• 제목/요약/키워드: Hospitalized

검색결과 1,865건 처리시간 0.028초

산모와 간호원이 본 선택된 산욕기 간호활동의 중요도에 관한 탐색적 연구 (An Exploratory Study about the Importance of Selected Nursing Activities during the Puerperal Period, as Viewed by Women in the Puerperal Period and by Nurses Caring for Them)

  • 박주봉
    • 대한간호학회지
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    • 제8권1호
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    • pp.152-162
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    • 1978
  • The desire to maintain health is increasing, consequently the role of nursing which has as one chief aim the solving of man′s basic problems is more and more important. Today, in spite of a growing concern about the nursing activities which nurses provide for individual human having specific needs, clinically in fact, it is questionable that individual′s expectation of nursing activities agrees with nurse′s performance of nursing activities. In this study the importance and agreement of the importance of the nursing activities during the hospitalized puerperal period as viewed by women in the puerperal period and by nurses caring for them, were assessed. The present study was undertaken in an attempt to furnish the basic data for expediting the progress of research activities in this area and further to be helpful in planning maternity nursing practice. The study population defined and selected was nurses (13) caring for women in the puerperal period and doing duty on obstetric & gynecologic ward at Y. hospital, and the women in puerperal period (39) as sum of 3 women selected by each nurse during the period of May 13th-June 4th 1976. The study data was collected by the direct interview method based on the questionnaire which the investigator made out. The study result was analyzed by percentage, t - test. The findings can be summarized as follows: 1. General characteristics of nurses doing duty on puerperal ward: a. Nurses′average age was 24.8 years old. b. 84.6% had educational background of 4 years of college. c. 69.2% had a religion. d. 53.8% were married. e. 53.8% had clinical experience of 1 year -3 years. f, 61.5% did duty on puerperal ward during 1 year -3 years. g. 46.2% desired to do duty on obstetric ? gynecologic ward. 2. General characteristics of the women who were studied during their puerperal period: a. Women′s average age was 26.4 years old. b. 79.5% had educational background above high school. c. 56.4% had a religion. d. 84.6% had living standard above medium. e. 89.7% had no occupation. f, 53,8% had previous hospitalization experience. g. 56.4% had previous delivery experience. 3. Examining the importance of 39 nursing activities during puerperal period selected by investigator, studied group of women considered that the most important nursing activity was "Record precisely about condition, medical treatment and nursing activity results etc". Nurses considered that the most important nursing activity was "Notice whether having pain and care for that". Both groups considered that the least important nursing activity was "Talk with her about topics such as news, hobbies, other interests". 4. Examining the importance of nursing activities in 4 specific categories, studied group of women considered that the most important nursing activity in physical nursing category was "Be sure of safety measure to prevent accidents, injuries", and nurses considered that the most important nursing activity was "Make her sleep and rest sufficiently". Studied group of women considered that the most important nursing activity in psychological category was "Explain about medical treatment and nursing activity ahead of time so she knows what to expect" , and nurses considered that the most important nursing activity was "Explain about puerperal period so she understands". Studied group of women considered that the most important nursing activity in relation to medical care was "Record precisely about condition, medical treatment and nursing activity results etc.", and nurses considered that the most important nursing activity was "Observing, cleaning and protecting the perineum" Studied group of women considered that the most important nursing activity in nursing category in preparation for discharge was "Instruct about personnel hygiene during puerperal period", and nurses considered that the most important nursing activity was "Instruct self-care to protect the perineum". 5. The analysis of this study showed a significant amount of disagreement computed by subtracting the nurse′s score from the patient′s score. Studied group of women put greater importance on physical nursing category, psychological nursing category, nursing in relation to medical care, than the nurses. These results were statistically significant at 0.01 level.

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엑스선 조사처리된 신선편의 채소류의 미생물학적, 이화학적, 관능적 품질 평가 (Microbiological, physicochemical, and organoleptic evaluation of fresh-cut vegetables irradiated using X-rays)

  • 문병금;송범석;박종흠;김재경;박하영;김동호;손은주;임돈순;은종방
    • 한국식품저장유통학회지
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    • 제24권1호
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    • pp.27-35
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    • 2017
  • 본 연구는 면역저하 환자용 신선편의 채소류의 위생화를 위해 당근, 오이고추, 방울토마토, 파프리카를 모델식품으로 선정하여 다양한 흡수선량으로 엑스선 조사처리한 후 미생물학적, 이화학적, 관능적 품질 평가를 수행하였다. 당근과 오이고추의 경우 0.4 kGy, 방울토마토와 파프리카의 경우 0.2 kGy 이상의 흡수선량으로 엑스선 조사처리 시 멸균이 확인되었으며, 총 호기성세균 및 대장균군을 제외한 병원균들은 1 log 수준의 검출한계 이하로 나타났다. 모델식품에 접종된 E. coli. L. monocytogenes, S. Typhimyrium에 대한 엑스선의 D10값은 0.11-0.32 kGy로 나타나, 0.4 kGy의 흡수선량을 신선편의 채소류의 멸균을 위한 잠정적인 최소 흡수선량으로 설정하였다. 최대 0.6 kGy의 흡수선량으로 엑스선 조사처리된 신선편의 채소류에 대한 전체 선호도의 경우 7점 척도에서 모두 5.0 점 이상으로 나타나 이들의 관능적 품질이 수용 가능한 수준인 것으로 판단하였다. 또한, 암환자를 대상으로 엑스선 멸균처리(0.4 kGy)된 신선편의 채소류에 대한 선호도 설문조사에서 오이고추와 방울토마토, 파프리카의 경우 모든 항목에 대한 평균 선호도 점수는 5점 척도에서 모두 4.0점 이상으로 나타났다. 따라서 엑스선으로 멸균처리된 오이고추, 방울토마토, 파프리카는 면역력이 저하된 환자들을 위한 위생학적으로 안전한 신선편의 채소로 제공이 가능할 것으로 판단된다.

Management of Patients with Traumatic Rupture of the Diaphragm

  • Hwang, Sang-Won;Kim, Han-Yong;Byun, Jung-Hun
    • Journal of Chest Surgery
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    • 제44권5호
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    • pp.348-354
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    • 2011
  • Background: Traumatic rupture of the diaphragm is an unusual type of trauma. In addition, it is difficult to diagnose because it can be accompanied by injuries to other organs. If it is not detected early, the mortality rate can increase due to serious complications. Diaphragmatic rupture is an important indicator of the severity of the trauma. The aim of this study was to investigate the factors affecting the incidence of complications and mortality in patients who had surgery to treat traumatic rupture of the diaphragm. Materials and Methods: The subjects were patients who had undergone a diaphragmatic rupture by blunt trauma or stab wounds except patients who were transferred to other hospitals within 3 days of hospitalization, from January 2000 to December 2007. This study was a retrospective study. 43 patients were hospitalized, and 40 patients were included during the study period. Among them, 28 were male, 12 were female, and the average age was 42 (from 18 to 80). Outcome predictive factors including hypoxia, ventilator application days, revised trauma score (RTS), injury severity score (ISS), age, herniated organs, complications, and the mortality rate were investigated. Results: Causes of trauma included motor vehicle crashes for 20 patients (50%), falls for 10 (25%), stab wounds for 8 (20%), and agricultural machinery accidents for 2 (5%). Most of the patients (36 patients; 90%) had wound sites on the left. Diagnosis was performed within 12 hours for most patients. The diaphragmatic rupture was diagnosed preoperatively in 27 patients (70%) and in 12 patients (30%) during other surgeries. For surgical treatment, thoracotomy was performed in 14 patients (35%), laparotomy in 11 (27.5%), and a surgery combining thoracotomy and laparotomy in 15 patients (37.5%). Herniated organs in the thoracic cavity included the stomach for 23 patients (57.5%), the omentum for 15 patients (37.5%), the colon for 10 patients (25%), and the spleen for 6 patients (15%). Accompanying surgeries included splenectomy for 13 patients (32.5%), lung suture for 6 patients (15%), and liver suture for 5 patients (12.5%). The average hospital stay was $47.80{\pm}56.72$ days, and the period of ventilation was $3.90{\pm}5.8$ days. The average ISS was $35.90{\pm}16.81$ (11~75), and the average RTS was $6.46{\pm}1.88$ (1.02~7.84). The mortality rate was 17.5% (7 patients). Factors affecting complications were stomach hernia and age. Factors affecting the mortality rate were ISS and RTS. Conclusion: There are no typical symptoms of the traumatic rupture of the diaphragm by blunt trauma. Nor are there any special methods of diagnosis; in fact, it is difficult to diagnose because it accompanies injuries to other organs. Stab wounds are also not easy to diagnose, though they are relatively easy to diagnose compared to blunt trauma because the accompanying injuries are more limited. Suture of the diaphragm can be performed through the chest, the abdomen, or the thoracoabdomen. These surgical methods are chosen based on accompanying organ injuries. When there are many organ injuries, there are a great number of complications. Significant factors affecting the complication rate were stomach hernia and age. ISS and RTS were significant as factors affecting the mortality rate. In the case of severe trauma such as pelvic fractures, frequent physical examinations and chest X-rays are necessary to confirm traumatic rupture of the diaphragm because it does not have specific symptoms, and there are no clear diagnosis methods. Complications and the mortality rate should be reduced with early diagnosis and with treatment by confirming diaphragmatic rupture in the thoracic cavity and the abdomen during surgery.

Respiratory syncytial virus로 인한 급성 하기도 감염 입원 환자에서 Palivizumab 예방요법 유무에 따른 비교 분석 (Analysis of Palivizumab Prophylaxis in Patients with Acute Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus)

  • 민성주;송정숙;최장환;선한수;강은경;김도현;김희섭
    • Pediatric Infection and Vaccine
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    • 제18권2호
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    • pp.154-162
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    • 2011
  • 목 적: Respiratory syncytial virus (RSV)에 의한 급성 하기도 감염은 소아기에 입원을 요하는 중요한 질환이다. 우리나라에서는 현재 미숙아와 후기미숙아의 출생률과 생존률이 증가하고 있으며, palivizumab ($Synagis^{(R)}$) 예방요법을 시행하고 있으나 아직 경제효과에 대한 연구가 없는 실정이다. 이에 저자들은 RSV로 인한 하기도 감염으로 입원한 미숙아들의 인구학적, 임상적 특성을 알아보고 우리나라에 적절한 예방요법 대상을 정하는데 도움이 되는 정보를 제공하고자 하였다. 방 법: 2007년 1월부터 2011년 2월까지 동국대학교 일산병원에 입원한 3세 미만의 급성 하기도 감염 환자중 multiplex RT-PCR을 통해 원인 바이러스를 밝힌 167명의 의무기록을 후향적으로 조사하였다. 결 과: 167명 중 RSV 감염으로 밝혀진 환자는 총 113명이었으며, 만삭아가 90명, 미숙아가 23명이었다. 이들의 평균 입원기간은 만삭아군이 9.0일, 미숙아군이 12.6일로 통계학적인 차이를 보였으며 이외 입원당시 나이, 발열 및 호흡기 증상, 혈액소견등은 유의한 차이를 보이지 않았다. RSV 감염으로 입원한 미숙아 22명을 조사하였을때(다른 질병과의 동반감염이 있었던 한 명 제외), 28주 미만이 4명, 28주 이상 32주 미만이 2명, 32주 이상이 16명(72.7%)으로 대부분이 palivizumab 예방요법의 대상이 아닌 미숙아들이었다. 이들 중 3명은 중환자실에서의 치료를 받았고 한 명만 28주미만의 환아로 palivizumab 투여를 받았으며 나머지 두 명은 32주 이상의 환아들로 기관지폐이형성 등 다른 위험요소가 없어 palivizumab을 투여 받지 않았다. 중환자실에서 치료받은 미숙아군과 만삭아군에서도 임상양상과 혈액학적 소견은 모두 유의한 차이를 보이지 않았다. 결 론: RSV에 의한 급성 하기도 감염으로 입원하는 환자들은 대부분 만삭아이거나 기관지폐이형성증과 같은 위험요인이 없는, palivizumab 투여 대상이 아닌 미숙아들이었다. 따라서 우리나라에서도 기관지폐이형성증 이외의 위험요인을 평가하고 더욱 최적의 시기에 pali-vizumab을 투여 하는 우리나라만의 예방요법지침이 하루속히 필요하다고 생각된다.

호스피스간호가 말기암환자의 통증에 미치는 효과에 관한 연구 (The Study on the Effects of Hospice Care on the Pain Management of the Terminal Cancer Patients)

  • 윤매옥
    • Journal of Hospice and Palliative Care
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    • 제6권1호
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    • pp.34-44
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    • 2003
  • 목적 : 본 연구는 호스피스 간호가 말기암환자의 통증정도에 미치는 효과를 파악하고 분석함으로써, 말기암환자의 안위를 도모하여 전인적이고 개별화된 간호를 제공하는데 도움을 주기 위하여 시도된 단일군 전후설계(one group pre-post test)이다. 방법 : 2000년 7월부터 11월까지 전주시에 소재하는 1개 종합병원의 호스피스에 의뢰되어 연구참여에 동의한 말기암환자 37명을 대상으로 하였다. 호스피스 간호는 1주일에 $5{\sim}6$회를 조주 동안 제공하였으며, 자료분석은 실수, 백분율, 평균, 표준편차 등의 서술통계와 paired t-test로 분석하였다. 결과 : 1) 통증정도의 중증도는 통증정도가 24시간 동안 가장 심했을 때 통증점수는 중재전이 6.35점, 중재후가 4.76점이었다. 통증으로 인한 지장정도는 중재전에는 인생을 즐김(8.22점), 통상적인 일(7.46점), 보행(7.08점), 일반적인 활동(7.08점)순이었으며, 중재후에는 인생을 즐김(6.62점), 통상적인 일(6.43점), 보행(6.11점), 일반적인 활동(5.78점)순으로 중재전과 후가 동일한 순위를 보였다. 2) 통증의 중증도는 중재전보다 중재후에서 각각 유의하게 감소하였다. 영역별로 분석하였을 때 24시간 동안 가장 심했을 때 통증(t=4.085, P=0.000), 24시간 동안 가장 약했을 때 통증(t=4.020, P=0.000), 평균통증(t=4.254, P=0.000), 조사당시 바로 지금 느끼는 통증(t=5.017, P=0.000)영역에서 중재후 통증이 중재전보다 유의하게 감소하였다. 3) 통증으로 인한 지장정도는 중재전보다 중재후에서 각각 유의하게 감소하였다. 영역별로 분석하였을 때 일반적인 활동(t=3.137, P=0.003), 기분(t=6.713, P=0.000), 보행능력(t=2.027, P=0.050), 통상적인 일(t=20.132, P=0.040), 대인관계(t=4.143, P=0.000), 수면(t=4.071, P=0.000), 인생을 즐김(t=3.881, P=0.000)에서 통계적으로 유의한 차이가 나타났다. 결론 : 호스피스 간호를 제공받은 말기암환자는 제공받지 않은 말기암환자에 비해 통증정도와 삶의 치장 정도에서 모두 낮아짐이 확인되었으며, 유의한 차이를 보였다. 이상과 같이 말기암환자에 대한 호스피스 간호는 통증감소와 통증이 생활에 지장을 주는 정도를 감소하는데 효과적인 것으로 확인되었으므로 앞으로 말기암환자를 위해 적극적인 활용을 권장한다.

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1개 종합병원 환자의 낙상에 관한 조사 (A Study on Fall Accident)

  • 이현숙;김매자
    • 대한간호
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    • 제36권5호
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    • pp.45-62
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    • 1998
  • The study was conducted from November 1995 to May 1996 at the one general hospital in Seoul. The total subjects of this study were 412 patients who have the experience of fall accident, among them 31 was who have fallen during hospitalization and 381 was who visited emergency room and out patient clinic. The purposes of this study were to determine the characteristics, risk factors and results of fall accident and to suggest the nursing strategies for prevention of fall. Data were collected by reviewing the medical records and interviewing with the fallers and their family members. For data analysis, spss/pc+ program was utilized for descriptive statistics, adjusted standardized $X^2$-test. The results of this study were as follows: 1) Total subjects were 412 fallers, of which 245(59.5%) were men and 167(40.5%) were women. Age were 0-14 years 79(19.2%), 15-44 years 125(30.4%), 45-64 years 104(25.2%), over 65 years 104(25.2%). 2) There was significant association between age and the sexes ($X^2$=39.17, P=0.00). 3) There was significant association between age and history of falls ($X^2$=44.41. P= .00). And history of falls in the elderly was significantly associated with falls. 4) There was significant association with age and medical diagnosis ($X^2$=140.66, P= .00), chief medical diagnosis were hypertension(34), diabetis mellitus(22), arthritis(11), stroke(8), fracture(7), pulmonary tuberculosis(6), dementia(5) and cataract(5), 5) There was significant association between age and intrinsic factors: cognitive impairment, mobility impairment, insomnia, emotional problems, urinary difficulty, visual impairments, hearing impairments, use of drugs (sedatives , antihypertensive drugs, diuretics, antidepressants) (P < 0.05). But there was no significant association between age and dizziness ($X^2$=2.87, P=.41). 6) 15.3% of total fallers were drunken state when they were fallen. 7) Environmental factors of fall accident were unusual posture (50.9%), slips(35.2%), trips (9.5%) and collision(4.4%). 8) Most of falls occurred during the day time, peak frequencies of falls occurred from 1pm to 6pm and 7am to 12am. 9) The places of fall accident were roads(22.6%), house-stairs 06.7%), rooms, floors, kitchen (11.2%), the roof-top, veranda, windows(10.9%), hospital(7.5%), ice or snowy ways(5.8%), bathroom(4.9%), playground, park(4.9%), subway-stairs(4.4%) and public-bathrooms (2.2%). 10) Activities at the time of fall accident were walking(37.6%), turning around or reaching for something(20.9%), going up or down stairs09.2%), exereise, working07.4%), up or down from a bed(2.7%), using wheelchair or walking aids, standing up or down from a chair(2.2%) and standing still(2.2%). 11) Anatomical locations of injuries by falls were head, face, neck(31.3%), lower extremities (29.9%). upper extremities(20.6%), spine, thorax, abdomen or pelvic contents(l1.4%) and unspecified(2.9%). 12) Types of injures were fracture(47.6%), bruises03.8%), laceration (13.3%), sprains(9.0%), headache(6.6%), abrasions(2.9%), intracranial hemorrage(2.4%) and burns(0.5%). 13) 41.5% of the fallers were hospitalized and average of hospitalization was 22.3 days. 14) The six fallers(1.46%) died from fall injuries. The two fallers died from intracranial hemorrage and the four fallers died of secondary infection; pneumonia(2), sepsis(1) and cell lulitis(1). It is suggested that 1) Further study is needed with larger sample size to identify the fall risk factors. 2) After the fall accident, comprehensive nursing care and regular physical exercise should be emphasized for the elderly person. 3) Safety education and safety facilities of the public place and home is necessary for fall prevention.

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여성의 고위험 임신에 대한 경험 (Womans experience of Risk Situation on the High-Risk Pregnancy)

  • 김경원;이경혜
    • 여성건강간호학회지
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    • 제4권1호
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    • pp.161-178
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    • 1998
  • In spite of the great progress of the theory and skill of the Nursing Care & Medical area in relation to pregnancy, nurses in clinics face up to many challenges in maternity nursing care areas. The reason is that the mobility and mortality of mothers was sharply decreased and the unknown high-risk diseases of pregnancy woman in the past is made public. That's why it is difficult to meet the pregnancy woman in natural process from pregnancy to delivery in recently. Admission rooms are filled with high-risk pregnancy women. As a matter of fact, we have done nursing care into the surface symptoms and diseases of high-risk pregnancy women so far. We have been indifferent to a long period hospitalization, separation from family, and conflict of repeated examination. Therefore, it is widely spread to understand the emotional conflict experienced by high-risk pregnancy women and to need for nursing intervention to bring up about emotional support and the ability of perception in psychological crisis. Although the pregnancy woman judged in high-risk should carry out normal task of pregnancy, she have to be confronted with secondary risk situation. The health of self & fetus threatened by the risk situation could be decreased through care plan, but psychological stress increases. Therefore, the pregnancy brings into non-control state. It is important to ask that what the hospitalized pregnancy women in high-risk think of themselves status. Because misunderstanding or serious anxiety of themselves status put into mother and fetus in danger. And adaptation mode makes all the difference. I would like to consider how nurses could deal with this high-risk circumstances in the position of pregnancy woman on the basis of the above fact. This study uses phenomenological method to suggest the basis material for nurses to do nursing intervention in view of pregnancy woman. Because this method understands the nature of true life of pregnancy woman throughly. The phenomenological method is the sources to describe or explain affluently the process generated in confirmation areas and environment and is the application for readers to understand and recognize clinic reality and then apply this method to reasoning study place or other places. Specifically, the phenomenon study method, one of the phenomenological method, is applied. The use of that method is to describe and generalize the experience in environment exactly. The study of this study is as follows : Among 187 descriptive stamens from 8 study participants are classified into 42 theme cluster at the stage of the first analysis. Those theme is categorized into 8 sub-subjects such as anxiety of uncertainty, foreknowledge about risk circumstance, will power about overcome, unsettled feeling about hospital, relief, optimistic thought, family support, and indifferences. At the last stage of analysis, those things are categorized into 3 subjects. When high-risk pregnancy woman foretell the situation, they feel unsettlement about uncertainty and untrust feeling about hospital. But they are ease with family support and hospital support. On the other hand, they express indifferent 3-way structure response to the situation having will of overcome and exceeding optimistic thought. In those statements, the experience by pregnancy woman shows 3 respect subjects. 1. They are anxious of this situation and are in desperation and don't recognize their role to be carried out 2. They think of this situation as normal process of pregnancy and are not concerned that this can give themselves and fetus fatal damage. 3. The pregnancy women will never confront this situation. This study shows the pregnancy woman has anxiety and optimistic relief about the situation, and ignores and optimistic relief about the situation, and ignores many things. Therefore, nurses in clinic should give pregnancy woman knowledge and information about the high-risk and help them to deal with the situation spontaneously. High-risk pregnancy woman should have the care plan in respect of the right perception. And the nurse know that their support help out pregnancy woman overcome the crisis in this respect of the special nursing intervention.

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중환자실 입원 환자의 섬망 발생과 처치 관련 위험인자 (Incidence and Procedure-Related Risk Factors of Delirium in Patients Admitted to an Intensive Care Unit)

  • 안지선;오주영;박재섭;김재진;박진영
    • 정신신체의학
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    • 제27권1호
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    • pp.35-41
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    • 2019
  • 연구목적 섬망은 중환자실에서 흔히 발생하는 것으로 알려져 있으나, 중환자실에서 일반적으로 수행되는 처치(procedure)와 섬망 발생 사이의 연관성을 조사한 연구는 아직까지 부족한 실정이다. 본 연구는 중환자실의 처치를 중점으로 섬망의 위험인자를 조사하기 위하여 후향적 관찰 연구를 시행하였다. 방 법 2016년 6월부터 2017년 5월까지 강남세브란스병원 중환자실에 입원한 환자 중 선정기준을 만족하는 1,156명의 환자를 포함하였으며, 섬망은 중환자실에 입실한 환자 전수를 정신건강의학과 전문의가 매일 규칙적으로 평가하였다. 문헌 고찰을 통해 선정한 섬망의 처치 관련 위험인자(risk factors for procedure-related)에 대한 노출 여부를 섬망 발생에 따라 비교하고, 유의한 차이를 보이는 변수에 대해 다중 로지스틱 회귀분석을 시행하여 섬망 발생 위험 확률을 높이는 요인을 확인하였다. 결 과 섬망 발생에 따라 유의한 차이를 보인 요인은 연령, 중증도, 수술 여부, 배액관 삽입, 도뇨관 삽입, 기관내 삽관과 신체 억제대가 있었다. 다중 로지스틱 회귀분석 결과에서 환자의 연령, 질병의 중증도와 신체 억제대 사용은 독립적으로 섬망 발생 위험 확률을 높이는 것으로 나타났다. 섬망 발생률은 15.3%였다. 결 론 신체 억제대의 사용은 중환자실 환자의 섬망 발생 위험 확률을 높이는 데 크게 기여하는 것으로 보인다. 이러한 결과는 중환자실의 섬망을 중재하기 위하여 연령과 중증도가 높은 고위험군에 대한 최소한의 신체 억제대 사용과 집중적인 관찰의 필요성을 시사한다.

최근 4년간 국내 단일 의료기관을 내원한 소아청소년에서 분리된 폐구균의 항생제 감수성 양상 분석 (Antibiotics Susceptability of Streptococcus pneumoniae Isolated from Single Tertiary Childrens' Hospital Since 2014 and Choice of Appropriate Empirical Antibiotics)

  • 정지원;유리나;성흥섭;김미나;이진아
    • Pediatric Infection and Vaccine
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    • 제26권1호
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    • pp.1-10
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    • 2019
  • 목적: 최근 4년간 서울아산병원에 내원한 소아청소년에서 분리된 폐구균의 항생제 감수성 양상을 파악하여, 3차 의료기관 내원 환자에서 발생한 폐구균 감염증에서 적절한 경험적 항균 요법을 제시하고자 하였다. 방법: 2014년 3월부터 2018년 5월까지서울아산병원어린이병원에폐구균감염으로입원하였던 18세미만의환아를대상으로 연령, 성별, 기저질환 및 폐구균의 ${\beta}-lactams$ 및 macrolide 항생제 감수성 양상을 후향적 의무 기록을 통해 조사하였다. Fallon 등이 제시한 Monte Carlo simulation 모델을 이용하여 경구 amoxicillin의 치료 효과를 예측하였다. 결과: 총 63례의 폐구균 감염증이 연구에 포함되었고, 87.3%(55례)는 기저질환이 있는 환아에서 발생하였다. 20.6%(13례)가 혈액(11례)을 포함한 무균성 체액에서 분리된 침습성 감염증이었으며, 폐구균에 의한 뇌수막염은 발생하지 않았다. Amoxicillin, 정주용 penicillin, cefotaxime 및 erythromycin에 대한 내성률은 각각 50.8%, 31.8%, 25.4% 및 95.2%이었으며, amoxicillin과 cefotaxime에 대한 고도 내성률은 각각 23.8% 및 9.5%이었다. Monte Carlo simulation에 의하면 경구용 amoxicillin을 90 mg/kg/day의 용량으로 투여 시 적절한 치료 효과를 기대할 수 있는 amoxicillin MIC 값은 $2.0{\mu}g/mL$ 이하로서 본 연구에서 포함된 비침습성 폐구균의 46.0%가 이 범위에 속하였다. 결론: 최근 4년간 기저질환을 가진 소아환자에서 분리된 폐구균 중 amoxicillin 및 cefotaxime에 고도 내성을 보이는 균주의 비율이 증가하였으며, erythromycin에 대하여 95% 이상 내성이다. 이에 다양한 기저질환을 동반한 고위험군 환아에서 발생한 폐구균 감염증에서 신중한 경험적 항생제 선택이 필요하겠으며, 침습 감염 및 내성 확산 방지를 위한 적절한 폐구균 백신 접종이 필수적이다.

소아에서 파라인플루엔자 바이러스 4형의 역학 및 임상 양상에 대한 단일기관 연구: 2015-2017 (Epidemiology and Clinical Characteristics of Parainfluenza Virus Type 4 in Korean Children: a Single Center Study, 2015-2017)

  • 손영주;최윤영;윤기욱;최은화;이환종
    • Pediatric Infection and Vaccine
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    • 제25권3호
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    • pp.156-164
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    • 2018
  • 목적: 본 연구는 국내 소아에서 parainfluenza virus (PIV) 4형 감염의 역학과 임상양상을 PIV 1-3형과 비교하여 분석하고자 하였다. 방법: 2015년부터 2017년까지 서울대학교 어린이병원에 내원한 소아들 중 실시간 중합효소연쇄반응법을 통해 PIV 1-4형이 검출된 환자들을 대상으로 의무기록을 후향적으로 분석하였다. 임상 진단은 열성 질환, 상기도 감염, 크룹, 모세기관지염과 폐렴으로 분류하였고, PIV 유형별 역학적 특징을 비교하였다. 인구학적 특징 및 임상적 특징은 건강한 환자만을 대상으로 분석하였다. 결과: 전체 PIV 감염은 472건이 확인되었고, 기저질환이 있거나 다른 바이러스가 중복 검출된 경우를 제외하여 최종 108건(22.9%)을 분석하였다. PIV 3형은 39건(36.1%), PIV 4형은 26건(24.1%), 1형은 24건(22.2%), PIV 2형은 19건(17.6%)이 검출되었다. PIV 4형 환자의 중간 연령은 11개월(0-195개월)이었으며, 2세 미만은 17명(65.4%), 2세 이상 5세 미만은 5명(19.2%)였다. PIV 4형환자군의임상진단은세기관지염(38.5%), 폐렴(30.8%), 상부호흡기감염(30.8%)의순이었다. 크룹은 PIV 2형 환자군에서 가장 우세하게 관찰되었고, PIV 4형 환자군에서는 한 명도 관찰되지 않았다(0% vs. 21.1%, P=0.026). 각 형 별 입원율의 유의한 차이는 없었다(P>0.05). 결론: PIV 4형은 우리나라에서 2015년과 2017년에 유행하였다. 입원 환자 중 5세 미만의 연령에서 주로 검출되었고, 입원을 필요로 하는 하기도 감염의 원인으로 고려되어야 할 것이다.