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급성 심근경색증 환자의 예후인자로서 내원 시 혈당의 유용성
승기배 ( Ki Bae Seung ),조명찬 ( Myeong Chan Cho ),박승정 ( Seung Jung Park ),김은정 ( Eun Jung Kim ),박오장 ( Oh Jang Park ),정명호 ( Myung Ho Jeong ),안영근 ( Young Keun Ahn ),김주한 ( Ju Han Kim ),김영조 ( Young Jo Kim ),채성철 대한내과학회 2010 대한내과학회지 Vol.79 No.1
Background/Aims: It has been suggested that admission hyperglycemia is associated with poor clinical outcomes in patients with acute myocardial infarction (AMI). The aim of this study was to assess the relationship between admission hyperglycemia and short-long term prognosis in patients with AMI. Methods: A total of 6,030 AMI patients without a previous history of diabetes were enrolled between Nov. 2005 and Jan. 2008. The patients were divided into three groups according to the levels of admission glucose levels: group I (<140 mg/dL, n=3,307), group II (140~199 mg/dL, n=1,946), and group III (≥200 mg/dL, n=777). In-hospital and one-year mortality were compared among three the groups. Results: The mean age was 64.3±13.3, 65.9±12.7, and 67.7±13.0 years in group I, II and III, respectively. The proportion of female gender (23.9%, 29.5%, 35.0%; p<0.001), Killip class III-IV (8.9%, 12.3%, 28.3%; p<0.001), ST-segment elevation myocardial infarction (54.6%, 71.5%, 71.7%; p<0.001), and in-hospital mortality (3.5%, 7.5%, 19.7%; p<0.001) increased with higher tertiles of elevated values of initial serum glucose. Hazard ratio (HR) for mortality rate were significantly increased in group II [HR=1.19, 95% confidential interval (Cl) 1.02~1.40, p=0.032], and in group III [HR=1.91, 95% Cl 1.59~2.30, p=0.001], compared with group I. And also significant differences were existed between group II and group III [HR =1.55, 95% Cl 1.27~1.88, p=0.001]. Conclusions: Admission glucose in patients with AMI provides incremental prognostic value, and significantly correlates with in-hospital and one-year mortalities.
D.D.D. 형 인공심박동기 시술 환자에서 심방심실 연속자극간격 변화가 수축기와 이완기에 미치는 영향
이만영(Man Young Lee),승기배(Ki Bae Seung),전승석(Seung Sok Chun),채장성(Jang Seong Chae),김종상(Jong Sang Kim),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1992 대한내과학회지 Vol.43 No.2
N/A Background: Although the duration of the atrioventricular delay is known to affect ventricular diastolic filling time, the hemodynamic effects have been controversial. Several recent studies attempted to clarify the issue of optimal AV delay and have come to different conclusions. So we performed this study to evaluate the hemodynamic effects of varying A-V delays in A-V sequential pacing by echocardiography. Methods: 9 patients of this study had D,D.D. pace- makers because of complete atrioventricular block or sick sinus syndrome. The mean age of 5 male and 4 female patients was 49±22 years. Using the programming device, the pacing rate was set at 70/min, and at 5 different A-V delays (100, 125, 150, 175, 200, 250 ms), we measured the changes of various time intervals during systolic and diastolic phase by recording the M-mode echocardiogram of aortic and mitral valve, ECG, and phonocardiogram simultaneously. Results: In systolic phase, preejection periods were significantly shortened at A-V delay 200ms, 250 ms comparing to those of A-V delays below l75 ms. Left ventricular ejection times showed no statistically significant changes between various A-V delays. Systolic time intervals showed significant decrements at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. Changing the A-V delay from 100 ms to 250 ms, isovolumic contraction times were significantly pro- longed and isovolumic contraction time/preejection period ratios were significantly increased. And in diastolic phase, mitral valve opening times were significantly shortened at A-V delay 200 ms, 250 ms comparing to those of A-V delays below 175 ms. A spike-Mc intervals were significantly prolonged as changing the A-V delay from 100 ms to 250 ms. Conclusion: These data suggest that the change of A-V delay in D.D.D. pacemakers had variable effects on various time intervals of systolic and diastolic phase. Considering the close relationship between the systolic time interval and cardiac function, relatively long A-V delay such as 200 ms or 250 ms was thought to be more desirable in patients of this study. And measurement of systolic time interval by echocardiography could be used as an useful, noninvasive guideline for determining the optimal A-V delay in individual patient.
이만영(Man Young Lee),승기배(Ki Bae Seung),김종진(Jong Jim Kim),노태호(Tae Ho Rho),채장성(Jang Seong Chae),김종상(Jong Sang Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Chol) 대한내과학회 1990 대한내과학회지 Vol.39 No.6
N/A To evaluate the clinical differences between Q wave myocardial infarction and non-Q wave myocardial infarction, the records of 336 patients with first myocardial infarction were reviewed. According to the presence or absence of Q waves on electrocardiogram, the patients were divided into two groups: a Q wave myocardial infarction group and a non-Q wave myocardial infarction group. The results were as follows: 1) According to standard electrocardiographic criteria, among 336 patients 271 patients (80.6%) had Q wave myocardial infarctions, and 65 patients (19.4%) had non-Q wave myocaridal infarctions. 2) The average age and male-to-female ratio were similar in the two groups. There were no significant differencres between the two groups in serum cholesterol levels and in incidences of a history of hypertension and diabetes mellitus. 3) Peak cardiac enzyme levels of CPK and LDH were significantly higher in the Q wave myocardial infarction group than in the non-Q-wave myocardial infarctions group. 4) When the complications of arrythmia, congestive heart failure and hospital mortality were compaired, incidences of AV block and congestive heart failure were significantly higher in the Q wave myocardial infarction group, but there was no difference in hospital mortality between the two groups. 5) Incidences of recurrent angina, congestive heart failure, reinfarction, death, and cause of death were not different statistically between the two groups, even though there was a tendency to have more recurrent angina and reinfarction in the non-Q wave myocardial infarction group and more congestive heart failure in the Q wave myocardial infarction group.
전두수(Doo Soo Jeon),정해억(Hae Uk Chung),승기배(Ki Bae Seung),강동헌(Dong Hun Kang),김상우(Sang Wo Kim),김용주(Young Ju Kim),채장성(Jang Sung Chae),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1996 대한내과학회지 Vol.50 No.6
N/A Objectives: Cardiogenic shock resulting from acute myocardial infarction is a serious complication with high mortality. The early identification of patients at high risk of developing post-infarction cardiogenic shock might allow early intervention in an attempt to prevent cardiogenic shock and to reduce the mortality due to cardiogenic shock. The aim of the present study was to examine the risk factors of inhospital development of cardiogenic shock among patients with acute myocardial infarction. Methods: We studied 152patients with acute myocardial infarction who were admitted to Kang-Nam St. Mary's hospital within 24hours after the onset of chest pain and did not have cardiogenic shack on admission between March 1991 and May 1994. Clinical data of these patients were analyzed. Results: Of 152patients, 17(11.1%) developed cardiogenic shock during their hospital stay. Cardiogenic shock developed in 53% of cases more than 24hours after admission. 82.4% of patients with cardiogenic shock died whereas a 6.7% in-hospital mortality was found among patients without cardiogenic shock. Multivariate regression analysis that controlled for variables affecting incidence of postinfarction cardiogenic shock showed that independent risk factors for in-hospital cardiogenic shock were history of myocardial infarction (adjusted relative odds[RO]=5.294, 95% confidence interval[CI]=2.149 to 13.041); heart failure on admission (RO=3.344, 95% CI=1.738 to 6.432); hyperglycemia (>180mg/dl) in non-diabetic patients (RO=3.270, 95% CI=1,590 to 6.727); age over 70 year old (RO=2.912, 95% CI= 1.816 to 4.668); ST deviation over 4mm (RO=2.417, 95% CI=1.225 to 4.767); peak LDH level greater than 1600U/ml (RO=1.154, 95% CI=1.080 to 1.233). Patients with one independent risk factor had an estimated probability of 10.5% for developing inhospital cardiogenic shock; patients with two independent risk factors, 48.5%, patients with three risk factors, 65.0% patients with four risk factors, 65.7% patients with five risk factors, 67.2%. Conclusion: Of post-infarction cardiogenic shock during admission, 53% developed more than 24hours after admission. The more independent risk factors on admission for inhospital cardiogenic shock patients with acute myocardial infarction had, the more likely in-hospital cardiogenic shock developed.