• 제목/요약/키워드: Physiology Health

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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.

남해안 연안에서 적조생물, Cochlodinium polykikoides, Gyrodinium impudicum, Gymnodinium catenatum의 출현상황과 온도, 염분, 조도 및 영양염류에 따른 성장특성 (Abundance of Harmful Algae, Cochlodinium polykrikoides, Gyrodinium impudicum and Gymnodinium catenatum in the Coastal Area of South Sea of Korea and Their Effects of Temperature, Salinity, Irradiance and Nutrient on the Growth in Culture)

  • 이창규;김형철;이삼근;정창수;김학균;임월애
    • 한국수산과학회지
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    • 제34권5호
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    • pp.536-544
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    • 2001
  • 적조생물 Cochlodinium polykrikoides, Gyrodinium impudicum, Gymnodinium catenatum은 독성을 지니거나, 적조를 일으킴으로써 수산피해 및 보건위생상의 문제를 야기시키는 종이다. 이 종들의 적조발생 환경과 기작을 이해하기 위해서는 종별 생태생리 (eco-physiology) 특성 등을 파악할 필요가 있다. 본 실험에서는 한국 남해안 연안에서 이들 3종의 출현상황과 성장특성을 파악하기 위해 이 해역에서 분리한 종을 대상으로 온도, 염분, 조도 및 영양염류에 따른 성장도를 조사하였다. 1999년도 남해안 남해도, 나로도, 완도 연안에서 이들 3종의 최초출현시기는 수온이 $22.8\sim26.5^{\circ}C$인 7월 중순에서 8월 중순으로써 서로 비슷한 시기에 동반 출현하였다. 유영세포의 소멸시기는 G. catenatum의 경우 8월 중, 하순이었고, C. polykrikoides와 G. impudicum은 수온이 $23^{\circ}C$ 이하로 하강하는 9월 하순이었다. 출현기간 중의 최대밀도는 C. polykrikoides의 경우 $40\times10^6$cells/L 이상으로써 고밀도 증식을 하였으나, G. impudicum과 C. catenatum은 각각 3,460ce11s/L 및 440ce11s/L로써 매우 낮은 밀도로 존재하였다. 배양실험에서 C. polykrikoides, G. impudicum, G. catenatum는 $22\sim28^{\circ}C$에서 양호한 성장을 보였고, 최적수온은 $25^{\circ}C$ 내외로 판단되었는데, 이러한 결과는 적조발생시의 수온과 대체로 일치하였다. 염분에 따른 성장률은 3종 모두 $30\sim35\%$에서 양호한 성장률을 보였다. 3종 중 G. impudicum은 비교적 광염성의 특징을 보였고, G. cstenatum은 $35\%$ 이상의 고염분에서 특히, 저조한 성장률을 보였다. 조도에 따른 성장은 C. polykrikoides와 G. impudicum의 경우 특히 7,5001ux 이상의 고조도에서 성장률이 현저히 높은 것으로 나타났다. 이러한 결과는 C. polykrikoides의 경우 조도가 높은 하계에 표층에서 강한 집적현상을 보이면서도 광저해현상을 밟지 않고 양호한 증식을 할 수 있는 특성과 관련이 있을 것으로 추정되었다. C. polykrikoides와 G. impudicum의 질산 및 암모니아 질소 농도에 따른 성장은 $40{\mu}M$까지는 농도가 높을수록 성장률도 증가하였으나 그 이상에서는 큰 차이를 보이지 않아, 두 종의 질소 임계농도는 $13.5\~40{\mu}M$로 판단되었다. 또한, 인산인은 $4.05{\mu}M$ 까지는 농도가 높을수록 성장률도 증가하였으나 그 이상에서는 큰 성장차를 보이지 않아, 두 종 모두 인산인의 임계농도는 $1.35\sim4.05{\mu}M$로 판단되었다. 한편, C. polyklikoides는 DIN과 DIP 농도가 각각 $1.2{\mu}M$$0.3{\mu}M$ 이하로 낮았던 나로도와 남해도 외측해역에서도 적조를 형성하였다. 이와 같이 낮은 영양염류 하에서 왕성하게 증식할 수 있었던 이유는 이 종의 경우 일간 수직이동을 통해 야간에 저층에서 풍부한 영양염류를 흡수할 수 있었기 때문으로 해석되었다.

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심질환 병력이 없었던 중환자에서 B-type Natriuretic Peptide 검사의 유용성 (The Usefulness of B-type Natriuretic Peptide test in Critically Ill, Noncardiac Patients)

  • 김강호;박홍훈;김에스더;천석철;이지현;이용구;이지현;김인재;차동훈;김세현;최정은;홍상범
    • Tuberculosis and Respiratory Diseases
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    • 제54권3호
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    • pp.311-319
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    • 2003
  • 연구배경 : B-type natriuretic peptide(BNP)는 주로 심장의 심실에서 분비되는 호르몬으로서 심부전의 진단, 중증도 및 예후와도 연관이 있다고 알려져 있다. 중환자의 경우 급성병색시 심부전이 올수 있는 것으로 알려져있고 이는 환자의 예후와 연관이 있을 가능성이 있다. 그래서 저자들은 우선 이전 심질환의 병력이 없는 중환자들에서 BNP를 측정하여 증가여부를 살펴보고, BNP와 중환자의 중등도 및 예후와의 관련성 여부를 살펴보기로 하였다. 방 법 : 2002년 6월부터 10월까지 본원 중환자실에 입원하였던 환자 중 환자의 중증도와는 관련이 없이 BNP가 증가될 수 있는 울혈성 심부전, 심방 세동, 허혈성 심질환, 신부전 등을 제외한 32명을 대상으로 하였고, 대조군으로는 일반 병동 및 외래 환자 32명을 무작위로 추출하였다. BNP는 Triage B-Type Natriuretic Peptide test를 이용하여 fluorescence immunoassay를 통해 측정하였다. APACHE II score와 APACHE III score 및 중환자실 사망 여부를 추적하였다. 결 과 : 남녀비는 16 : 16이었고, 연령은 $59.2{\pm}20.6$세 였다. BNP는 $186.7{\pm}274.1$ pg/mL으로 정상 대조군의 $19.9{\pm}21.3$ pg/mL 보다 유의하게 높았다. 중환자군에서 BNP 100 pg/mL이상은 14명으로 43.8%였다. APACHE II score는 $16.5{\pm}7.6$이었고, 11명이 사망하였다. BNP값은 APACHE II score및 사망과 유의한 상관 관계를 보였고(r=0.443, p=0.011, r=0.530, p=0.002), 생존군과 사망군 BNP값은 유의한 차이를 보였으나($83.2{\pm}55.8$ pg/mL vs. $384.1{\pm}401.7$ pg/mL ; p=0.033), $PaO_2/FiO_2$와는 상관 관계를 보이지 않았다. 결 론 : BNP는 이전 심질환병력이 없었던 중환자에서 증가되어 있었고, 사망률 및 중증도 점수와도 유의한 상관 관계가 있었다. 따라서 중환자들의 예후를 예측하는데 비침습적이고 빠른 방법으로 도움이 될 가능성이 있다.

일부(一部) 중학생(中學生)의 성(性)에 대한 의식행태조사(意識行態調査) (A study on the Awareness and Behavior about Sex of Middle School Students -from middle school students in Taegu area-)

  • 김상옥;남철현
    • 한국학교보건학회지
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    • 제5권2호
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    • pp.42-65
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    • 1992
  • A survey was made of 976 students who were selected among students of 5 middle schools at Taegu so that it could furnish basic knowledge about sex education of adolescents by analyzing students recognition of sex, acquaintance with the opposite-sex, sex-education, The survery took a month from Nov. 1, to Nov 30, 1991. The results of this study are summarized as follows. 1. The general characteristics of the surveyed students. The survey consisted of 332 boys middle school student & 325 girls middle school students, 157 male & 162 female students of coeducational middle schools. 32.9% of them were from the first grade, 33.2% from the second grade & 33.9% from the third grade. 35.7% of them believed in Buddhism, 19% Christianism and the mode of their living standard, 86.7%, fell on 34.7% of their parents engaged in commerce and they were followed by salary man and public officals, 93.1 % of the students, parents were alive. 44.9% of their fathers were graduates of high school and 42.2% of their mothers middle school. 2. Sexual maturity 89.1 % of the surveyed girls had experienced menstruation. The mode of first menstruation, 48.2%, was at the age of 13 and the mean of it was 12.9, 3.7% the surveyed boys had exprienced a wet drem before. The mode of the first wet dream, 40.0%, was at the age of 14 and the mean was 13.4. 21.3% of surveyed students had the experience of masturbation but the number of girls fell far short of that boys. The mode of the first masturbation, 37.0%, was at the age of 14 and the mean was 13.4. 3. The acquaintance and sexual relations with the opposite sex 1) Analyzing the students actual conditions with the opposite, I found out that 52.3% of them wanted to have any kind of relations with the opposite and that 30.25 had already had some kind of relations. 73.2% of the students having relations with the opposite thought the other sex merely as a friend and the number of students who were thinking that way was distributed evenly among schools. 28.8% of the students had got acquainted with the other sex through their frieds and there were not much difference between boys and girls in the method of getting acquainated with the opposite. About 35.2% of the students having relations with the opposite came from the third grade. 47.8% of them answered that the meeting place was not fixed and 26.4% answered that they were meeting their parthers outdoors. 60.7% replyed that they were not disturbed in their studies by the relations with the other sex. 2) Most of the students 79.4%, answered that they had never had sexual relations and 16.3% of the rest said that thery were expressing their feelings by grasping each other's hand. 3) 16.6% of the surveyed students asid that they had the exprience of smoking, 1.1 % of an illusion caused by inhaling chemical addhesives, 44.0% of drinking and 41.4% of warching pornographic films. 4. The knowledge and attitude about the sex 1) The distribution and analysis according to schools and grades : 64.8% of the surveyed students answered correctly to the questions about mensturation, 49.3 % did so about wet dreams, 94.3 % did so about conception, 60.6% did so about child birth, 73.9% did so about AIDS and 50.1 % did so about sexual diseases. Roughly speaking, they had not much knowledge of sexual diseases. 2) The recognition of sex according to schools and grades : 39.0% of the students said that they had worries about sex. 33.1 % of what they worried was concerned with their bodies and 26.8% was about the acqaintance and relationship with the opposite sex. The girls were much more concerned about the former and the boys the latter. 51.1 % of the students asid that they had no specific opinion of masturbation but 19.2% said that's alright if self-restrained. About the sexual intercourse before marriage, 75.7% said negatively. 5. The need for sex education most of the students, 99.4% said they needed sex education and there was not much difference in that thought among schools. And 49.7% answered that schools, families, and societies were equlally important in sex education. About half of the students, exactly 50.2%. considered it as the main reason of sex education to prevent accidents cauesd by ignorance of sex. 81.4% said that they had had some kind of sex education. Most of the educations, 87.0%, had taken place at schools but 5.2% said they were getting most of the knowledge about sex from therir friednds, juniors and seniors. 59.5% of the students who had ever had a sex education said "Just so, so" when asked of the level of their contentment but the number of students who said "satisfied" was only a few, 16.1 %. 20.7% of the survered answered that thery wanted sex education to be made in the course of home life, and 26.6 % of the students most wanted to know about the acquaintance and relationship with the oppostie sex, 29.0% preferred nurse teachers as proper councellors of sex education. The mode of their present councellors, 42.0%, was friends but only 7.6% answered they dicussed with teachers. 6. The correlation analysis between general characteristcs and sexual behaviors of the surveyed students revealed that sex had a signigicant(P<0.001) positive correlation with parents' love toward students(P<0.01), the experience of masturbation, smoking, an illusion caused by inhaling chemical adhesives and the experience of watching pornographic films. And the standard of living had a significant(P<0.01) positive correlation(P<0.01) with grade point average, parents' existence(P<0.01) and parents' love, but a significant(P<0.01) negative correlation with sexual worries. grade point average had a significant(P<0.01)negative correlation with the experience of an illusion caused by chemical adhesives(P<0.01) and smoking. Parents' existence had significant(P<0.01) positive correlations with parents' love and smoking but a significant(P<0.01) negative correlation with the experience of an illusion by chemical adhesives. There was a significant(P<0.01) negative correlations between parents' love and the experience of an illusion by chemical adhesives, and a significant(P<0.001) positive correlation among masturbation and sexual worries, smoking, an illusion by chemical adhesives and the experience of watching pornographic films. There was a significant(P<0.001) positive correlation among acquaintance with the opposite sex, smoking, the experience of an illusion by chemical adhesives and watching pornographic films. Sexual worries had significant(P<0.01) positive correlations with smoking, the experience of an illusion by chemical adhesives and watching pornographic films. smoking had a significant positive correlation with drinking the experirence of, an illusion by chemical adhesives and watching pornographic films. Finally, there was a significant(P<0.01) positive correlation between the drinking experience and the illusion experience by chemical adhesives. According to the results mentioned above, the fact is certain that there is a great need for sex education of adolescents. Therefore, it is desirable that the schools teach sexual physiology and normal positively and that sex education including hygien education be an independant course in the curriculums. Furthermore, it is essential that the schools should have enough nurse teachers to take up sex education, expand training opportunities for them and that they develop educational materials. Considering the unbalance of the level of sex educations between boys and girls, I want to suggest that all boys and girls have sex education evenly and lead happy lives by correction irrational thought about sex, that is to say, sex discrimination, Sex education programs, especially of middle school students, should be reexamined if it is to give the students effective and profitable knowledge about sex. In addition, the government should establish a policy of adolescents' sex education to have healthy opinions of sex settled nationwide.

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