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Glycine에 의한 가토심방근 및 동방결절세포의 활동전압의 변동
최경훈,김진혁,고상돈,신흥기,김기순,Choe, Kyung-Hoon,Kim, Jin-Hyuk,Koh, Sang-Don,Shin, Hong-Kee,Kim, Kee-Soon 대한생리학회 1988 대한생리학회지 Vol.22 No.2
The effect of glycine, structurally the most simple amino acid was investigated on the electrophysiological characteristics of the isolated superfused atrial muscle and sinus node cells of the rabbit heart. Superfusion of the sinus node cell with glycine solution (3, 5 and 8 mM) produced concentration-dependent increments of OS (overshoot potential) and MDP (maximum diastolic potential). Generally action potential amplitude increased as a result of greater increment of OS than that of MDP. The changes in action potential of the sinus node cell peaked in $7{\sim}10{\;}minutes$ after onset of superfusioin. On the contrary to the response to intravenously administered glycine, the rate of spontaneous firing of sinus node cell was invariably increased following superfusion with glycine. Action potential duration manifested as $APD_{60}$ (time to 60% repolarization) was significantly shortened by glycine. And the electrophysiological effects of glycine on the atrial muscle cell were similar to that on the sinus node cells. The results of present study suggest that glycine can exert direct effects on the atrial muscle and sinus node cells of the rabbit heart.
황성오 ( Sung Oh Hwang ),안무업 ( Moo Eob Ahn ),김영식 ( Young Sik Kim ),임경수 ( Kyung Soo Lim ),윤정한 ( Jung Han Yun ),최경훈 ( Kyung Hoon Choe ) 대한응급의학회 1992 대한응급의학회지 Vol.3 No.1
Background: In Korea, the victims with prehospital cardiac arrest have little chance to survive, because bystanders do not know how they resuscitate the victims and emergency medical system is incomplete. And there has been no report about resuscitation attempt and survival rate of the prehospital cardiac arrest in Korea. Study Objectives : This study was undertaken to determine the overall survival rate and the factors influencing to survival when cardiopulmonary resuscitation was attempted to the victims of prehospital cardiac arrest. Study Subjects . We studied prospectively 31 consecutive victims with prehospital cardiac arrest. Results . Cardiac arrest were caused by trauma(52 %), cardiac diseases(26%) and non-cardiac medical diseases(22%). Spontaneous circulation was restored (ROSC) in 12 victims(39 %). And patient with non-traumatic cardiac arrest were more likely to restore spontaneous circulation(73%) than were patients with traumatic cardiac arrest(0.7%, P<0.05). Patients having ventricular fibrillation on ECG monitoring were more likely to restore spontaneous circulation(64.3% ) than were other patients(13%, P<0.05). Mean circulatory arrest time was 19.1+-9.9 minutes and it was shorter in patients with ROSC(13.8+-5.3) than patients without ROSC(22.4+-10.7, P<0.05). Cutting point between two group was 19 minutes. Among 12 patients who restored spontaneous circulation, 6 patients had only transient ROSC, 5 patients died from brain death(two moribund discharge was included) and only 1 patient discharged alive without neurologic complication.Conclusion . Under the current setting of emergency medical system in Korea, our data revealed improved rate of ROSC in victims of prehospital cardiac arrest, when circulatory arrest time was short(<19 minutes) and ECG rhythm on hospital arrival was ventricular fibrillation from non-traumatic causes. And considering the feasibility to survive, cardiopulmonary resuscitation should be attempted to the victims with prehospital cardiac arrest.
급성 심근경색증 환자에서 조기에 적절한 재관류 요법을 시행받지못한 요인
유병수(Byung Su Yoo),윤정한(Jung Han Yoon),박금수(Keum Soo Park),여경구(Kyung Koo Yoh),조윤경(Yun Kyung Cho),안승찬(Seung Chan Ahn),이용규(Yong Kyu Lee),송광선(Kwang Seon Song),최경훈(Kyung Hoon Choe),이부수(Boo Soo Lee),황성오(Sung 대한내과학회 1995 대한내과학회지 Vol.48 No.6
N/A Objectives: Early application of reperfusion therapy such as thrombolytic agent or direct PTCA is utmost important to amximize the efficacy of reperfusion therapy in patients with aute myocardial infarction. However, early adequate reperfusion thearpy was given only in 15% to 36% pf patients with acute myocardial infarction and substantial patients were not benefited from reperfusion therapy, Therefore, we performed these study to evaluate the reasons for which patients with acute myocardial infarction cannot receive an adequate reperfusion therapy. Methods: We analyzed the initial electrocardiogram and various time delays from chest pain onset time, first hospital arrival time, transfer time, ER arrival time, and door to reperfusion time in 138 patients with acute myocardial infarction from Jan. 1991 to Oct. 1993 admitted to Wonju Christian Hospital. Patients were grouped as reperfusion group(n=55) who had reperfusion therapy such as thrombolytic trial or direct PTCA and conservative grou who had not received reperfusion therapy(n= 83). Results: 1) Eighty-three cases(60.1%) did not received an adequate reperfusion therapy. 2) Hospital arrival time of patients was 237±162min and 786±615min in reperfusion and conservative group(p<0.05) respectively. Patient time delay was 103±98min and 439±511min, first hospital time delay, 93±78min and 333±482min, and transfer time, 81±59min and 105±64min in reperfusion and conservative group respectively(p<0.05). Only 4.8% of patients was transferred from first hospital after reperfusion therapy. 3) Patient time delay was the most common reason of not receiving reperfusion therapy, and time delay and lack of adequate reperfusion therapy at the first hospital inspite of early arrival were the second place. Other reasons were contraindication to lytic therapy(4 cases), definite Q wave MI(11 cases), inconclusive EKG(4 cases), and delay in therapy(4 cases). Conclusion: The most common reason of not receiving reperfusion therapy was patient delay in seeking medical care(45.8%) and time delay at first hospital in 22 cases(26.5%). To maximize the effectiveness of reperfusion therapy, it is important to shorten hospital arrival time delay and widespread use of reperfusion therapy at first hospital is recommeded.
심방중격결손증 환자에서 도플러심초음파와 심도자술을 이용한 폐혈류량과 체혈류량의 비교
오미희(Mee Hee Oh),전근재(Geon Je Jeon),민병철(Byoung Chul Min),박금수(Keum Soo Park),최경훈(Kyung Hoon Choe) 대한내과학회 1989 대한내과학회지 Vol.37 No.3
N/A The measurement of systemic flow (Qp) and pulmonary flow (Qs) is clinically important in the management of adult patients with an atrial septal defect. In clinical practice, this is usually assessed by oximetry, radionuclide technique. 1n previous experimental and pediatric studies, the ratio of pulmonary to systemic flow (Qp/Qs) was accurately estimated by Doppler echocardiography in various cardiac shunt lesions. The purpose of this study was to assess the accuracy of pulsed Doppler echocardiography in adult patients with atrial septal defect. In 10 patients and 10 normal persons, blood flow was measured in the right and left ventricular outflow tracts by pulsed Doppler echocardiography and compared with the oximetric measurement. The results were as follows; 1) In 10 patients without heart disease, the correlation (r) between systemic (Qs) and pulmonary (Qp) blood flow was 0.91 (y=0.88 x±0.8) and the Qp/Qs ratio ranged from 0.85 to 1.14 (mean 0.96±0.09). 2) In 10 patients with an atrial septal defect, the mean Qp/Qs ratio measured by oximetry was 1.68J0.46 and by pulsed Doppler echocardiography was 1.56±0.30 (p=NS). In these patients, the correlation between the Qp/ Qs ratio determined by oximetry and pulsed Doppler echocardiography was significant (r=0.89, y=0.58x±0.58). 1n adult patients with artial septal defect and high quality echocardiograms, the magnitude of the pulmonary to systemic flow ratio can be assessed by noninvasive and simple pulsed Doppler echocardiography.
이형협심증(Variant Angina)에 의한 급성심장사(Sudden Cardiac Death) 환자의 성공적인 소생
윤정한,황성오,안무업,임경수,박금수,김영식,최경훈 대한응급의학회 1992 대한응급의학회지 Vol.3 No.2
In our contry, prehospital cardiac arrest means death because layman can not perform cardiopulmonary resuscitation(CPR) and there is no emergency medical technician and transport system for treating victims with prehospital cardiac arrest. And many of physicians usually do not try to perform CPR because they used to treat victims with prehospital cardiac arrest as the dead, so-called “death on arrival(DOA)”. Recently, we experienced a 52 year-old mean who sustained from prehospital cardiac arrest induced presumably by variant angina initiated about 20 minutes before hospital arrival. On hospital arrival, he had a fine ventricular fibrillation, but spontaneous circulation was restored (ROSC) at 14 minutes after CPR strated. At 2 hours after ROSC, marked elevation of ST segment appeared and shortly, complete AV block developed. After sublingual and intravenous administration of nitroglycerin, ECG changes disappeared. Diffuse spasm of coronary artery with ST segment elevation was documented during coronary angiogram which showed no atherosclerotic change of coronary artery. He recovered good neurologic function (cerebral performance categories 1) and discharged on his foot.