뇌졸중 환자의 일상생활동작, 우울과 삶의 질의 관계

김원옥 ( Won Ock Kim ),강현숙 ( Hyun Sook Kang ),왕명자 ( Jmyung Ja Wang ),김정화 ( Jeong Hwa Kim ),최진이 ( Jin Yi Choi ) 경희대학교 동서의학연구소 2007 동서간호학연구지 Vol.13 No.2

본 연구는 뇌졸중 환자의 일상생활동작, 우울, 삶의 질의 관계를 파악하고자 하는 서술적 조사 연구로서 일상생활동작,’ 우울, 삶의 질 정효〉 관계가 있음을 확인하였다. 그러므로 본 안구의 주요한 결과를 중심으로 다음과 같이 고찰하였다. 뇌졸중 환자들의 일상활동 수행능력을 측정하는 도 구로 FIM, Modificd Barthel Index (MBI) 등이 많이 쓰 이고 있는데 FIM은 분야에 상관없이 표준화를 통한 높은 실용성,실행성, 이해도로· 인하여 널리 사. 하고 있는 도구로 이를 이용하여 측정한 본 연구에서는 872점으로 국내에서 만성 뇌졸중 환자와 퇴원 시 뇌졸중 환자를 대상으로 측정한 85. 9점 (Hw떼g, 2004) 과 85. 3점 (Kim, 2004) , 85. 8점 (Hong et al., 1998) 에 비하 여 약간 높아졌으나 비슷하였고, 일본 뇌졸중 환자를 대상으로 한 연구의 77. 1점보다는 높은 결과이었다 (Hama et al., 2007) . 특히 하부역역인 운동영역은 다 른 연구에 비해 높았으나 인지영역은 다른 연구에 비 해 낮은 편이었다 (Hwang, 2004二 Hama et al. , 2007, Hong 嫩 al. , 200긱 Kim, 2004) . 미국의 지역사회시설 에 있는 뇌졸중이 처음 발병한 환자들을 대상으로 재 활 후 5년간 환자를 추적한 연구에서 3년 후까지는 FIM점수가 상승하였으나 그 이후 감소되는 양상을 보였고 본 연구에서는 친단 후 경과 기간이 35.5개월 (87.2점)로 퇴원 후 3년 된 시점의 결과no도4점) 와 비교하였을 때 낮은 편이었다〈 Leonard, Mnler, Griffiths, Mcclatchie, & wherry, 1998) . 이러한 결과는 지역사 회와 집에서 간호를 받고 있는 뇌졸중 환자들에게 지속적인 재활 프로그램의 필요성이 높다는 것을 시사 한다고 볼 수 있다. 그러므로 입원을 한 직후부티 환 자에게 적절한 재활프로그램을 계획하여 시작하고 퇴원 후에는 연계되어 재활을 받을 수 있는 시설과 연결하여 환자가 지속적으로 재활을 할 수 있도록 돕는 병원과 지역사회가 공동으로 개발하고 시행하는 개활프로그램이 필요하다. 우울은 뇌졸중을 진단 받은 환자들의 급성기와 회 복기에 많이 동반되는 증상으로 본 연구에서도 CES- D를 이용하여 우울을 측정한 결과 23. 8점으로 Bak (2003) 의 연구와 비슷한 정도로 높게 측정되어 이 전의 연구결과와 같이 뇌졸중 환자의 가장 흔한 후유 증이 우울임을 다시 확인할 수 있었다 (Cho et al. 2003, `` Chon & Rhee, 1992, `` Kim, 2005, `` Kim, Seo, & Kang, 2000; singh et al. , 2000) . 그러므로 입원 시부터 신체적인 증상 뿐 아니라 우울도 같이 사정하고 우울이 진행되지 않도록 지속적인 관찰과 정서적인 간호가 뇌졸중 환자를 위한 재활프로그램에 포함이 되어야 한다. 삶의 질은 3 ``03점으로 뇌졸중 환자 l이명을 대상으로 한 chung (2000) 의 연구에서 의 3. 41점보다는 낮았으나 Kim과 Kim (2003) 의 연구의 3. 17점과는 비슷하였고 전체적으로 낮은 편이었다. 이런 결과는 최근 의학기술의 발전으로 뇌졸중으로 인한 사망률이 감소 되고 만성적인 뇌졸중 환자가 증가함에도 불구하고 재가뇌졸중 환자들에 대한 재활과 관리가 효과적으로 이루어지지 않고 있음으로 확인할 수 있었다. 따라서 뇌졸중과 삶의 질은 단기간에 향상되는 것이 아니므로 개활 프로그램이 단기적인 것보다는 체계적으로 계획되고 지속적으로 수행되어져 삶의 질을 관찰하는 연구가 필요할 것으로 생각된다. 또한 일상생활 동작을 잘 할수록 우울점수가 낮게 나타났고 삶의 질 정도가 높게 나타났다. 그리고 우 울 정도가 심할수록 삶의 질 정도가 낮은 것으로 나타났다. 뇌졸중 환자들에 대한 선행연구결과들을 살 펴보면 뇌졸중은 일상생활동작 수행과 같은 신체적인 문제, 우울, 대인관계 감소 등의 사회적 문제가 발생 되고 장기적인 치료와 간호를 요구하는 질병으로서 최종적으로. 삶의 질이 저하되는 것을 보고하고 있다 (Chung, 2000; Hama et al. , 2007, `` Ingrid, Kwakkel, Bruin, & Lindeman, 2007; Khan, 2004; Kim & Kim, 2003; singh et al. , 2007) . 이러한 연구 결과는 일상생활동작, 우울, 삶의 질이 단계적으로 순환되는 관계로 서 모두 뇌졸중환자를 위한 재활프로그램 내용에 포함되어야 함을 의미한다. 이런 연구결과들을 종합하여 볼 때 뇌졸중은 환자 의 뇌손상을 일으켜 장기적인 우울과 신체적인 기능 장애를 발생시킬 가능성이 높으므로 뇌졸중 환자의 재활프로그램은 입원을 하자마자 계획하여 치료와 동 시에 시작하고 특히 우울은 뇌졸중의 만성적인 건강 문제로 재활과정을 방해할 수 있으므로 신체적인 중 재와 더불어 정서적인 중재를 포함한 포괄적인 내용 의 프로그램이 바람직하고 장기적으로 삶의 질을 평 가함이 바랑직할 것이다. 또한 뇌졸중은 장기적인 재 활이 요구되는 질환이므로 단기간의 재활 프로그램을 병원에서만 시행하는 것이 아니라 퇴원 후 병원과 지 역 사회에서 연계하여 치료적인 연속성을 가지고 유지 할 수 있는 재활 프로그램의 개발이 반드시 필요할 것이 라고 본다. Introduction: The purpose of this study was to examine relationships among stroke patients`` activities of daily living(ADL), depression, and quality of life(QOL). Methods: Data were collected by questionnaires from 251 stroke patients at 5 hospitals and 2 public health centers in Seoul and Kyonggi-Do. The following Questionnaires were utilized for this study: Functional independence measure(FIM) from Grange, Hamilton, and Sherwin(1986), the Korean CES-D scale from Randloff(1977), and quality of life scale from Bang, Hwal-Lan(1991). Results: Data were analyzed using the pearson correlation, t-test, and ANOVA with SPSS/WIN 12.0. The results of this study were as follow; The subjects consisted of 110 females and 141 males. The mean score of activity of daily living was 87.2(range 18-126). Age, family history, comorbidity, paralysis site, and duration after diagnosis were significantly associated with activity of daily living. The mean score of depression was 23.8(range 11-44). Age, gender, education, and job were significantly associated with depression. The mean score of quality of life scale was 3.0(range 1-5). Gender, religion, education, job, economic status, and duration after diagnosis were significantly associated with quality of life. Relationships among activity daily living, depression, and quality of life scale: The activity of daily living had a negative relationship with depression score. The activity of daily living had a positive relationship with QOL score. The depression had a negative relationship with QOL score. Conclusion: Based on these results, it is necessary to run rehabilitation programs to improve stroke patients`` ADL, depression. Also, it research for of identifying stroke patients`` quality of life according to rehabilitation program.

〈교녀가〉연구

김정화(Kim, Jeong-Hwa) 한국어문학회 2014 語文學 Vol.0 No.125

〈Gyonyoga〉 is a kind of genyoga, which was written by father for daughters who lost their mother early. The author is conjectured to be Lee Jungen who also wrote 〈Bukgeongga〉. This is the first study on 〈Gyonyoga〉. There are 4 editions of 〈Gyonyoga〉 among which 〈Gyonyoga〉 possessed by Yangju Song is the complete work. 〈Gyonyoga〉 contained various contents focusing alert about wrong doing and discipline about well doing as two pillars. It warns wrong doing, and behavior focusing on Genyoga item. In well doing, it is based on theory of Taeguk, the basic of Confucianism explaining the origin of all things in the universe. And, as for behavior of women, it focused on sewing and spinning and the proprieties of food. While 〈Gyonyoga〉is a full-length work, it has outstanding structural unification overall. 〈Gyonyoga〉 not only deals with the warning against evil and admonition for good behavior as the broad structure, but also have structural density shown in ‘sewing and spinning songs’, which demonstrated the characteristics of male writer pursuing organized writing from the first. And ‘sewing and spinning songs’ in 〈Gyonyoga〉 connected to the recommendation on the mind of women. Father as the author of 〈Gyonyoga〉 regarded the mind ruling important based on the Confucian view of the world precedent to the importance of behavior. While it is positive to explain difficult issues easily for the understanding of daughters, it stresses the didactic purpose too much, which could be a limit of literature for women. Meanwhile, ‘Bettle song as a folk song is a work song composed by women. Accordingly, it contains emotion and suffering of women’s life. But, ‘Bettle song’ in 〈Gyonyoga〉 was composed by a man. Accordingly, emotion and suffering of women’s life was not the subject of consideration to the author of 〈Gyonyoga〉. Narrativity of ‘Bettle song’ is also closely related to the fact that it is song of women. Narrative story itself stirs curiosity of women, and women can be comforted regardless of its reality. To the contrary, ‘Bettle song’ in 〈Gyonyoga〉 completely excluded narrative story and did not include any emotional expression on the life of women. That is because ‘Bettle song’ was used for the didactic purpose from the perspective of male as a part of 〈Gyonyoga〉 regardless of the authorship of the song.

국내 경북지역 소에서 분리된 브루셀라 분리주의 생물학적 특성

김정화,임정주,김동혁,이진주,김대근,전무형,김상훈,장홍희,이후장,민원기,김석,Kim, Jeong-Hwa,Lim, Jeong Ju,Kim, Dong Hyeok,Lee, Jin Ju,Kim, Dae Geun,Jun, Moo-Hyung,Kim, Sang Hun,Chang, Hong Hee,Lee, Hu Jang,Min, Won-Gi,Kim, Suk 대한수의학회 2010 大韓獸醫學會誌 Vol.50 No.2

Members of the genus Brucella are facultative intracellular bacteria and cause brucellosis, a chronic disease in humans and abortion in animals. In this study, we tested sera for brucellosis of 15 Hanwoo farms in the western part of Gyeong-buk province, resulting 5 farms were brucellosis positive in 2008. We collected blood from 277 heads in the brucellosis positive 5 farms, and performed serological diagnosis, brucella positive cattle which had shown higher than 200 antibody titer in tube agglutination test were slaughtered, supramammary lymph nodes were collected, and Brucella spp. wild type isolation and identification were performed. From these results, 15 of Brucella spp. wild type strains were isolated and all strains were identified as B. abortus biotype 1 by biological and molecular analysis. In the antimicrobial susceptibility test, all 15 strains had a similar susceptibility and resistance pattern. This study may be useful for bacteriological and epidemiological understanding of cattle brucellosis in Korea.

청간소요산으로 호전된 설통 환자 3례

김연진,양승보,김정화,이상화,조승연,박성욱,박정미,고창남,Kim, Yeon-jin,Yang, Seung-bo,Kim, Jeong-hwa,Lee, Sang-hwa,Cho, Seung-yeon,Park, Seong-uk,Park, Jung-mi,Ko, Chang-nam 대한한방내과학회 2017 大韓韓方內科學會誌 Vol.38 No.4

Objectives: This clinical study reports the effects of Cheonggansoyo-san (CSS) on three patients with glossodynia. Methods: Three patients with glossodynia were treated with CSS (i.e., an herbal medicine) and acupuncture. Numeric rating scales (NRSs) for glossodynia and dry mouth and hwa-byung questionnaire scores were evaluated, and the results from heart rate variability (HRV) evaluations were analyzed. Results: After treatment with CSS, three patients' glossodynia symptoms, such as burning sensations, tingling, and numbness of the tongue, were improved. NRS ratings for glossodynia and dry mouth and the hwa-byung questionnaire scores also improved, and HRV parameters were closer to the normal range. Conclusion: Cheonggansoyo-san could be used to treat glossodynia.

니트웨어 소재의 감성 및 선호도

김정화,이선영,이정순,Kim, Jeong-Hwa,Lee, Sun-Young,Lee, Jung-Soon 한국섬유공학회 2007 한국섬유공학회지 Vol.44 No.6

The purpose of this research was to find out the factors that explain the subjective texture sensibility and image sensibility of knit fabrics. 43 different kinds of commercial knit fabrics were assessed subjectively by 178 consumers using the 7-point scale of 65 descriptors. The dimensions evaluating the texture sensibility and image sensibility of knit fabrics were also developed using the multi-dimensional scaling method. Hand and preference were predicted by the texture and image sensibility factors, respectively. The texture sensibility is explained by five factors: bulk, stiffness, density, elasticity and evenness. The image sensibility is explained by seven factors: feminine/masculine, new, casual, clear, classic, old and orderly. Better hand is found in knit fabric of pliable, light, and dry & bouncy texture. Higher preference is found in knit fabric of clean, comfortable, silent, attractive and chic image. The hand was predicted 51.1% with stiffness, density, bulk, and evenness factor. The preference was predicted 43.6% with new, feminine/masculine, casual, orderly and clear factor. The correlation coefficient between hand and preference was 0.358. Image sensibility is more important than hand on the preference of top outerwear.

뇌혈관질환의 재활간호

김정화,Kim, Jeong-Hwa 한국산업간호협회 2006 한국산업간호협회지 Vol.13 No.4

PU-나노 웹과 필름 처리한 투습방수 자카드 직물의 성능

김정화,이정순,Kim, Jeong-Hwa,Lee, Jung-Soon 한국섬유공학회 2014 한국섬유공학회지 Vol.51 No.6

The aim of this study was to measure the functional properties of a nanofiber web laminate, microporous film laminate, and nonporous coating fabric and then compare their performances as a breathable waterproof fabric. We focused on the performance of the nanofiber web laminate as a breathable waterproof fabric. A PU nanofiber web was prepared by electrospinning. The measured functional properties included the water vapor permeability, air permeability, waterproofness, adhesive strength, and water vapor resistance, as well as the property of a warm/cool feeling. The measurement results showed that the nanofiber web laminate fabric provided excellent moisture permeability as well as sufficient waterproofness and water vapor resistance in comparison to the microporous film laminate and nonporous coating fabric. We concluded that the performance of the nanofiber web laminate is sufficient for use as cloth in outdoor wear if an optimum electrospinning and lamination process is used in its production.

재가 뇌졸중 환자의 삶의 질에 영향을 미치는 요인

김정화,강현숙,김원옥,왕명자,장정미,Kim, Jeong-Hwa,Kang, Hyun-Suk,Kim, Won-Ock,Wang, Myung-Ja,Chang, Chong-Mi 한국재활간호학회 2006 재활간호학회지 Vol.9 No.1

Purpose: The purpose of this study was to identify factors affecting the Quality of Life of the Stroke Patients. Method: The subjects were 249 Stroke Patients who had visiting at the hospital and health care center. The research tools were FIM, CES-D, ATD PA, Quality of life Scale. Data were analyzed with SPSS WIN program in which frequency, percentage, Pearson's correlation and stepwise regression were used examination the factors affecting the quality of life. Result: There were positive correlation between patient's FIM and Quality of life, depression and physical disability, and negative correlation between FIM and depression and physical disability. Depression was the most important factor with influence on quality of life. Conclusion: Based on the results, Active nursing intervention to decreased depression and to improve patients physical functional status in needed.

방사선 조사가 백서 하악과두 연골 형성에 미치는 영향에 관한 형태계측학적 연구

김정화,허민석,이삼선,최순철,Kim Jeong-Hwa,Heo Min-Suk,Lee Sam-Sun,Choi Soon-Chul 대한영상치의학회 1999 Imaging Science in Dentistry Vol.29 No.1

Purpose: This study was undertaken to quantitatively estimate the degree of the damage and recovery of the irradiated rat condylar cartilage using the Image Analyzer. Materials and Methods: Experimental animals were 16 male rats of the Sprague-Dawley strain at the age of 20 day irradiated with the dose of 10 Gy in their head and neck region. Four rats were sacrificed at the each of the following time intervals - 1, 4, 7 and 14 days, respectively. The same number of control group animals were sacrificed at the each age of 21. 24, 27 and 34 days, respectively. The specimens were stained with 0.5% toluidine blue and examined with light microscope. The condylar cartilage was divided into 4 zones; fibrous zone, proliferating zone, upper hypertrophic zone, and lower hypertrophic zone. And then, the proliferating zone was subdivided into 2 layers - upper and lower layer, and upper and lower hypertrophic zone were subdivided into three layers, respectively - upper, middle and lower layer. With the aid of Image Analyzer, morphometric analysis was performed. The thickness, the numerical density of cells, the cell area density, the extracellular matrix area density, the mean area of single cell, the mean area of extracellular matrix per single cell were measured and analysed. Results: In the experimental group, the thickness of the fibrous zone was slightly increased and that of the proliferating zone and the upper and the lower hypertrophic zone was markedly decreased. With time, the thickness of the fibrous zone was gradually increased and that of the proliferating zone and the upper and the lower hypertrophic zone was steadily in the decreased state. The numerical density of cells of the proliferating zone was increased on post-irradiated 1 day, but decreased after post-irradiated 4 day, and that of the upper hypertrophic zone was decreased. The numerical density of cells of the lower hypertrophic zone was decreased in the early stage and then was decreased or not significantly different from that of the control group with time. In the experimental group, the cell area density of the fibrous zone and the proliferating zone was decreased in the early stage and then gradually increased or not significantly different from that of the control group with time. The cell area density of the upper and the lower hypertrophic zone was varied with time. The extracellular matrix area density value were totally opposite to the cell area density values: The mean area of single cell of the fibrous zone and the proliferating zone was .decreased on post-irradiated 1 day, and increased after post-irradiated 4 day. The mean area of single cell of the upper hypertrophic zone was varied with each layer and time. In the experimental group, the mean area of extracellular matrix per single cell of the fibrous zone was not significantly different with control group, and that of the proliferating zone was decreased on post-irradiated 1 day, and increased after post-irradiated 4 day. The mean area of extracellular matrix per single cell of the lower hypertrophic zone was increased in the early stage. and that of upper hypertrophic zone was varied with each layer and time. Conclusion: The condylar cartilages of rats were affected by irradiation, but the changes were vaned with each layer and time. By morphometric analysis. the changes of the cells of the condylar cartilage of irradiated rat could be calculated quantitatively.

가미귀비탕을 포함한 한방치료로 회상기억이 향상된 뇌졸중 후 인지저하 환자 2례

김정화,이형민,신희연,김하리,양승보,조승연,박성욱,고창남,박정미,Kim, Jeong-Hwa,Lee, Hyeong-min,Shin, Hee-yeon,Kim, Hari,Yang, Seung-Bo,Cho, Seung-Yeon,Park, Seong-Uk,Ko, Chang-Nam,Park, Jung-Mi 대한중풍순환신경학회 2018 대한중풍.순환신경학회지 Vol.19 No.1

■ Objectives This case study is to report the two cases of Gami-Guibitang on cognitive impairment after stroke with improved recall memory. ■ Methods We used Korean medicine treatments including Gami-guibitang, acupuncture and moxibustion to treat patients who had cognitive impairment after stroke for at least two months. We observed the changes of symptoms by measuring Korean version of Mini-mental status examination (MMSE-K), Clinical Dementia Rating (CDR) and Global Detration Scale (GDS). ■ Results After treatment, the patient's symptoms were improved including MMSE-K, CDR and GDS. Improvement appeared to be prominent in recall memory. The general condition were also improved after treatment. ■ Conclusion This clinical case study suggests that Korean medicine including Gami-guibitang could be used to treat patients who had cognitive impairment after stroke especially suffering from degraded recall memory.