Journal of the Institute of Electronics Engineers of Korea SC (전자공학회논문지SC)

The Institute of Electronics and Information Engineers (대한전자공학회)
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A New Shock Index for Predicting Survival of Rats with Hemorrhagic Shock Using Perfusion and Lactate Concentration Ratio

흰쥐의 출혈성 쇼크에서 관류와 젖산 농도 비를 이용한 새로운 생존 예측 지표 개발

  • Choi, Jae-Lim (Graduate Program in Biomedical Engineering, Yonsei University) ;
  • Nam, Ki-Chang (Clinical Trials Center for Medical Devices, Severance Hospital) ;
  • Kwon, Min-Kyung (Brain Korea 21 Project for Medical Science, Yonsei University) ;
  • Jang, Kyung-Hwan (Graduate Program in Biomedical Engineering, Yonsei University) ;
  • Kim, Deok-Won (Dept. of Medical Engineering, Yonsei Uinversity College of Medicine)
  • 최재림 (연세대학교 생체공학협동과정) ;
  • 남기창 (세브란스병원 의료기기 임상시험 센터) ;
  • 권민경 (연세대학교 의과학과) ;
  • 장경환 (연세대학교 생체공학협동과정) ;
  • 김덕원 (연세대학교 의과대학 의학공학교실)
  • Received : 2011.04.22
  • Accepted : 2011.07.04
  • Published : 2011.07.25
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Abstract

Hemorrhagic shock is a clinically widespread syndrome characterized by inadequate oxygenation and supply. It is important to diagnose hemorrhagic shock in its early stage for improving treatment effects and survival rate. However, an accurate diagnosis and treatment could be delayed in the early stage of hemorrhagic shock by evaluating only vital signs such as heart rate and blood pressure. There have been many studies for the early diagnosis of hemorrhagic shock, reporting that lactate concentration and perfusion were useful variables for tissue hypoxia and metabolic acidosis. In this study, we measured both perfusion using a laser Doppler flowmeter and lactate concentration from the volume controlled hemorrhagic shock using rats. We also proposed a new shock index which was calculated by dividing lactate concentration by perfusion for early diagnosis. As a result of the survival prediction by the proposed index with the receiver operating characteristic curve method, the sensitivity, specificity, and accuracy of survival were 90.0, 96.7 and 94.0%, respectively. The proposed index showed the fastest significant difference among the other parameters such as blood pressure and heart rate. It could offer early diagnosis and effective treatment for human hemorrhagic shock if it is applicable to humans.

쇼크(shock)란 조직에 필요한 산소 요구량과 공급 간의 불균형에 의해 유발되는 임상증후군을 말한다. 환자의 치료효과와 생존율 향상을 위해서 쇼크의 조기 진단은 매우 중요하다. 그러나 현재 쇼크 진단에 사용되는 맥박, 혈압 등 생체 징후의 경우 출혈 정도를 제대로 반영하지 못하여 환자에 대한 처치가 늦어질 수 있다. 따라서 쇼크의 조기 진단을 위한 많은 연구들이 진행되어 왔으며, 조직의 저산소증, 대사성 산증을 반영해주는 지표인 젖산 농도와 관류 측정의 유용성이 입증된 바 있다. 본 연구에서는 흰쥐를 대상으로 정량적 출혈을 유도한 후, 젖산 농도 측정과 laser Doppler flowmeter를 통해 관류를 측정하였으며, 지혈 후 젖산 농도/관류의 비(ratio)를 생존 예측을 위한 새로운 지표로써 제안하였다. 새로 제안된 지표를 통한 생존예측을 ROC 커브 방법에 적용한 결과, 민감도 90.0%, 특이도 96.7%, 정확도 94.0%를 보였으며, 생존군과 사망군 간 새로운 지표의 유의한 차이도 가장 조기에 보여주었다. 향후 임상 적용 연구를 통해 새롭게 제안한 지표의 임상 적용이 가능하다면, 쇼크 환자를 조기 진단하고 치료효과를 높일 수 있을 것으로 생각된다.

Keywords

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