• Journal of Chest Surgery
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• 제35권10호
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• pp.730-735
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• 2002

횡격막은 횡격막 신경과 동측의 하 흉벽 늑간신경의 지배를 받는다. 상완신경총의 적출 손상을 가진 환자에서 신경총의 일부 신경의 신경이식술에 횡경막 신경의 신경 이식편이 종종 이용된다. 이와 같이 횡격막 신경이 신경이식편으로 사용된 환자에서 횡격막 신경의 탈신경으로 인하여 발생하는 횡격막의 위치 및 운동의 변화를 연구하였다. 대상 및 방법 : 어께의 둔상으로 상완신경총의 적출 손상 때문에 동측의 횡격막 신경으로 근피부신경에 신경이식술을 시행한 13예를 대상으로 하였다. 흉강경 수술방법으로 흉강 내 횡격막 신경을 박리하고 횡격막 바로 위에서 횡격막 신경을 절단하여 경부 절개창을 통해서 외부로 끌어낸 다음 피하 터널을 통해서 동측의 근피부신경에 이식하였다. 엑스선 투시검사와 흉부 엑스선 촬영으로 수술 전후의 횡격막 위치 및 운동 상태를 조사하였다. 결과 : 흉강경을 이용하여 횡격막 신경을 박리 절단하는데 기술적 어려움이나 경미한 합병증도 없었다. 횡격막 신경의 절단 직후에는 횡격막이 평균 1.7 늑간 정도 올라가 있었으나, 엑스선 투시검사에서 흡기시 횡격막의 역행성 운동은 보이지 않았다. 1.5개월 이후의 엑스선 검사에서 횡격막의 위치는 수술 전에 비해 유의한 차이 없을 정도(평균 0.9 늑간 차이; p＝NS로 복원되었다. 횡격막 신경의 절단으로 횡격막의 운동 범위는 탈신경 전에 비해 유의한 차이가 없었다. 결론 : 횡격막 신경의 차단으로 인한 탈신경 후 횡격막의 운동기능은 남아 있었으며 횡격막의 위치는 시간이 경과함에 따라 어느 정도 회복되는 현상을 보였다. 그러나 폐활량이 계속 감소된 소견은 횡격막의 흡기력이 완전히 회복되지 않았음을 추정할 수 있다.

• Journal of Chest Surgery
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• 제30권10호
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• pp.1005-1009
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• 1997

흉부와 복부장기 두 곳에 손상을 심하게 받으면 쇼크와 급성 호흡곤란이 동시에 발생하여 치명적일 수 있 다. 둔상이나 관통상으로 인해 발생되는 외상성 횡격막 손상은 대부분 홉부와 복부에 퐁반 손상이 유발 됨 으로 이에 대한 요인 및 평가는 중요하다 본 연구는 1993턴 3월 부터 1997년 2월 까지 5년간 서을 위생병원 흉부외과에서 치료받은 17명의 횡격막 손상 환자를 대상으로 이루어졌다. 환자의 평균 나이는 36.2세였고 남 녀 성별 비율은 3.2 1이었다. 들상에 의한 손상(N=5, 우측=4, 좌측긱)은 29.5%, 관통상에 의한 손상(N=12, 우측f5, 좌측:7)은 70.5%이었다. 호흡곤란이 가장 흔한 증상(76%)이었고, 손상의 크기(mean$\pm$ SD)는 둔상(9.8 $\pm$3.7 Cm)이 관통상의 경우(3.2$\pm$1.3 Cm) 보다 컸으며(P<0.05) 모든 환자에서 동반 손상이 있었고 치료는 수 술적 방법으로 개흉술 11례(64%), 개복술 3례(18%)그리고 개흉복술 3례(18%)였다. 다른 장기의 손상으로 수 술 중 발견된 횡격막 손상은 관통상의 경우 5례(41%)였다 흉부나 복부에 둔상이나 관통상을 입은 환자에 일 단 횡격막 손상을 의심해 보고 평가하여 뒤늦게 나타날 수 있는 합병증을 예방하는 것이 필요하다고 사료된다.

• Journal of Chest Surgery
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• 제43권4호
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• pp.413-416
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• 2010

47세 남자 환자가 교통사고로 인한 감속 손상후 흉부 통증 및 호흡곤란을 주소로 내원하였다. 청진시 우 흉골연에서 수축기 심잡음이 들렸고 심전도에서는 분당 120∼130회의 동빈맥을 보였다. 경흉부 심장 초음파에서 삼첨판막의 전엽이 동요하는 형태를 보였고 유두근의 파열과 함께 심한 판막 폐쇄 부전이 관찰되었다. 수술은 통상적인 심폐기하에서 우심방절개를 통해 접근하여, 전엽의 유두근과 후엽의 건삭이 파열되어 있는 것을 확인하였다. 전엽과 후엽에 각각 우심실내의 유두근으로 새로운 인공 건삭을 조성하였다. 또한 De-Vega 판륜 성형술을 병행하여 시행하였다. 저자들은 매우 드물게 발생한다고 알려져 있는 외상후 유두근 파열로 인한 삼첨판막의 기능부전의 수술을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.232-240
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• 2015

Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.29-37
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• 2010

Purpose: Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria. Methods: From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis. Results: Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042). Conclusion: If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.218-226
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• 2009

Purpose: In multiple blunt trauma patients, transfusion may be a significant therapeutic adjunct to non-operative management. The blood products must be expedited and efficiently to patients in impending shock caused by hemorrhage or traumatic coagulopathy, but the decision to perform blood transfusion has been made empirically, based on the clinician' and has not been guided by objective parameters, but own opinion, that may result in an underestimate of or a failure to detect bleeding, in delayed transfusion, and in a reduced outcome. This article presents quickly assessable predictive factors for determining if a blood transfusion is required to improve outcomes in multiple blunt trauma patients admitted to the emergency room. Methods: In a retrospective review of 282 multiple blunt trauma patients who visited our emergency center by emergency rescuer during a 1-year period, possible factors predictive of the need for a blood transfusion were subjected to univariate and multivariate logistic regression analysis. Results: Of blunt trauma patients, 9.2% (26/282), received red blood cells in the first 24 hours of care. Univariate analysis revealed significant associations between blood transfused and heart rate (HR) > 100 beats/min, respiratory rate (RR) > 20 breaths/min, Glasgow Coma Scale (GCS) < 14, Revised Trauma Score (RTS) < 11, white blood cell count (WBC) < 4000 or > 10000, and initial abnormal portable trauma series (Cspine lateral, chest AP, pelvis AP). A multiple regression analysis, with a correction for diagnosis, identified HR > 100 beats/min (EXP 3.2), GCS < 14 (EXP 4.1), and abnormal trauma series (EXP 2.9), as independent predictors. Conclusion: In our study, systolic blood pressure (SBP) < 90 mmHg, old age > 65 years, hemoglobin < 13g/dL, mechanism of injury were poor predictors of early blood transfusion. Initial abnormal portable trauma series, HR > 100 beats/min, and GCS < 14 were quickly assessable useful factors for predicting a need for early blood transfusion in blunt trauma patients visiting the emergency room.

• Journal of Trauma and Injury
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• 제22권1호
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• pp.57-64
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• 2009

Purpose: Computed tomography (CT) is an accurate test for evaluating hemodynamically stable patients with blunt abdominal trauma. Until now, there have been few studies concentrating on the diagnostic and prognostic significance of the intravenous contrast extravasation (CE) site. We investigated the site of CE on abdominopelvic CT (APCT) and its effect on treating trauma patients and predicting the clinical outcome. Methods: The 50 patients admitted to our emergency department with blunt abdominal trauma showing CE on APCT from January 2004 to September 2006 were included in this study. Patients were prospectively collected, and medical records were reviewed and analyzed. The patients'clinical and lab findings, Focused Assessment with Sonography for Trauma (FAST) findings, CT findings were analyzed. CE sites were classified as intraperitoneal, retroperitoneal, and pelvic cavity and were correlated with post-treatment complications, mortality, and morbidity. Results: Of the 50 patients (mean age : $45{\pm}18years$, 29 males, 21 females) included in our study, 33 patients died (66%). There was no correlation between CE site and ICU or total hospitalization duration (p=0.553, p=0.523). During the first 24 hours of resuscitation, the pelvic cavity group required a mean of 20 units more of packed red blood cell (pRBC) transfusion compared to other groups (p=0.003). In the intraperitoneal group, more patients received operative invasive intervention - either laparotomy or embolization (p=0.025). The intraperitoneal group had the highest mortality, with 13 deaths (11/33, 39%), and the highest early mortality rate (10/13, 76%) in the first 24 hours (p=0.001). Conclusion: Intraperitoneal CE on the CT scan in cases of blunt abdominal trauma is regarded as an indication of a need for invasive intervention (either angiography or laparotomy) and of a higher mortality rate in the first 24 hours. A pelvic cavity CE rquires more aggressive transfusion with pRBC. However, the CT findings themselves showed no significant correlation with overall mortality, morbidity, or hospitalization.

• Journal of Trauma and Injury
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• 제22권2호
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• pp.199-205
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• 2009

Purpose: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. Methods: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. Results: The mean age of the study subjects was $40.2{\pm}2.6$ years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. Conclusion: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.

• Journal of Chest Surgery
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• 제43권1호
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• pp.47-52
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• 2010

배경: 외상성 횡격막 파열은 흔하지는 않지만 응급을 요하는 손상이다. 이 연구에서는 외상성 횡격막 파열의 원인, 동반된 손상의 종류, 진단 방법, 수술 후 예후 인자 등을 알아 보고자 하였다. 대상 및 방법: 2001년 1월부터 2008년 12월까지 본원 응급실을 통해서 내원한 외상 환자들 중에서 수술을 통해서 외상성 횡격막 파열로 진단된 37명의 환자를 대상으로 하였다. 외상의 종류, 동반된 손상, 술 전 활력 징후, Injury Severity Score (ISS), 진단 방법 및 수술까지 걸린 시간, 수술 시 접근 방법, 파열부위 및 파열 정도, 파열된 횡격막을 통한 장기의 이탈 정도 등이 수술 후 사망률에 미치는 영향을 분석하였다. 결과: 둔상에 의한 경우가 30명(81.1%), 관통상에 의한 경우가 7명(18.9%)이었다. 34명 (91.9%)에서 횡격막 파열 이외에 동반된 손상이 있었으며, ISS는 평균 20.8이었다. 술 후 합병증은 총 11명(29.7%)에서 발생하였으며, 술 후 사망은 6명(16.2%)에서 발생하였다. 술 후 사망에 영향을 미치는 인자로는 술 전 기관 삽입, 술 전 저혈압, 20점 이상의 ISS 등이 있었다. 결론: 외상성 횡격막 파열은 다발성 손상의 한 부분으로 발생하는 손상이며, 수술 후 예후는 횡격막 손상 자체보다는 동반된 손상 정도에 따라 결정되었다.

• Journal of Trauma and Injury
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• 제26권2호
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• pp.39-46
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• 2013

Purpose: Non-invasive blood pressure measurement is widely used as a pre-hospital triage tool for blunt trauma patients. However, scant data exits for using the mean arterial pressure (MAP), compared to the systolic blood pressure, as a guiding index. The aim of this study was to determine the association between adverse outcomes and mean arterial pressure (MAP) and to exhibit the therapeutic range of the MAP in adult blunt trauma patients. Methods: The electronic medical records for all trauma patients in a single hospital from January 2010 to September 2012 were retrospectively reviewed. Patients below 17 years of age, patients with penetrating injuries, and patients with serious head trauma (injuries containing any skull fractures or any intracranial hemorrhages) were excluded. Adverse outcomes were defined as one of the following: death in the Emergency Department (ED), admission via operating theater, admission to the intensive care unit, transfer to another hospital for emergency surgery, or discharge as hopeless. Results: There were 14,537 patients who met entry criteria. Adverse outcomes occurred for MAPs in range from 90 to 120 mmHg. Adverse outcomes were found, after adjusting for confounding variables, to occur increasingly as the MAP declined below 90 mmHg or rose above 120 mmHg. Conclusion: Not only lower but also higher mean arterial pressure is associated with increased adverse outcomes in adult blunt trauma patients. Thus, patients with a MAP above 120 mmHg should be considered as a special group requiring higher medical attention, just as those with a MAP below 90 mmHg are.