died. Conclusion: Using a multidisciplinary approach, the trauma team has only a short amount of time to determine their treatment strategy and to achieve prompt management of bleeding, with the fi nal objective to decrease the mortality rate in patients with hemodynamically unstable pelvic fractures.

외상성 췌장 손상에서 내시경적 담췌관 조영술의 역할

정민영 ( Min Young Jeong ),김영환 ( Young Hwan Kim ),경규혁 ( Kyu Hyouck Kyoung ),이성구 ( Sung Koo Lee ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.2

Purpose: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. Methods: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. Results: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. Conclusion: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.

고도 중증외상 환자에서 급성 혈액응고장애가 초기 및 조기 사망에 미치는 영향

노민수 ( Min Su Noh ),양성수 ( Song Soo Yang ),경규혁 ( Kyu Hyouck Kyoung ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.4

Purpose: Numerous studies have investigated the pattern of traumatic death with a focus on the injury mechanism, the severity of the injury and the presence of hemorrhage. Acute coagulopathy has been treated as only one of many complications. The purpose of this study was to investigate the influence of acute coagulopathy on acute and early death due to trauma. Methods: A retrospective analysis of trauma patients with injury severity score (ISS)≥25 who had been treated between January 2011 and December 2012 was conducted. Based on the time of injury, traumatic death was categorized into acute (within 48 hours) and early (from 3 to 7 days). The correlations between various parameters within 24 hours after injury and time of death were analyzed. Results: A total of 124 patients were enrolled. Of them, 8.1% (n=10) of the patients experienced acute mortality. For those patients, significant differences in initial systolic blood pressure, coagulopathy score, amount of transfusion, abbreviated injury scale of the head and neck, the abdomen and the extremities were noted. Early mortality was experienced by 7.0% (n=8) of the patients, only coagulopathy score was found to be a significant independent risk factor for acute (odds ratio: 3.127; 95% confidence interval: 1.185-8.252; p=0.021) and early mortality (odds ratio: 2.470; 95% confidence interval: 1.029-5.929; p=0.043). Conclusion: Acute traumatic coagulopathy has an important role in the mortality, even after the acute phase. Early management and prevention of acute coagulopathy may improve survival of trauma patients. [ J Trauma Inj 2014; 27: 158-64 ]

외상환자의 보험체계에 따른 진료비 분석

박희성 ( Hee Seung Park ),정윤중 ( Yooun Joong Jung ),김영환 ( Young Hwan Kim ),김태현 ( Tae Hyun Kim ),금민애 ( Min Ae Km ),경규혁 ( Kyu Hyouck Kyoung ),김정재 ( Jung Jae Kim ),홍석경 ( Suk Kyung Hong ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4

Purpose: In Korea, the nation`s medical expenses were 12 billion won in 2010. The medical costs for individuals can also be overwhelming. If a patient has sustained severe trauma, his/her insurance company responsible may pay only part of the medical bills. In Korean, there are diverse types of medical insurance, such as health insurance, automobile insurance, and industrial accident compensation insurance. And each insurance system has a different type of payment system. Our study will be essential for establishing the optimal medical expense payment system. Methods: From January to December 2011, we retrospectively reviewed the medical charts of 161 patients who were admitted to our hospital`s emergency room after having undergone severe trauma. Of those 161 patients, 125 were retrospectively reviewed. Written permission was obtained from all of the patients. We analysed the demographic characteristics, clinical outcomes, data of the trauma, type of the patient`s insurance, and the entire bill when the patient was discharged. Results: Seventy-one patients had health insurance, 48 automobile insurance, and six industrial accident compensation insurance. High-deductible insurance included health insurance and industrial accident compensation insurance, with the deductibles up to 20.6% and 19.1%, respectively. We attempted to analyze the cause of the high deductible rate. In patients with health insurance, medicines, primarily sedatives, pain killers, antibiotics, and fluids. comprised a large proportion. On the other hand, industrial accident compensation insurance deducted for a high-grade hospital room charge. Conclusion: We found that medical expenses were diverse according to the type of insurance. In particular, health insurance forced patients to pay too much of the medical expenses. Therefore, in Korea we should try to identify the insurance problems and improve the wage system. (J Trauma Inj 2012;25:178-187)