• Journal of Chest Surgery
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• 제31권5호
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• pp.502-508
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• 1998

인공 심폐기를 이용한 체외순환은 우리 몸에 전신적인 염증반응을 일으키므로 수술후에 여러장기의 기능부전을 초래할수 있다. 이러한 염증반응은 체외순환후 체액성, 세포성 및 보체계등의 면역계가 활성화 되어 전체적인 염증반응을 일으키는 것으로 일부연구에서 보고하고 있으며, 이러한 염증반응에는 Tumor Necrosis Factor-$\alpha$(TNF-$\alpha$)를 비롯한, Interleukin-1, Interleukin-6, Interleukin-8 등의 cytokine등 이 전구물질로써 중요한역할을 하는 것으로 알려져 있다. 본 교실에서는 이러한 cytokine의 유리를 억제함으로 체외순환후 염증반응을 줄일수 있다는 가정하에 항염증작용이 있는 부신피질 호르몬을 체외순환전에 투여함으로서 염증반응이 현저히 감소하는지를 혈청내 TNF-$\alpha$를 측정하여 비교 연구하였다. 1996년 6월부터 1996년 8월까지 심장수술환자 20명에서 전향적 연구를 했다. 10명의 비교군은 수술 하루전, 마취전, 체외순환 시작 5분후, 대동맥 차단시작 5분후, 대동맥 차단 끝나기 5분전, 체외순환 끝나기 5분전, 재관류후 2시간, 4시간, 6시간, 12시간, 24시간 별로 10cc씩 채혈하여 TNF-$\alpha$의 수치를 ELISA 방법으로 측정하였고 10명의 스테로이드군은 마취 1시간전에 부신피질 호르몬(Dexamethasone 1mg/Kg)을 정맥주사하고 채혈은 비교군과 같게 했다. 그리고 양군에서 수술전 심전도 및 혈청내 LDH, CPK 효소치와 백혈구 수치를 측정하고 수술후 1일째, 3일째 재측정하였으며, 수술후 3일째내에 환자의 혈압동태 ,폐기능 상태 및 회복상태를 관찰하여 비교하였다. 환자군 간에 LDH 및 백혈구 수치간에 의미있는 차이는 없었으나 CPK 수치가 수술후 첫째날/세째날 비교군이 1122$\pm$456/864 $\pm$42 이고 스테로이드군은 567$\pm$471/325$\pm$87로 큰 차이를 보였고(P=0.002), CPK-MB 효소는 술후 1일째 비교군이 106.4, 스테로이드군이 29.5로 이의있는 차이를 보여주었으나(P=0.02) 수술후 3일째에는 두 군간의 차이가 없었다. 수술후 72시간 관찰기간중 비교군에서 4명의 환자가 3번 이상의 저혈압으로 처치가 필요했고 38$^{\circ}C$ 이상의 발열은 3명의 환자에서 있었다. 환자군 간에 대동맥 차단시간과 체외순환 시간간에 의미있는 차이는 없었고, 인공호흡기 부착시간과 중환자실 체류기간, 입원기간 비교에 있어 스테로이드군이 적은 수치를 보였으나 통계학적 의미는 없었다. TNF-$\alpha$는 대동맥 차단 5분후부터 체외순환 끝나기 5분전까지 양군에서 현저히 증가하였는데 비교군은 체외순환 끝나기 5분 전에 측정한 수치의 평균은 22.3$\pm$6.8 pg/ml였고, 스테로이드군은 대동맥 차단 끝나기 5분 전에 측정한 수치의 평균은 11.9$\pm$4.7 pg/ml였다. 이상의 연구결과에서 수술전 부신피질 호르몬을 정주함으로 체외순환시 Cytokine의 분비를 억제하여, cytokine으로 인한 심장수술후 발생할수있는 전신적 염증반응을 감소시킬것으로 기대되므로 수술후 환자의 중환자실 체류기간, 입원기간 및 합병증률을 줄일 수 있으리라 생각된다.

• 수산경영론집
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• 제15권1호
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• pp.131-153
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• 1984

Fishery resources are still abundant compared with other resources and the possibility of exploitation is probably great. The Korean fishery industry has grown remarkably since 1957, and Korea is ranked as one of the major fishery countries. Its of fishery products reached the 9th in the world and the value of exports was 5th in 1982. But recently a growth rate has slowed down, due to the enlargement of territorial seas by the declaration of the 200 mile, Exclusive Economic Zone, the tendency to develop fishery resources strate-gically in international bargaining, the change in function of the international organizations, the expansion of regulated waters, the illegal arrest of our fishing boats, the rapid rise in oil prices, and the fall in fish prices, the development of fishery resources as a symbol of nationalism, the fishing boats decreptitude, the rise of crew wages, regulations on fishing methods, fish species, fishing season, size of fish, and mesh size, fishing quotas and the demand of excessive fishing royalties. Besides the the obligation of coastal countries, employing crews of their host countries is also an example of the change in the international environment which causes the aggravation of foreign profit of fishing firms. To ameliorate the situation, our Korean fishery firms must prepare efficient plans and study systematically to internationalize themselves because such existing methods as conventional fishing entry and licence fishing entry are likely to be unable to cope with international environmental change. Thus, after the systematic analysis of the problem, some new combined alternatives might be proposed. These are some of the new schemes to support this plan showing the orientation of our national policy: 1. Most of the coastal states, to cope with rapid international environmental change and to survive in the new era of ocean order, have rationalized their higher governmental structure concerning the fishery industries. And the coastal countries which are the objectives of our expecting entry, demand excessive economic and technical aid, limit the number of fishing boats’entry and the use of our foreign fishing bases, and regulate the membership of the international fishery commissions. Especially, most of the coastal or island countries are recently independent states, which are poorer in national budget, depend largely on fishing royalties and licence entry fees as their main resources of national finance. 2. Alternatives to our entry to deep sea fishing, as internationalization strategies, are by direct foreign investment method. About 30 firms have already invested approximately US $ 8 million in 9 coastal countries. Areas of investment comprise the southern part of the Atlantic Ocean, the Moroccan sea and five other sea areas. Trawling, tuna purse seining and five other fields are covered by the investment. Joint-venture is the most prominent method of this direct investment. If we consider the number of entry firms, the host countries, the number of seas available and the size of investment, this method of cooperation is perhaps insufficient so far. Our fishery firms suffer from a weakness in international competitive ability, an insufficiency of information, of short funds, incompetency in the market, the unfriendliness of host coastal countries, the incapability of partners in joint-ventures and the political instability of the host countries. To enlarge our foreign fishing grounds, we are to actively adopt the direct investment entry method and to diversity our collaboraboration with partner countries. Consequently, besides proper fishing, we might utilize forward integration strategies, including the processing fied. a. The enterprise emigration method is likely to be successful in Argentina. It includes the development of Argentinian fishing grounds which are still not exploited in spite of abundant resources. Besides, Arentina could also be developed as a base for the exploitation of the krill resources and for further entries into collaboration with other Latin American countries. b. The co-business contract fishing method works in American territorial seas where American fishermen sell their fishery products to our factory ships at sea. This method contributes greatly to obtaining more fishing quotas and in innovation bottom fishing operation. Therefore we may apply this method to other countres to diffuse our foreign fishing entry. c. The new fishing ground development method was begun in 1957 by tuna long-line experimental fishing in the Indian Ocean. It has five fields, trawling, skipjack pole fishing and shrimp trawling, and so on. Recently, Korean fisheries were successful in the development of the Antarctic Ocean krill and tuna purse seining. 3. The acceleration of the internationalization of deep sea fishing; a. Intense information exchange activities and commission participation are likely to be continues as our contributions to the international fishery organizations. We should try to enter international fishery commissions in which we are not so far participating. And we have to reform adequately to meet the changes of the function of the international commissions. With our partner countries, we ought to conclude bilateral fishery agreements, thus enlarging our collaboration. b. Our government should offer economic and technical aids to host countries to facilitate our firms’fishery entry and activities. c. To accelerate technical innovation, our fishery firms must invest greater amount in technical innovation, at the same time be more discriminatory in importing exogeneous fishery technologies. As for fishing methods; expanded use of multi-purpose fishing boats and introduction of automation should be encuraged to prevent seasonal fluctuations in fishery outputs. d. The government should increases financial and tax aid to Korean firms in order to elevate already weak financial structure of Korean fishery firms. e. Finally, the government ought to revise foreign exchange regulations being applied to deep sea fishery firms. Furthermore, dutes levied on foreign purchaed equipments and supplies used by our deep sea fishing boats thould be reduced or exempted. when the fish caught by Korean partner of joint-venture firms is sold at the home port, pusan, import duty should be exempted.