Basic of NCS

한형태 대한임상병리사협회 2009 임상생리검사학회 발표자료집 Vol.2009 No.-

파열 된 뇌동맥류 목 묶음술에 대한 고찰

김동준,박상구,한형태 대한임상검사과학회 2015 대한임상검사과학회지(KJCLS) Vol.47 No.1

To measure motor evoked potentials (MEP) during emergency surgery is often difficult in patients with subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm, The cause of these difficulties may be considered as damage to the motor pathway by hemorrhage. To identify the cause of difficulties in measuring MEP, we defined the association between motor evoked potentials during surgery and the severity of the hemorrhage in patients with subarachnoid hemorrhage.

열전소자의 독립제어를 활용한 스마트 와인셀러

공유빈,전찬욱,박기백,한형태 한국조명·전기설비학회 2023 한국조명·전기설비학회 학술대회논문집 Vol.2023 No.11

SAH 환자에서 수술중 운동유발전위와 출혈의 중증도와의 연관성

김동준,임성혁,박찬우,박진우,박상구,한형태 대한임상병리사협회 2014 임상생리검사학회 발표자료집 Vol.2014 No.-

배경(Background) : To measure motor evoked potentials(MEP) during emergency surgery is often difficult in patients with subarachnoid hemorrhage(SAH) from a ruptured cerebral aneurysm, The cause of these difficulties may be considered as damage to the motor pathway by hemorrhage. To identify the cause of difficulties in measuring MEP, we defined the association between motor evoked potentials during surgery and the severity of the hemorrhage in patients with subarachnoid hemorrhage. 방법(Methods): From January 2010 to June 2014, we analyzed the initial CT and intraoperative MEP finding of 95 patients, who were admitted to Samsung Seoul hospital due to SAH from a ruptured cerebral aneurysm and had emergency operation on admission date. The severity of SAH was classified using the Fisher grade. The anesthesia was induced with total intravenous anesthesia(TIVA), and the use of muscle relaxant was avoided after induction of anesthesia. For stimulation and recording MEP, subdermal needle electrodes were used. The recording electrode were placed on abductor pollicis brevis(APB) and abductor digiti minimi(ADM) muscle in upper extremity and on tibialis anterior(TA) and abductor hallucis brevis(AHB) in lower extremity. 결과(Results): All 74 people since the beginning of the MEP wave formation is not surgery or left and right showed a significant difference when 13 people, but the significant difference is the wave of the form (5), unilateral phase annaon but if five people, but the upper extremity or if annaon 2 adults 1 patient each. Gr 4 of which more than eight out of 13 Fisher gr 4 suggest that this was more than the formation of the MEP waveform can not be carried out smoothly, it can be seen that the point is to set a baseline MEP hemorrhage after removal of the dura open to any should be made about the timing of. 고찰(Discussion): In fact, tests performed in the operating room during surgery intensive monitoring only one portion of the MEP waveforms were not observed and not one of SAH emergency surgery when considering characteristics may be quite embarrassing if the preoperative condition of the patient, such as Fisher grade carefully Check that the setting of Baseline MEP is somewhat removed from hemorrhage at the time should be set at the time of the change of the waveform during surgery surgeon to accurately observe and can give an appropriate warning sign..

수술 중 신경계 감시검사의 세계적 동향 및 임상병리사의 역할과 방향

박상구,김동준,박진우,박찬우,임성혁,현순철,한형태 대한임상병리사협회 2015 임상생리검사학회 발표자료집 Vol.2015 No.-

배경(Background): 수술 중 신경계 감시검사는 전세계적으로 매우 중요한 검사로 자리매김을 하였고, 점점 역할과 영역이 커지는 추세이다. 수술 이후에 회복 실에서 환자의 상태를 파악하던 수준에서, 수술중에 환자의 상태를 정확하게 파악을 할 수 있으므로, 잘못된 수술이나 수술후의 문제가 발생하는 경우를 사전에 예방할 수 있는 매우 중요한 검사이다. 이러하기 때문에 신경외과, 정형외과, 재활의학과, 마취과, 신경과, 갑상선 외과, 마취과 등에서 수술 중 신경계 감시검사를 자기의 과에서 시행하는 것으로 하기 위한 법적인 노력을 서로 하고 있다. 이러한 현실에서 중요한 점은 의료법에 검사의 행위자는 ``임상병리사``로 명시가 되어있다는 것이다. 다양한 여러 과에서 필요로 하는 수술 중 신경계 감시검사를 최적의 상태로 수행하여 수술 중 신경계 감시검사의 영역을 임상병리사의 영역으로 확고히 하는 노력이 필요하리라 생각한다. 방법(Methods): 수술 중 신경계 감시검사의 세계적 동향을 살펴보고, 우리의 현실을 자각하고, 앞으로 나아가야 할 방향을 모색해 보자. 결과(results): 전문임상병리사제도와 같은 수술 중 신경계 감시검사 자격증이 미국에 여러 가지 있다. 그 중에 한가지를 자세히 살펴보면, ㄱ.현재 수술 중 신경계 감시검사를 하고 있는 사람이고, ㄴ.150건 이상의 수술 중 검사 경력이 있어야 하고, ㄷ.뇌파나 유발전위 자격증 소지자이거나 이에 버금가는 이러한 자격증 시험비중을 살펴보면, ㄱ.기본 적인 준비사항(25%) ㄴ.수술 중 발생하는 문제(66%)ㄷ.수술 이후 발생하는 문제(6%) ㄹ.전문적인 윤리학(3%) ㅁ.유발전위 실행능력(20%) 등으로 분류된다. 이러한 자격증과 시험비중을 살펴봄으로써 우리가 좀더 자세하게 공부하고 공유해야 할 부분이 무엇인지 우리의 부족한 부분이 도출된다. 고찰(Discussion): 수술 중 신경계 감시 검사자 들 간에 기본지식을 공유하고, 이론적 지식을 다 함께 공부하고, 실무능력을 향상 시키기 위한 학술활동을 더욱 열심히 한다면 국내뿐만 아니라 전 세계적으로 수술 중 신경계 감시검사를 선도하리라 생각한다.

수술 중 FVEP의 유용성과 한계

박찬우,임성혁,박진우,김동준,박상구,한형태 대한임상병리사협회 2014 임상생리검사학회 발표자료집 Vol.2014 No.-

배경(Background): Intraoperaive flash visual evoked potentials(FVEPs) monitoring are often irreproducible during surgery, has been regarded as having limited significance for the preservation of visual function during surgery. The aim of this study was to define the relationship between changes in the intraoperative flash visual evoked potentials waveform and postoperative outcome associated with visual function, and to suggest useful warning criteria during transsphenoidal surgery. 방법 (Methods): Between January 2013 and December 2013, we performed intraoperative FVEP monitoring during endoscopic transsphenoidal surgery for 28 patients with pituitary tumors. Flash stimuli were presented through the closed eyelid by an array of light-emitting diodes(LED) mounted in an opaque eye patch. Stimulus rate of 0.9Hz with 0.3msec duration were used. Red LEDs were flashed at maximum intensity. All patients had pre- and post-operation visual function examination including visual acuity(VC) and visual field(VF) analysis. Improvement in VC was defined as post-operative VC was improved 0.2 more compared to pre-operative VC, and deterioration in VC was defined as post-operative VC was decreased 0.2 more compared to pre-operative VC. Patients was divided to 3 groups (improvement, no change, and deterioration) for VF comparing preoperative and postoperative VF examination. Based on intraoperative FVEP latency changes, patients were also classified into the following three groups: (A) group: prolongation of wave IV<20msec, (B) group: prolongation of wave IV<50msec (C) group: prolongation of wave IV..50msec. Based on intraoperative FVEP amplitued changes, patients were also classified into the following three groups: (a) group: decreasement of wave III-V and IV-V amplitude<50% (b) group: decreasement of wave III-V and IV-V amplitude.. 50%, (c) group: decreasement of wave III-V and IV-V amplitude.. 80%. We analyzed the association between changes in the intraoperative flash visual evoked potentials waveform and postoperative outcome associated with visual function. 결과(Results): I was able to eye 40 out of 56 in the eye (71.4%), to measure the base line. Changes in the latency of FVEP was as follows: of the 40 eyes. (A) group 34 eyes(85.0%), (B) group 4 eyes(10.0%), (C) group 2 eyes(5.0%). Vision loss was as follows. (B) group 1eye(25.0%), (C) group 1eye(50.0%). Visual field defects, were as follows. (A) group 3 eyes(8.8%), (B) group 1 eye(25.0%), (C) group 1 eye(50.0%). Changes in the amplitude of the 40 eyes in FVEP is as follows. (A) group 30 eyes(75.0%), (B) group 7 eyes(17.5%), (C) group 3 eyes(7.5%). Vision loss is as follows. (A) group 1 eye(3.3%), (C) group 1 eye(33.3%). Are as follows: visual field defect, (A) group 2 eyes(6.6%), (B) group 1 eye(14.2%), (C) group 1 eye(33.3%). 고찰 (Discussion): Intraoperaive FVEPs monitoring during transsphenoidal surgery may be useful to protect visual function, in terms of visual acuity. prolongation of wave IV≥20msec, decreasement of wave III-V and IV-V amplitude≥80% in intraoperaive FVEPs monitoring can be used as a criterion for protecting visual acuity during transsphenoidal surgery.

수술 중 새로운 청신경 검사법의 유용성

박상구,임성혁,박찬우,박진우,김동준,한형태 대한임상병리사협회 2014 임상생리검사학회 발표자료집 Vol.2014 No.-

배경(Background): Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) has been widely used as a non-invasive and simple technique for continuous surveillance of the functional integrity of the peripheral and central auditory systems. To obtain reliable response in intraoperative monitoring of BAEPs, usually 10Hz stimulated rate and 1000 averaged trials are recommended in which it takes about 2 minutes. However, these conventional methods may miss the real-time nerve damage. As to ensure a stable waveform, using faster stimulation rates can be possible to collect a fixed number of averaged trials for shorter periods, which in turn allows for a faster feedback to the surgeon. This study was performed to evaluate the usefulness and suggest the meaningful waning criteria of new BAEP monitoring method using faster stimulation rate in microvascular decompression (MVD) for patients with hemifacial spasm (HFS). 방법(Methods): From January to December 2013, intraoperative monitoring of BAEPs using faster stimulation rate was conducted for 254 HFS patients during MVD. All patients, conducted in intravenous anesthesia, Sound intensity 120dB SPL, Tubal insert phone acoustic transducer stimulation. Subdermal needle electrodes were used for intraoperative monitoring, and electrode placement followed the standard set-up. We used BAEP stimulation rate of 40 ~ 50Hz and 400 averaged trials, which enabled to check the responses within 10 seconds. To evaluated usefulness the new BAEP monitoring method, we defined the proportion of patients with hearing loss using pure tone audiometry (PTA) and speech audiometry (SA) 3 month after MVD surgery. Hearing loss was defined as follows: In PTA, shows a hearing loss of 15dB or more, SA was based on the reduction of 20%. 결과(Results): 72 people total HFS254 hit man, a woman was 182 people. 50.1 .. 12.5 years old man, was 52.6 .. 10.9 years old female. 131 people left, was right 123 people. During surgery BAEP waveform, patients 26.4% (254 hit 67 people), was observed (amplitude) changes in the waveform. Amplitude changes in the number of V waveform, (51 patients, 20.1%) recovery after the reduction of less than 50% relative to the V-V ``in intraoperative BAEP waveform, recovery after 50% reduction (14 patients, 5.5%), wave loss (2 patients, 0.8%) was investigated by separating. V-V ``wave changes were observed in the patients`` change in V at less than 1ms latency of the waveform (7 patients, 10.4%), 1 ~ 2ms or less (38 patients, 56.7%), 2 ~ 3ms or less (16 patients, 23.9 %), 3ms or more (6 patients, 8.9%), separated by an extended period examined. Changes in hearing, which was confirmed after three months after surgery, patients were patients of the collision of two complete 254. One patient was PTA 20dB reduction in these, the waveform is reduced by more than 50% during surgery, latency was prolonged 3ms more than to a case where the recovered, one of the other occurs Deaf, it was when the latency of the waveform is extended 3ms and during surgery has decreased and disappeared. 고찰(Discussion): We found that the new BAEP method using faster stimulation rate when monitoring in MVD for HFS patients was more useful to protect the auditory systems compared with conventional method. I think it has a test with a warning based on the reduction of 50% of the waveform, and is associated with hearing loss case is the loss of the waveform.

Brain tumor 환자에서 수술 중 TceMEP 및 DCS 모니터링의 유용성

임성혁,박찬우,박진우,김동준,박상구,한형태 대한임상병리사협회 2014 임상생리검사학회 발표자료집 Vol.2014 No.-

배경(Background): During operation to remove the tumor in patients with brain tumor near motor cortex, it is very important to monitor the motor pathway for protecting motor function. There are two methods in intraoperative monitoring for motor pathway: Transcranial electric stimulation (TES) and Direct cortical stimulation (DCS). Some patients showed same findings in both of the two tests, however some patients presented different findings in the two tests as follows: no MEP potential in DCS and normal MEP potential in TES. To define the importance of intraoperative DCS compared with intraoperative TES, we checked the intraoperative finding and the changes in motor function after surgery in patients with brain tumor near motor cortex. 방법(Methods): Three patients with brain tumor near motor cortex had both of TES and DCS during surgery. The progression in intravenous anesthesia at the time of surgery of all, you have to maintain the state of the muscle relaxant to TOF4 / 3 or more. For TES, needle electrode were used, and the position of the stimulation electrodes 10 to 20 followed the standard EEG electrode placement, location of the point of C3 and C4 were stimulated region.The recording electrode were placed on abductor pollicis brevis(APB) and abductor digiti quinti (ADQ) muscle in upper extremity and on tibialis anterior(TA) and abductor hallucis (AH) in lower extremity. For DCS, bipolar stimulation was used, and recording electrode were placed on deltoid, biceps brachii, APB and ADQ in upper extremity and on vastus lateralis, TA, and AH in lower extremity. Both TES and DCS were performed frequently during surgery. We checked the change in motor function by comparing preoperative and postoperative motor function. 결과(Results): Case1. In patients with Lt. Patients with frontal High grade glioma, has been conducting inspections using only TES method during surgery, there was no change in the waveform is TES, Paralysis occurs after surgery. Case2 In patients with Rt. parietal Adenocarcinoma patient, I proceeded with the Direct cortical Stimulation inspection and TES way during surgery. In a continuously Stimulation looking for central sulcus can use Grid electrode, to find the correct function of the brain, and surgery to avoid the site, post-operative patients is very normal. Case3. In patients with Rt.frontal High grade glioma, I went to Direct cortical stimulation and testing TES way during surgery. The Stimulation looking for a central sulcus using the Grid electrodes, it proceeded continuously, but in the cerebral cortex, and proceeds the operation of any function may not be observed at the tumor site, and placebo feeling appeal somewhat after surgery perfectly normal and to recover from. 고찰(Discussion): To check DCS as well as TES during intraoperative monitoring in patients with brain tumor near motor cortex is very important for protecting motor function. To rely on the change in TES be unreliable in surgery for patients with brain tumor near motor cortex.

천막상부 뇌종양 측두엽 절제술 환자에서 운동유발전위 파형의 변화 분석

박진우,임성혁,박찬우,김동준,박상구,한형태 대한임상병리사협회 2014 임상생리검사학회 발표자료집 Vol.2014 No.-

배경(Background): Monitoring motor evoked potentials (MEPs) during surgery is useful test to surveillance motor function. If bilateral upper and lower extremity response are changed in monitoring MEPs, one should consider a systemic etiology, such as blood pressure change or anesthetic factors. In contrast to this would be a change that only affects the lower extremity or affects an upper and lower extremity on only one side, another etiology, not a systemic etiology, must be considered. Non-systemic causes is very diverse, and to identify the cause of such a phenomenon requires lots of experience. We investigated the non-systemic cause and the proportion for presenting MEPs change during brain surgery 방법(Methods): We analyzed intraoperative MEPs findings of the patients who had brain surgery due to brain tumor or temporal lobe epilepsy from January 2012 to June 2014. We checked patients who showed a significant (50% or greater) decrease in amplitude or disappear of MEPs on only one extremity or one side during brain surgery. The anesthesia is induced with total intravenous anesthesia (TIVA), and two to four twitches in a train of four (TOF) were guaranteed. Anodal stimulation was used. The location of the stimulation electrode followed the standard 10-20 EEG electrode placement, and the recording electrode were placed on abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscle in upper extremity and on tibialis anterior (TA) and abductor hallucis brevis (AHB) in lower extremity. 결과(Results): Intraoperative monitoring records of total 779 patients (630 brain tumor and 149 temporal lobe epilepsy) were retrospectively analyzed. 39 (5.0%) patients (34 brain tumor and 5 temporal lobe epilepsy) showing MEP changes that suggested non-systemic causes were defined. 15 patients of these were associated with resection of the lesion, and were not recovered. On the other hand, 24(3.0%) patients were occurred by other causes, were not related with resection of the lesion. 9 of 24 patients showed MEP changes on only one upper extremity, 3 patients showed on only one lower extremity, and the remaining 12 patients showed an upper and lower extremity on only one side. The causes of MEP changes showing the recovery after removing the cause were retraction, bleeding, and artery adhesion. 고찰(Discussion): Intraoperative MEP changes were occurred by non-systemic causes in considerable patients that had surgery due to supratentorial brain tumor or temporal lobe epilepsy. To interpret the causes of MEP changes is very important, and It shall be provided with recognized various causes in the process of tumor removal and the process of accessing the lesion.

당일 검사에 대한 원스톱 서비스 전과 후의 고객만족도 비교

강건우,이의정,이현경,이은선,임양희,한형태,Kang, Kun-Woo,Lee, Eui-Jeong,Lee, Hyun-Kyung,Lee, Eun-Son,Lim, Yang-Hee,Han, Hyung-Tae 한국의료질향상학회 2020 한국의료질향상학회지 Vol.26 No.2

Purpose:Hospitals provide top medical service using exceptional manpower, medical technology, and state-of-the-art equipment, thus raising the standard of customer satisfaction. In addition, their medical service is becoming higher than before. One-stop service is a good way to improve the quality of customer-centered service as a qualitative marketing strategy. This study thus aims to facilitate subsequent research and compare customer satisfaction before and after one-stop service. Methods: The study included 72 patients who received the reserved examination and one-stop service for 20 days from April 23 to May 12, 2014. The surveyed questionnaire data were analyzed using SPSS 18.00. Results: The comparison results of customer satisfaction showed that the satisfaction score was generally high in the areas of kindness of examination staff, the speedy/accuracy of work processing of examination staff, and the kindness of reservation staff. The group before one-stop service showed their dissatisfaction with repeated visits and difficulty of booking a desired day. The group after one-stop service showed dissatisfaction with the long waiting time for examination or same-day treatment. Conclusion: The one-stop service showed good results, but new uncomfortable issues for the customer were revealed as well, which may result in more work of employees. Considering the characteristics of various clinical departments, the author hopes to find an efficient operation plan through the development and improvement of an appropriate one-stop service method.