• 제목/요약/키워드: ECG(electrocardiogram)

검색결과 425건 처리시간 0.023초

ADHD 환자에 대한 OROS-Methylphenidate 약물치료의 부작용과 관련요인들에 대한 연구 (The Side Effects and Correlates of OROS-Methylphenidate in the Treatment of Children and Adolescents with ADHD)

  • 김진선;김붕년;조수철;신민섭;유희정;김재원;송동호;신동원;정유숙;천근아;신의진;김예니;하은혜
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제21권2호
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    • pp.63-71
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    • 2010
  • Objectives : The aim of this study was to investigate the effect of the clinical and demographic variables such as body weight, dosage, family history of attention-deficit hyperactivity disorder (ADHD), and psychiatric co-morbidity on the side-effects of OROS-Methylphenidate (OROS-MPH), and to evaluate the relationship between drug response and side effect severity. Methods : A total of 144 children (ages 6-18) with diagnosed ADHD were treated with OROS-MPH. Children were examined at baseline and after 1, 3, 6, 9, and 12 weeks of each treatment condition. The stimulant drug side effect rating scale (SERS), pulse rate, systolic blood pressure, diastolic blood pressure, and electrocardiogram (ECG) were evaluated to assess side effect profiles. Changes in these parameters from baseline were examined and analyzed. Results : Anorexia (30.95%) and insomnia (13.10%) were the most commonly reported side effects during this study. Insomnia and loss of appetite score increased at one week follow-up, but was sustained or decreased as treatment progressed. Small but significant increases in pulse rate and diastolic blood pressure were observed during treatment ; however, no clinically meaningful changes in ECG parameters were noted during the study. Low body weight, high dosage of OROS-MPH, and family history of ADHD were associated with cardiovascular side effect. In contrast, there was no significant relationship between OROS-MPH treatment response and the severity of side effect and no difference resulted between the responder and non-responder groups with respect to OROS-MPH dosage in the 12 weeks of follow-up. Conclusion : To the best of our knowledge, this study is the first Korean study to investigate comprehensive side effect profiles and their correlates in OROS-MPH treatment for ADHD children. OROS-MPH was well tolerated with no clinically significant side effects during the treatment period. In conclusion, low body weight, high dosage of OROSMPH, and family history of ADHD could be used as predictive factors in increasing pulse rate and blood pressure.

선천성 심장병의 개심술 후 신호 평준화 심전도의 변화 (The changes in signal-averaged electrocardiogram after surgical correction of congenital heart disease)

  • 김여향;최희정;김근직;조준용;현명철;이상범
    • Clinical and Experimental Pediatrics
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    • 제52권12호
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    • pp.1364-1369
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    • 2009
  • 목 적 : 이번 연구에서는 소아기에 흔한 선천성 심장병 환자들을 대상으로 개심술 이후 생긴 반흔과 수술로 인한 용적 또는 압력 과부하 상태의 변화로 초래되는 비정상적인 심실 활성화를 신호 평준화 심전도를 이용하여 분석하고자 하였다. 방 법 : 선천성 심장병으로 개심교정술을 시행한 환자 52명을 대상으로 하였다. 환자군은 우심실 용적 과부하군(심방 중격 결손군, 1군), 좌심실 용적 과부하군(심실 중격 결손군, 2군), 우심실 압력 과부하군(활로씨 4징군, 3군)으로 나누었다. 대상 환자 모두에서 표준 12 유도 심전도와 신호 평준화 심전도 검사를 시행하였고, 평균 QRS 기간, QT와 QTc 간격, f-QRS, HFLA, RMS in terminal 40 ms를 구하였다. 결 과 : 수술 전에는 1군에서 다른 군에 비해 의미 있게 긴 QRS 기간을 보였고(P=0.011), 수술 후에는 3 군에서 다른 군에 비해 QTc 간격이 의미 있는 증가가 있었다(P=0.004). 그러나 신호 평준화 심전도는 수술 전후 환자군 간에 차이가 없었다. 전체 대상 환자 중 신호 평준화 심전도 측정값이 한가지 이상 후전위의 진단 기준에 해당되는 경우가 수술 전 12명(23%)에서 수술 후 21명(40%)로 증가하였다. 특히 2군과 3군에서는 수술 전에 비해 수술 후에 신호 평준화 심전도의 이상 소견을 보이는 경우가 의미있게 많았다(2군: 20% versus 28%, P<0.001, 3군: 14% versus 64%, P<0.001). 결 론 : 비정상적인 신호 평준화 심전도 값은 수술 후 반흔뿐만 아니라 개심술 자체, 심실의 과부하에 의해서도 발생할 수 있다.

Catecholamines에 관(關)하여 -제4편(第四編) : 심실전동발생(心室顫動發生)에 있어서의 catecholamines의 의의(意義)- (Role of Catecholamines in Ventricular Fibrillation)

  • 이우주
    • 대한약리학회지
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    • 제19권1호
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    • pp.15-35
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    • 1983
  • Although it has been well known that ventricular fibrillation is the most important complication during hypothermia, much investigation has failed to show the exact nature of the etiology of ventricular fibrillation. Recently, there has been considerable research on the relationship between sympathetic activity and ventricular fibrillation under hypothermia. Cardiac muscle normally contains a certain amount of norepinephrine and the dramatic effect of this catecholamines on the cardiac muscle is well documented. It is, therefore, conceivable that cardiac catecholamines might exert an influence on the susceptibility of heart muscle to tachycardia, ventricular fibrillation and arrhythmia, under hypothermia. Hypothermia itself is stress enough to increase tonus of sympatheticoadrenal system. The normal heart is supplied by an autonomic innervation and is subjected to action of circulating catecholamines which may be released from the heart. If the reaction of the heart associated with a variable amount of cardiac catecholamines is. permitted to occur in the induction of hypothermia, the action of this agent on the heart has not to be differentiated from the direct effects of cooling. The studies presented in this paper were designed to provide further information about the cardio-physiological effects of reduced body temperature, with special reference to the role of catecholamines in ventricular fibrillation. Healthy cats, weighing about 3 kg, were anesthetized with pentobarbital(30 mg/kg) intraperitoneally. The trachea was intubated and the endotracheal tube was connected to a C.F. Palmer type A.C. respirator. Hypothermia was induced by immersing the cat into a ice water tub and the rate of body temperature lowering was $1^{\circ}C$ per 5 to 8 min. Esophageal temperature and ECG (Lead II) were simultaneously monitored. In some cases the blood pH and serum sodium and potassium were estimated before the experiment. After the experiment the animals were killed and the hearts were excised. The catecholamines content of the cardiac muscle was measured by the method of Shore and Olin (1958). The results obtained are summarized as follows. 1) In control animal the heart rate was slowed as the temperature fell and the average pulse rates of eight animals were read 94/min at $31^{\circ}C$, 70/min at $27^{\circ}C$ and 43/min at $23^{\circ}C$ if esophageal temperature. Ventricular fibrillation was occurred with no exception at a mean temperature of $20.3^{\circ}C(21-l9^{\circ}C)$. The electrocardiogram revealed abnormal P waves in each progressive cooling of the heart. there was, ultimately, a marked delay in the P-R interval, QRS complex and Q-T interval. Inversion of the T waves was characteristic of all animals. The catecholamines content of the heart muscle excised immediately after the occurrence of ventricular fibrillation was about thirty percent lower than that of the pre-hypothermic heart, that is, $1.0\;{\mu}g/g$ wet weight compared to the prehypothermic value of $1.41\;{\mu}g/g$ wet weight. The changes of blood pH, serum sodium and potassium concentration were not remarkable. 2) By the adrenergic receptor blocking agent, DCI(2-3 mg/kg), given intramuscularly thirty minutes before hypothermia, ventricular fibrillation did not occur in one of five animals when their body temperature was reduced even to $16^{\circ}C$. These animals succumbed at that low temperature, and the changes of heart rate and loss of myocardial catecholamines after hypothermia were similar to those of normal animals. The actual effect of DCI preventing the ventricular fibrillation is not predictable. 3) Administration of reserpine(1 mg/kg, i.m.) 24 hours Prior to hypothermia disclosed reduced incidence of ventricular fibrillation, that is, six of the nine animals went into fibrillation at an average temperature of $19.6^{\circ}C$. By reserpine myocardial catecholamines content dropped to $0.045\;{\mu}g/g$ wet weight. 4) Bretylium pretreatment(20 mg/kg, i.m.), which blocks the release of catecholamines, Prevented the ventricular fibrillation under hypothermia in four of the eight cats. The pulse rate, however, was approximately the same as control and in some cases was rather slower. 5) Six cats treated with norepinephrine(2 mg/kg, i.m.) or DOPA(50 mg/kg) and tranylcypromine(10 mg/kg), which tab teen proved to cause significant increase in the catecholamines content of the heart muscle, showed ventricular fibrillation in all animals under hypothermia at average temperature of $21.6^{\circ}C$ and the pulse rate increased remarkably as compared with that of normal. Catecholamines content of cardiac muscle of these animals markedly decreased after hypothermia but higher than control animals. 6) The functional refractory periods of isolated rabbit atria, determined by the paired stimulus technique, was markedly shortened by administration of epinephrine, norepinephrine and isoproterenol. 7) Adrenergic beta-blocking agents, such as pronethalol, propranolol and sotalol(MJ-1999), inhibited completely the shortening of refractory period induced by norepinephrine. 8) Pretreatment with either phenoxftenbamine or phentolamine, an adrenergic alphatlocking agent, did not modify the decrease in refractory period induced by norepinephrine. From the above experiment it is possible to conclude that catecholamines play an important role in producing ventricular fibrillation under hypothermia. The shortening of the refractorf period of cardiac muscle induced by catecholamines mar be considered as a partial factor in producing ventriculr fibrillaton and to be mediated by beta-adrenergic receptor.

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간호교육기관의 실험실습설비 보유실태 조사 (A Survey on the Actual State of Laboratory Facilities and Equipments at Nursing Schools)

  • 임난영;이선옥;서문자;김혜숙;김문실;오경옥
    • 대한간호
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    • 제36권1호
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    • pp.108-117
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    • 1997
  • This study was carried out to examine the standards for evaluation of laboratory facilities and equipment. These constitute the most important yet vulnerable area of our system of higher education among the six school evaluation categories provided by the Korean Council for University Education. To obtain data on the present situation of holdings and management of laboratory facilities and equipment at nursing schools in Korea, questionnaires were prepared by members of a special committee of the Korea Nursing Education Society on the basis of the Standards for University Laboratory Facilities and Equipment issued by the Ministry of Education. The questionnaires were sent to nursing schools across the nation by mail on October 4, 1995. 39 institutions completed and returned the questionnaires by mail by December 31 of the same year. The results of the analysis of the survey were as follows: 1. The Physical Environment of Laboratories According to the results of investigation of 14 nursing departments at four-year colleges, laboratories vary in size ranging from 24 to 274.91 pyeong ($1{\;}pyeong{\;}={\;}3.3m^2).$. The average number of students in a laboratory class was 46.93 at four-year colleges, while the number ranged from 40 to 240 in junior colleges. The average floor space of laboratories at junior colleges, however, was almost the same as those, of laboratories at four-year colleges. 2. The Actual State of Laboratory Facilities and Equipment Laboratory equipment possessed by nursing schools at colleges and universities showed a very wide distribution by type, but most of it does not meet government standards according to applicable regulations while some types of equipment are in excess supply. The same is true of junior colleges. where laboratory equipment should meet a different set of government standards specifically established for junior colleges. Closer investigation is called for with regard to those types of equipment which are in short supply in more than 80 percent of colleges and universities. As for the types of equipment in excess supply, investigation should be carried out to determine whether they are really needed in large quantities or should be installed. In many cases, it would appear that unnecessary equipment is procured, even if it is already obsolete, merely for the sake of holding a seemingly impressive armamentarium. 3. Basic Science Laboratory Equipment Among the 39 institutions, five four-year colleges were found to possess equipment for basic science. Only one type of essential equipment, tele-thermometers, and only two types of recommended equipment, rotators and dip chambers, were installed in sufficient numbers to meet the standards. All junior colleges failed to meet the standards in all of equipment categories. Overall, nursing schools at all of the various institutions were found to be below per in terms of laboratory equipment. 4. Required Equipment In response to the question concerning which type of equipment was most needed and not currently in possession, cardiopulmonary resuscitation (CPR) machines and electrocardiogram (ECG) monitors topped the list with four respondents each, followed by measuring equipment. 5. Management of Laboratory Equipment According to the survey, the professors in charge of clinical training and teaching assistants are responsible for management of the laboratory at nursing schools at all colleges and universities, whereas the chief of the general affairs section or chairman of the nursing department manages the laboratory at junior colleges. This suggests that the administrative systems are more or less different. According to the above results, laboratory training could be defined as a process by which nursing students pick up many of the nursing skills necessary to become fully qualified nurses. Laboratory training should therefore be carefully planned to provide students with high levels of hands-on experience so that they can effectively handle problems and emergencies in actual situations. All nursing students should therefore be thoroughly drilled and given as much on-the-job experience as possible. In this regard, there is clearly a need to update the equipment criteria as demanded by society's present situation rather than just filling laboratory equipment quotas according to the current criteria.

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가와사끼병에서 감마글로불린 재투여가 필요했던 경우의 임상적 특징 (Clinical Characteristics in Patients with Kawasaki Disease Who Received Intravenous Gamma-globulin Retreatment)

  • 김덕수;한윤수;한헌석
    • Clinical and Experimental Pediatrics
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    • 제45권11호
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    • pp.1411-1416
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    • 2002
  • 목 적 : 저자들은 IVGG의 재투여가 필요했던 환아들의 검사소견 및 임상적 특징을 알아보고, 재투여가 필요 없었던 환아들과 비교하여 재투여가 필요한 환아를 예측할 수 있는지 알아보고자 하였다. 방 법: 1997년 10월부터 2001년 2월까지 적어도 6개월 이상의 추적관찰이 가능하였던 117명의 환자를 대상으로 통상적인 혈액검사, 심전도, 신호평준화 심전도, 심초음파도를 후향적으로 검토하였다. IVGG 한번 투여 후 recurrent fever 혹은 recrudescence fever를 보이는 6명(5.1%)에게는 IVGG를 한번 더 투여하였으며, 그래도 발열이 지속되는 경우는 methylprednisolone를 한번 내지 두번을 pulse로 주었다. 결 과: 전체 117명의 환아 중 23명(19.7%)에서 6개월 이상의 추적 기간중 심장의 합병증이 생겼으며, 초기 심장의 합병증이 23명에서, 후기 합병증은 4명에서 관찰되었다. IVGG의 재투여가 필요했던 환자는 6명(5.1%)이었으며, 초기의 심장합병증은 IVGG을 재투여한 군에서 1회 투여한 군에 비하여 높으며(P<0.0001), 장기적인 심장 합병증도 재투여군이 높았다(P<0.0001). IVGG 재투여군 중 m-PD까지 사용했던 군도 초기 합병증 및 후기 합병증이 1회 투여군에 비하여 현저히 높았다. 전체적인 합병증 유무에 따른 여러 가지 검사 소견 중 CRP만이 합병증이 있는 군에서 유의하게 증가되어 있었으며($11.94{\pm}7.43$ vs $6.97{\pm}6.41$ P<0.01), IVGG 재투여군이 1회 투여군보다 CRP가 현저히 증가되어 있었다($15.68{\pm}8.67$ vs $7.44{\pm}6.50$ P<0.05). 결 론: 초기 검사에서 CRP가 현저히 높은 군이 합병증의 발생빈도도 높고 IVGG을 재 투여할 가능성도 높다. 그러나, IVGG의 재투여가 관상동맥 합병증의 발생을 감소시키지는 못하였다. 이는 IVGG의 재투여가 필요했던 군에서는 CRP의 결과에서 보듯이 많은 양의 IVGG가 필요할 정도로 심한 염증반응이 있었거나 IVGG 자체로는 효과적으로 심장 후유증을 예방할 수 없기 때문이라고 생각된다.