산후우울증의 선별도구 간 일치도 및 관련 요인 연구

김미운 ( Mi Woon Kim ),양회생 ( Hoe Saeng Yang ),김장락 ( Jang Rak Kim ) 대한산부인과학회 2009 Obstetrics & Gynecology Science Vol.52 No.11

목적: 본 연구는 산후우울증의 선별 척도간 일치도와 유병률을 알아보고, 관련 요인을 파악하기 위해 시행되었다. 연구 방법: 연구에 동의한 323명의 환자에게 산후 1주일째에 3 종류의 산후우울증 선별 검사와 개인 정보를 위한 설문을 시행하였으며, 산부인과 정보는 의무기록에서 얻었다. EPDS와 BDI에 공통으로 위험군인 경우를 산후우울증으로 정의하였고, 유병률, 검사간 일치도 및 관련요인을 파악하였다. 결과: 산후우울증 유병률은 19.8%, Kappa지수는 EPDS, BDI, QIDS-SR16에서 각각 0.803, 0.711, 0.395였다. 산후우울증 관련요인은 단순분석시 수유방법, 흡연력, 산전 불안/우울증상, 부모와의 거주, 결혼 만족도, 임신전 시부모와의 관계, 산후조리형태 등이, 로지스틱 회기분석 시 미숙아 분만, 조제분유 수유, 결혼 불만족, 전문직 남편, 산전 불안/우울 증상 등이 유의한 관련요인으로 나타났다 (P<0.05). 결론: 산후 1주일째 2가지 선별 검사를 동시 이용하여 효과적으로 산후우울증 유병률을 파악하였으며, EPDS가 가장 높은 일치도를 나타내었다. 여러 관련 요인들이 파악되었고 향후 더욱 많은 연구가 필요하리라 생각된다. Objective: This study was performed to assess agreements among screening tests, to estimate prevalence, and to identify related factors with postpartum depression. Methods: For 323 women at 7 days postpartum, self-administered questionnaires were given including postpartum depression screening test such as EPDS, QIDS-SR16, BDI and questionnaires for their demographic and psycho-social information. Obstetric information were collected from medical records. Simultaneous positive cases in EPDS and BDI were defined as gold standard and used to estimate the prevalence of postpartum depression and agreements between 3 kind of screening test and gold standard. Related factors of postpartum depression were analysed by using SPSS. Results: The prevalence of postpartum depression was 19.8% and the Kappa indices were 0.711 in BDI, 0.803 in EPDS, and 0.395 in QIDS-SR16. Feeding method, smoking history, antenatal anxiety/depression symptoms, residence status, marital satisfaction, relationship with husband`s parents, and postpartum care method in univariate analysis and premature delivery (odds ratio: 2.9), formulated feeding (odds ratio: 3.8), marital dissatisfaction (odds ratio: 4.3), professional husband`s occupation (odds ratio: 4.4), and antenatal anxiety/depression symptoms (odds ratio: 4.4) in the logistic regression analysis were significantly related to postpartum depression (P<0.05). Conclusion: Simultaneous test of BDI and EPDS was effective to evaluate postpartum depression prevalence at 1-week postpartum and highly agree with EPDS. Significant related factors were defined and further prospective community-based studies are warranted.

증례보고 : 척추 융합술 시 저체온으로 인해 발생한 심실세동

주민호 ( Min Ho Ju ),김미운 ( Mi Woon Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5

A 63-year-old man was scheduled for T12-S1 posterolateral spinal fusion surgery. The patient`s vital signs were stable and there were no specific laboratory findings except for high triglycerides. In addition, echocardiography showed mild left ventricular hypertrophy, but normal left ventricular function, no regional wall abnormal contractility and normal ejection fraction. During the operation, a warming blanket and fluid warmer were applied. Near the end of the operation, the blood pressure waveform from the radial artery and pulse oxymeter became flat. Cardiotonics were administered and an infusion of intraoperative salvage of blood was administered using the cell-saver. However, the hemodynamic status of the patient deteriorated to severe hypotension, with ventricular fibrillation. The patient`s vital signs with temperature became stabilized after warming for 4 hours using active warming methods, including a forced air warming blanket and warming of the fluids and blood components with a rapid infusion system. (Korean J Anesthesiol 2009;57:647∼51)

임상연구 : 전신 마취와 경막외 마취하의 슬관절 관절경수술시 지혈대 제거 후 D-dimer의 정량 비교

김행균 ( Haeng Gyun Kim ),김미운 ( Mi Woon Kim ),박은지 ( Eun Jee Park ),김수진 ( Su Jin Kim ),안승원 ( Seung Weon Ahn ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.5

임상연구 : 소아에서 Sevoflurane 마취 시 Remifentanil 병용 투여가 수술 후 회복시간과 각성흥분에 미치는 영향

남복희 ( Vo Ki Nam ),김미운 ( Mi Woon Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: Sevoflurane anesthesia may show emergence agitation and delirium in children, compared to other inhalation agents. Therefore, we studied the effect of low dose sevoflurane on recovery time and emergence agitation in children. Methods: We studied 50 patients who were planned for surgery under general anesthesia, aged between 2 and 8 years. They were randomly divided into two groups. Patients of group S were anesthetized with sevoflurane 2.5-3 vol%, whereas those of group R were given sevoflurane 1.2-1.5 vol% and continuous intravenous infusion of remifentanil 0.1-0.2μg/kg/min. All patients received N2O:O2 50:50 during maintenance of anesthesia. After the surgery, the anesthesiologist recorded recovery time and determined agitation score using 5-point scoring scale in both groups. Agitation score, incidence of emergence agitation and recovery time were compared with each other between the two groups. Results: The agitation scores were 2.72 ± 0.98 and 2.64 ± 0.95 in S and R groups, respectively, showing statistical insignificance. The incidence of emergence agitation score 4 or 5 was not significantly different, either. The recovery time was statistically shorter in R group (P<0.05). Conclusions: Compared with sevoflurane inhalation anesthesia alone, the use of sevoflurane and remifentanil in combination provided shorter recovery time, but no effect on emergence agitation. (Korean J Anesthesiol 2007; 52: 675~80)

증례보고 : 노인환자에서 측와위하 짧은 내시경 수술 후 일측성에서 양측성으로 발전한 급성 폐부종

이성원 ( Sung Won Lee ),김미운 ( Mi Woon Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Although pulmonary vascular permeability and gravity changes have been known to be the mechanism of pulmonary edema, yet the etiology of pulmonary edema remains speculative. The multiple conditions such as congestive heart failure, fluid overload, hypoalbuminemia, upper air way obstruction, increased pulmonary artery pressure and laparoscopic surgery cause poor pulmonary circulatory condition. Pulmonary edema usually occurs bilaterally, but unilateral pulmonay edema is uncommon entity. Unilateral pulmonary edema was reported to occur in special circumstances such as one lung ventilation, lateral decubitus position and unilateral pulmonary damage. We experienced abruptly onset and rapid healing pulmonary edema from unilateral to bilateral after brief laparoscopic operation under lateral decubitus position. Thus, we report this case as complicated condition of acute pulmonary edema in elderly patient without fluid overload, long operation time. (Korean J Anesthesiol 2008;55:644~7)

임상연구 : 노인환자의 척추마취 시 진정에 필요한 Midazolam의 최소용량에 대한 고찰

임성문 ( Sung Moon Lim ),김미운 ( Mi Woon Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1

Background: It is stated that spinal anesthesia may alter susceptibility to the soporific effects of sedatives. In the geriatric patients who are susceptible to midazolam, the adequate dosage of midazolam for sedation was evaluated in spinal anesthesia. Methods: ASA 1 or 2 50 elderly patients (over 65 years old) who were scheduled for lower abdominal or extremities operations, were randomly assigned into two groups. Midazolam 0.01 mg/kg was administered every 5 minutes until becoming sedated before general anesthesia in the control group, while 0.01 mg/kg was administered every 5 minutes after stabilized for 15 minutes after spinal anesthesia in the study group. Results: It took 15 ± 5.0 minutes for the control group to fall asleep while the spinal anesthesia group showed significantly less time with 11 ± 4.2 minutes. The total amount of midazolam administered were 1.5 ± 0.6 mg in the control group and 1.2 ± 0.5 mg in the study group, which showed no significance. However, the amount of midazolam compared with the body weight revealed 0.031 mg in the control group and 0.023 mg in the spinal anesthesia group suggesting significantly decreased dosage in the study group. Conclusions: Midazolam revealed significant sensitivity as well as sedative susceptibility in the elderly patients who underwent spinal anesthesia. Therefore, the dosage titration of midazolam for the elderly patients in spinal anesthesia should be carefully considered. (Korean J Anesthesiol 2006; 51: 65~9)

흔적 나팔관을 가진 완전 고환성 여성화 증후군

조재훈(Je Hun Jo),박영복(Young Bock Park),박태형(Tae Hyoung Park),장원연(Won Yeon Jang),김도균(Do Gyun Kim),김경원(Kyoung Won Kim),이동기(Dong Ki Lee),윤혜원(Hae Won Yoon),김동훈(Dong Hun Kim),김미운(Mi Woon Kim),박성태(Sung Tae Park 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.5

The Complete testicular feminization syndrome is a hereditary syndrome characterized clinically by female phenotype with 46, XY karyotype and bilateral testes. There is a congenital insensitivity to androgens, transmitted by means of a maternal X-linked recessive gene responsible for the androgen intracellular receptor. Therefore, androgen induction of Wolffian duct development does not occur. However, anti-mullerian hormone activity is present and the individual does not have mullerian development. Principle of treatment is reinforced to live normal female life. This is a case report of testicular feminization syndrome with rudimentary salpinx with the brief review of literatures.

척추마취시 Midazolam 과 Diazepam 의 진정작용에 대한 비교

김미운,김성태,김혜경 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3

Midazolam, a water soluble benzodiazepine, was compared with diazepam as a sedation for spinal anesthesia. Forthy healthy patients were allocated at random to receive midazolam 0.1mg/kg or diazepam 0.2mg/kg at 15 min after tetracaine inction for spinal anesthesia and increments of half of the initial dose every 2 min to induce sleep. Mean dose of midazolam 8.5 mg and diazepam 17.1 mg were injected for sedation throughout surgery. There was no difference concerning sedation level during surgery and speed of recovery. With the same degree of sedation, midazolam produced a higher frequency of anterograde amnesia(70% vs. 30%). Uenous tolerance was better for midazolam. Neither drug caused obstruction of airway nor significant cardiovascular change. Higher degree of amnesia and venous tolerance with midazolam may be advantages of sedation for spinal anesthesia.

정형외과에 입원한 외상환자의 치료경향에 관한 연구

김미운 東國大學校醫學硏究所 2003 東國醫學 Vol.10 No.2

교통사고를 비롯한 외인에 의한 상해가 증가함에 따라 개인 및 사회적 경제적 손실 또한 증가하고 있다. 일반적으로 남성은 여성보다 외상의 발생이 높고 교통사고환자는 그 외의 다른 외상환자에 비해 입원기간이 길다고 알려져 있다. 이에 정형외과에 입원한 201명의 외상환자를 대상으로 입원치료 경향을 알아보기 위해 성별, 연령, 외상발생 시각, 외상발생 원인, 치료방법, 치료비 지불방법, 진단일, 입원치료일, 의사가 판단한 입원치료의 종료시점 등 여러 변수를 가지고 조사하였다. 조사결과 남성의 외상발생은 여성보다 2배 정도 많았으며, 외상발생은 오전 10시에서 오후 6시 사이에 빈발하였으며, 요일별 차이는 없었다. 전체 입원기간은 진단일의 62%, 의사가 판단한 입원종료시점은 진단일의 46%였으며 전체 입원기간의 27%가 과잉 입원으로 나타났다. 환자자신이 피해자라고 느끼고 치료비를 본인이 부담하지 않는 군에서 입원치료기간 및 과잉입원기간이 길었으며 성별, 치료방법에 따른 치료경향의 차이는 없었다. As the incidence and mortality of trauma by accident have been increased, personal, social, and economical deficit are also increased. It has been generally believed that trauma was more common in males and victims of traffic accidents took longer hospital admission than other trauma patients. In this study, 201 trauma patients who were admitted to orthopedic surgery department were evaluated to find out the causes and treatment trends of trauma. Trauma patients were evaluated by age, sex, accident causes, treatment methods, diagnosis days, duration of admission, termination of admission treatment judged by doctor, and payment methods. The author found that the incidence of trauma was mere common in male nearly 2 times than famale. Trauma occurred mere common from 10:00 am to 6:00 pm, but there was no significant difference between weekdays and weekends. Total duration of adimission was 62% of diagnosis days and adimission treatments were completed at 46% of diagnosis days. It turned out to be that 27% of admission days were over-hospitalized. The duration of admission and over-hospitalization were significantly longer in the injured and indirectly payed group. In contrast there was no significant difference in treatment trend based on sex and treatment methods.

노인환자에서 고혈압 유무에 따른 수술 전 긴장 및 심혈관계 변화에 미치는 Midazolam 의 효과

김미운 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6