• 대한한방체열의학회지
• /
• 제1권1호
• /
• pp.28-37
• /
• 2002

Stable Compression Fractures(SCF hereafter) are most often caused by trauma such as traffic accidents. These SCFs usually occur in the thoracic and lumbar regions of the spinal cord. Human life spans have increased as a result of medical advances, which in turn has led to an increase in the elderly population. SCFs are divided into the categories of stable and unstable. The categories are determined through X-rays and P/Ex tests. The D.I.T.I. is then used to diagnose the severity and prognosis of the fracture injuries, and it allows an objective evaluation of the symptoms. This author researched 40 patients who were treated at Wonkwang University Oriental Medical Center from October 1995 to December 1996. The patients were diagnosed by X-ray as having SCFs and treated primarily with acupuncture. Both the changes in D.I.T.I. and patients' self-diagnoses of their conditions before and after treatment yielded the meaningful results which have been presented here. 1. 75% of those who suffer from Stable Compression Fractures are 60 years of older. Of those, the ratio of male to female is 1 to 4. This is due in part to the fact that many elderly women seek Oriental medicine treatment for conditions associated with advanced age. 2. 53.3% of these injuries occurred between T11 and L2. 3. 65% of patients were hospitalized for 10 to 29 days, and then able to be treated on an outpatiens basis. 4. The D.I.T.I. results showed 50% below $0.2^{\circ}C$, 30% between 0.3 and $0.5^{\circ}C$, 10% between 0.5 and $0.7^{\circ}C$, 10% between 0.7 and $0.9^{\circ}C$, and 0% over $0.9^{\circ}C$. 5. The results of treatment using Modified Evaluation System in Thoracolumbar Vertebral Fractures Method showed that 55% of patients achieved excellent recovery and 40% achived good recovery. After comparing the D.I.T.I. results before and after treatment, we found 50% of patients showed excellent recovery $({\Delta}T{\leq}0.2)$ and 40% showed good recovery$(0.2<{\Delta}T{\leq}0.5)$.

• 대한간호
• /
• 제35권2호
• /
• pp.71-91
• /
• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.

• The Korean Journal of Physiology
• /
• 제26권2호
• /
• pp.143-150
• /
• 1992

The purpose of this study is to obtain the effective concentration of capsaicin to relieve pain with no change in the number of C-fibers and its effective duration for pain relief. Capsaicin has been used extremely as a experimental tool and as topical medications for acute or chronic tissue injuries and partial nerve injury is the main cause of causalgiform pain disorders in humans. Here, the left sciatic nerve was ligated unilaterally at the high level of the thigh to prepare an animal model of this pain condition. The rat developed guarding behavior of the ipsilateral hind paw within a few hours after the operation and this behavior was maintained for several months thereafter, suggesting the possibility of spontaneous pain. These animals were divided into two groups(4-week & 8-week) and each group was subdivided into five groups by different concentration (0.05, 0.1, 0.5, 1.0 & 2.0%). Each capsaicin concentration was treated locally on the spinal cord-side of the ligated nerve and the foot withdrawal latency was measured. Thereafter, the dorsal roots of L5 were removed from both sides immediately after in tracardial perfusion for the counting of C-fibers by the histological procedure. There were no significant differences in the foot-withdrawal latency and the number of C-fibers between the left side treated with 0.05% capsaicin and the right side treated with the vehicle. However, latencies of the left sides treated with 0.1, 0.5, and 1.0% capsaicin increased significantly throughout 4-6 weeks with almost no change in the number of C-fibers, and the latencies showed the trends to approach slowly to those of the conditions after operation. The latency of subgroup treated with 2.0% increased by approximate 10% more than that of the right side throughout 8 weeks, and the number of C-fibers decreased by about 30% or more These results suggest that the elevated latency with capsaicin(0.1-1.0%) treatment is due to the inhibition of impulse transmission throughout the primary afferent fiber and the data from 2.0% are due to partial destruction of C-fibers. Therefore, capsaicin concentrations from 0.1% to 1.0% are probably very effective for the treatment of causalgiform pain with almost no destruction of C-fibers.

• 인터넷정보학회논문지
• /
• 제14권6호
• /
• pp.33-39
• /
• 2013

거동이 불편한 노인 및 장애인의 이동을 위한 휠체어 사용 시, 사용하지 않는 상 하지의 근력 저하 등 운동 능력의 감소를 초래할 수 있다. 특히, 척수손상 및 뇌졸중 편마비와 같은 중증 장애인은 거동이 제한되어 운동이 부족하고 근력 유지가 어렵다. 본 논문에서는 이러한 중증 장애인의 특성을 고려하여 상 하지 운동 및 재활훈련이 가능한 지능형 휠체어 로봇 시스템을 설계하였다. 이 시스템은 전동 휠체어, 개인의 특성 파악을 위한 생체인식모듈, 그리고 상 하지 재활 로봇으로 구성되어 있다. 본 논문에서는 개발된 로봇의 설계 및 구성에 대해 설명하고 운용 방법을 제시한다. 또한, 제안한 시스템의 추종 성능을 검증하기 위하여, 비장애인 피험자를 대상으로 재활 운동 수행시 생체 신호 변화에 따른 위험상황 분석과 휠체어 로봇이 이동하면서 상 하지 재활운동 기능에 대한 성능평가를 수행한 결과, 피험자의 재활 운동 수행 시 위험상황 분석에 대한 평균 정확도는 86.7%, 관절각도 최대 오차는 상지 2.5도, 하지 2.3도로 재활 운동 수행에 충분한 추종성능을 나타냈다.

• 생명과학회지
• /
• 제23권9호
• /
• pp.1096-1103
• /
• 2013

만성외상성뇌병증(Chronic traumatic encephalopathy, CTE)은 운동선수와 매우 밀접하게 관련되어 있으며 장기간에 걸쳐 반복적인 외상성뇌손상(traumatic brain injury, TBI)로 인한 퇴행성뇌질환이다. 신경영양인자(neurotrophic factor)는 여러 종류가 알려져 있으며 이들은 뇌와 척수의 물리적 손상시에 신경보호효과가 있다. 따라서, 신경영양인자의 혼합물인 cebrolysin을 이용하여 CTE질환에 가장 적합하다고 여겨지는 repetitive mild TBI (rmTBI) 모델에서 cerebrolysin의 신경보호효과를 알아보고자 하였다. 실험군은 5군(groups 1 and 2: rmTBI for 4 weeks following cerebrolysin injection for 4 weeks; groups 3 and 4: rmTBI for 8 weeks with or without cerebrolysin injection for 4 weeks; group 5: control)으로 나누어 진행하였다. CTE의 가장 대표적 표시인자인 tau 단백질의 인산화를 조직학적으로 조사한 결과, 대뇌겉질과 해마내 CA3 영역에서 phospho-tau단백질의 발현이 증가되었으며 cerebrolysin ($10{\mu}l$ of 1 mg/ml)를 미정맥으로 투여시 p-tau발현이 감소되었다. CTE의 병인으로 알려진 별아교세포와 미세아교세포의 활성을 각각의 표시인인 GFAP, iba-1을 이용하여 면역조직화학염색을 시행하였다. 별아교세포의 활성은 rmTBI에 의하여 증가하였으며 cerebrolysin에 의해 회복되었으나 미세아교세포의 활성은 관찰되지 않았다. 또한 rmTBI모델에서 체내 탐식세포(macrophage)의 뇌내유입유무를 관찰하고자 CD45 염색을 시행하였으나 유의한 차이를 관찰하지 못하였다. 이상의 결과를 종합하면, cerebrolysin이 rmTBI에 의한 tau단백질의 인산화 및 별아교세포의 활성을 조절하는 것으로 사료된다. 따라서 cerebrolysin이 CTE 환자에 대한 치료 약물의 후보가 될 수 있음을 시사한다.

• Journal of Korean Neurosurgical Society
• /
• 제30권10호
• /
• pp.1210-1219
• /
• 2001

서 론 : 후방 경유 경추 융합을 위한 후관절 금속판 고정술은 외상성 및 퇴행성 불안정성의 치료에 효과적인 방법이다. 후관절 금속판 고정의 안정성은 여러 가지 인자에 의해 결정된다. 이중 하나가 나사못의 삽입깊이이다. 이 방법이 처음 소개될 때에는 양피질골성 삽입이 이용되었다. 외과의사의 관심은 어떻게 안전하면서 생역학적으로 강력한 고정을 얻느냐에 있다. 목 적 : 이 연구의 목적은 사체에서 단피질성과 양피질성 나사못 삽입술을 시행한 후 안전성, pull-out 강도, 방사선학적 특성을 분석하고 나사못의 삽입에 대한 교육 훈련의 수준에 따른 영향을 평가하는데 있다. 방 법 : 평균 나이 78.9세인 21구의 사체에 대하여, Magerl의 기술을 변형하여 C3-C6(n=168)까지 3.5mm AO 나사못을 양쪽 후관절에 삽입하였다. 수술중 방사선 사진영상은 사용되지 않았다. 오른 쪽(단피질성 삽입)은 14mm 나사못(11mm의 유효 길이)을 이용하고, 왼쪽은 양피질성 삽입을 시도하였다. 각 사체는 3개의 군으로 나누어 척추 수술 수련의 수준이 다른 받은 3명의 척추 외과 의사들(전임 강사, 임상 강사, 수석 레지던트)이 수술을 시행했다. 수술 후 경추를 떼어내어 나사못의 위치를 육안적으로 확인하고 방사선학적으로 안정성과 삽입 위치 (1,2,3)를 평가하였다. 척수, 후관절, 신경근과 척추 동맥에 대한 나사못의 위치를"만족할 만한","위험한", 그리고"직접적인 손상"으로 구분하였다. material testing machine을 이용하여 모든 나사못에 대해서 Pull-out 강도를 측정하였다. 결 과 : 대다수의 나사못(92.9%)은 만족할 만한 상태였다. 전예에서 척수에 대한 위험성은 없다. 오른 편(단피질성 : 14mm) 나사못의 98.9%는"만족할 만한"에 속했다. 그리고 왼쪽 편(양피질성)의 68.1%는"만족할 만한"에 속했다. 양피질성 나사못 군에서 5.8%의 척추 동맥에 대한 직접적인 손상이 있었고 신경근의 직접적인 손상 발생율은 17.4%였다. 반면에 단피질성 나사못 군에서는 이들에 대한 직접적인 손상은 없었다. 양피질성 나사못에서 보인"직접 손상"의 거의 대부분은 외과 의사의 경험 부족으로 발생하였다. 나사못의 안정성과 삽입 위치 사이에는 특별한 관련이 없었다. 모든 나사못의 pull-out 강도는 $542.0{\pm}296.6N$였다. 단피질성에 있어서의 pull-out 강도($519.0{\pm}289.9N$)와 양피질성($565.2{\pm}306N$) 나사못에는 아무런 통계학적으로 의미있는 차이점을 발견할 수 없었다(p>0.05). 나사못 삽입위치와 pull-out 강도 사이에는 의미있는 차이가 없었다. 결 론 : 이번 연구는 경추 후관절 나사못 고정술시 단피질성과 양피질성 나사못의 안정성과 효능을 집중적으로 알아보았다. 명백한 것은 14mm의 나사못(효과적인 길이는 11mm)이 보다 긴 양피질성 나사못 보다 손상의 위험이 훨씬 낮고 거의 동등한 pull-out강도를 갖는다는 것이다. 또한, 수술시 방사선 영상을 사용할 수 없을 때, 훈련과 축적된 경험에 의해 나사못 삽입의 정확성과 안전성이 향상될 수 있다.

• 대한간호
• /
• 제31권4호
• /
• pp.77-99
• /
• 1992

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

• Tuberculosis and Respiratory Diseases
• /
• 제49권5호
• /
• pp.624-632
• /
• 2000

서론 : 최근 발달된 기술로 작고 기능이 뛰어난 가정용 인공호흡기가 개발되어 구미에서는 장기간 기계환기가 필요한 만성호흡부전 환자를 대상으로 그 사용아 점차 보편화 되어 가고 있다. 우리나라에서도 가정에서 기계환기치료의 적용이 최근 확산되고 있으나 이 치료법에 대한 임상 경험 보고나 그 실태 조사 자료가 거의 없어 이에 대한 기초 자료의 조사가 필요한 상태이다. 본 연구는 장기간 기계환기 보조가 필요하여 가정용 인공호흡기를 사용하는 환자에서 간호 관리의 문제점과 가정용 인공호흡기 사용 실태를 조사하기 위하여 연구를 시행하였다. 연구대상 및 방법 : 서울 및 경기 지역에서 가정용 인공호흡기를 사용하고 있는 환자 92명의 명단을 인공호흡기를 공급 관리하는 업체에서 제공 받아 전화 통화를 시도하여 방문에 동의하는 29명을 대상으로 하였다. 대상 환자의 집을 방문하여 병력 청취와 신체 검사를 시행하였고, 환자 간호 관리에 대한 설문을 실시하였다. 설문의 내용에는 간호 관리에 대한 사전 교육 여부, 의료인의 가정 방문 여부, 인공호흡기 이상의 경험 여부, 인공호흡기 및 부가 장비의 구입 경비, 환자 간호와 연관된 문제점 및 개선을 위한 제안 등이 포함되어 있었다. 가정용 인공호흡기의 설정 요소들을 확인하고, 측정되는 일회호흡용적(tidal volume), 최대 기도압, 산소포화도 등을 기록하였다. 연구결과 : 1) 방문을 마친 환자 29명중 남자는 26명(90%)이었고, 나이는 48.0(${\pm}$20.1)세였다. 환자들의 기저 질환은 신경근 질환 21명(72.4%), 척수 손상 2명(6.9%), 만성 폐질환 6명(20.7%)이었다. 2) 간호 관리자는 배우자가 14명(48.3%)으로 가장 많았으며, 가정 간호 관리를 위한 사전 교육은 주로 입원 중 간호사로부터 배우고 있었다. 3) 인공호흡기를 구입하여 사용하는 경우는 23명으로 압력달성양식(pressure targeted type)은 745(${\pm}$329)만원, 용적달성양식(volume targeted type)은 1,428(${\pm}$313)만원이 각각 소요되었다. 장비 구입에 소요되는 총 비용은 1,13l(${\pm}$653)만원이었다. 환자를 간호 관리하는데 1개월간 소요되는 평균 비용은 112(${\pm}$136)만원이었다. 4) 29명의 환자 중 25명 (86%)은 기관절개술을 시행한 상태로 기계환기를 시행하고 있었다. 인공호흡기는 용적달성양식이 20명(69%)으로 압력달성양식(9명, 31%)보다 더 많았다. 결론 : 우리나라에서 가정용 인공호흡기를 사용하는 환자는 신경근 질환 환자가 가장 많았고, 대부분 기관절개술을 시행한 상태로 경보 기능을 가진 용적달성양식을 많이 사용하고 있었다. 환자와 가족들은 장비 구입 및 유지와 연관된 경제적인 어려움을 당연한 문제로 제시 하였으며 환자들 중 일부는 가정간호사들의 도움을 받고 있었으나 의사들의 지속적인 감시를 받지 못한 채 방치되어 있었다.