• 디지털융복합연구
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• 제13권10호
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• pp.385-395
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• 2015

목격자 심폐소생술 시행률을 높이는 핵심 방안 중 하나가 학생들에게 심폐소생술 교육을 하는 것이다. 본 연구의 목적은 보건교사가 실시하는 중학생 심폐소생술 교육의 결과를 교육 전 수준과 비교 검증하는 것이다. 2014년 3월부터 6월까지 부산광역시 중학생 812명을 대상으로 교육 전과 후의 관찰 값을 SPSS, SAS프로그램을 사용하여 카이검정과 맥네머 검정으로 분석하였다. 대상자의 성별과 과거교육 경험을 층하한 후 각 층하군에서 인식, 의지 및 자신감의 모든 항목에서 교육 전보다 교육 후에 통계적으로 유의하게 긍정적인 변화가 관찰되었다(p<0.05). 목격자 심폐소생술이 더 많이 실시되기 위해서는 중학생에게 보건교사가 이론과 실습으로 구성된 심폐소생술 교육을 실시하는 것이 바람직하다고 판단된다. 이러한 교육의 실현을 위하여 교육 도구의 공급을 위한 지역사회의 정책 개발을 위한 추가적인 연구가 더 필요할 것으로 생각한다.

• 한국보건간호학회지
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• 제11권2호
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• pp.38-56
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• 1997

A great deal of attention has been paid to the quality of life in citizens due to the increased number of long term life expectancy. reported as effective in the health promotion of the senior citizens. In this study, the principal investigator developed an exercise program for the senior citizens, which could be educated and managed by nursing staff. This kind approach may support the need of exercise program on regular base via the social organization, which may mean the intentional change of life style. The exercise program consisted of exercise, health education, and a direct the population of the senior A regularexercise has been nursing care. A quasi -experimental study was conducted to investigate the effects of excercise program on health of the elderly in senior citizen's center. Independent variable was a 9 weeks exercise program. Dependent variables were: 1) physical health [e.g. physical fitness(cardiopulmonary endurance, back muscle strength, grip strength, muscular tolerance, flexibility and body fat proportion), physiologic parameters(blood pressure, pulse, respiration. and blood glucose), and perceived physical health status; 2) mental health measured by depression score; and 3) cognitive perception of exercise measured by usefulness and self-efficacy. A total of 37 subjects was randomly assigned into either the control group (without the exercise program: n=18) or the intervention group(with the exercise program: n=19). The results of the study analyzed using a SAS, were as follows: 1) In physical fitness of physical health, there was a significant improvement in cardiopulmonary tolerance. back muscle strength. muscular tolerance and flexibility in the intervention group, compared to the control group, while no difference in grip strength and body fat proportion. The exercise program resulted in decreases in blood pressure, pulse, respiration and blood glucose within normal range and improvement of perceived physical health status in the intervention group. 2) There was a slight increase of mental health(depression score) in the intervention group compared to the control group. but without statistical significance. 3) There was a significant improvement in cognitive perception of exercise(e.g. usefulness and self -efficacy) in the intervention group, compared to the control group. It was concluded that the exercise program employed in this study was appropriate for women senior citizens and had a positive effect on health in general.

• Journal of Chest Surgery
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• 제10권2호
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• pp.299-314
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• 1977

Clinical experience on 16 cases of open heart surgery under the extracorporeal circulation with mild or moderate hypothermia and partial hemodilution technique at the National Medical Center during the period from June 1976 to October 1977. Nine of sixteen were congenital heart disease and seven were acquired heart disease. The age of the patient ranged between 6 and 48 years. The body weight varied from 18.5kg to 60kg and body surface area 0. 79-1.70m2. The average priming volume of pump oxygenator was 2080 ml, which was consisted fresh ACD blood, buffered Hartmann`s solution, Mannitol, 50% dextrose in water and Vit. C. The average hemodilution rate was 27%. The average flow 2.3 L/min/m2 or 80 ml/min and the duration of perfusion varied from 31 min to 270 min with average of 107 min. The perfusion was carried out under the mild or moderate hypothermia using core cooling alone in 10 cases, core cooling and local myocardial cooling with $0-4^{\circ}C$ physiologic saline in 2 cases. From a hemodynamic point of view, the blood pressure dropped down around 80 mmHg after the initiation of perfusion follwed by increase to safety level and stable during the perfusion. The central venous pressure remained within normal limits. In most cases, hemoglobin and hematocrit decreased during and after the perfusion. Hemogiobin level was decreased, average of 20.6 %, hematocrit 18.6%, pletelets 55% postoperatively. Plasma hemoglobin increased moderately, from preperfusion average valve of 7.79 mg % to post-perfusion value of 54.7 mg %. Electrolytes changes during cardiopulmonary bypass showed definite hypokalemia but changes of Na, Ca were not definite. Arterial blood gas analysis during cardiopulmonary bypass suggested that the metabolic acidosis which was accompanied by respiratory alkalosis which was corrected postoperatively. As the opera tive complication, transient hemoglobinuria in 4 cases and neurological signs in 2 cases were all cured. There were 2 death cases and operative mortality rate was 12.5%.

• Journal of Chest Surgery
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• 제22권4호
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• pp.562-572
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• 1989

The changes of serum glutamic oxaloacetic transaminase [SGOT], serum glutamic pyruvic transaminase [SGPT], serum lactic dehydrogenase [LDH] and serum creatine phosphokinase [CPK] were examined during and after the open heart surgery. In the total of 52 patients with heart diseases including 40 cases of congenital heart anomalies and 12 cases of acquired valvular heart diseases who undergone open heart surgery under cardiopulmonary bypass. The results obtained are as follows: 1. The average value of SGOT before surgery was 30.27 [ 18:86 units. The enzyme was reached to the maximum of 139.88 [ 89.43 units on the 1st day after the operation [p< 0.05], the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 7th day after the operation. 2. The average value of SGPT before surgery was 14.36 [ 7.45 units. The enzyme was reached to the maximum of 34.67 [ 27.64 units on the 2nd day after the operation, but it was valueless statistically, the enzyme activity was gradually decreased from the 3rd day after the operation, returned to the normal range on the 5th day after the operation. 3. The average value of LDH before surgery was 263.07 * 86.66 units. The enzyme was reached to the maximum of 662.29 * 303.60 units on the 2nd day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 4. The average value of CPK before surgery was 141.35 * 43.44 units. The enzyme was reached to the maximum of 377.42 [ 222.02 units on the 1st day after the operation [p < 0.05], the enzyme activity was gradually decreased from the 5th day after the operation, returned to the normal range on the 7th day after the operation. 5. In the relationships of the serum enzymes and duration of the extracorporeal circulation, the values on the group over 90 minute of the extracorporeal circulation were increased than on the group below 90 minute of the extracorporeal circulation, but it was valueless statistically.

• Journal of Chest Surgery
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• 제36권10호
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• pp.772-775
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• 2003

모야모야 질환은 원위부 내경 동맥과 근위부 뇌동맥들의 폐쇄성 내피 이형증으로 특징지워는 뇌혈관 질환으로, 아직까지 정확한 병인이 밝혀지지 않은 질환이다. 상기 질환은 양측 내경 동맥의 원위부에 부분적인 협착이나 폐쇄를 야기하게 되고, 이러한 뇌혈관의 해부학적인 변이는 뇌의 기저부에 매우 미세한 혈관들의 문합을 형성하게 하는데, 이러한 신생 혈관들이 뇌혈관 조영검사상 구름처럼 보인다 하여 ‘Moyamoya’라 불리운다. 모야모야 환자군들에게서 관상 동맥 질환 등으로 인한 개심술의 시행은 매우 드물다고 알려져 있으며, 이러한 환자군들에서의 인공심폐기를 이용한 개심술은 수술 중, 그리고 수술 후 허혈성 뇌질환 등의 위험성이 매우 높다고 보고되고 있다. 본 교실은 모야모야 환자에서 심방중격결손 폐쇄와 관상동맥우회술을 인공심폐기를 이용한 개심술을 시행하여 성공적으로 치료하였기에 간략한 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제48권2호
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• pp.99-104
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• 2015

Background: We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Methods: Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Results: Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were $194.8{\pm}48.6$ minutes and $126.1{\pm}22.6$ minutes in mitral valve repair operations and $132.0{\pm}32.0$ minutes and $76.1{\pm}23.1$ minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was $128.3{\pm}43.1$ minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Conclusion: Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

• Journal of Chest Surgery
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• 제32권11호
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• pp.971-977
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• 1999

Background: Immunologic and inflammatory responses of cardiopulmonary bypass(CPB) influence postoperative mortality and morbidity with multiple organ injury. It has been reported that ischemia/reperfusion induced-myocardial injury during CPB is causative of release of inflammatory cytokines such as interleukin-6(IL-6) and tumor necrosis factor-$\alpha$ (TNF-$\alpha$). The purpose of this study was to detect the time course of the activated cytokine and troponin-T(TnT), and to examine the correlation between such parameters during CPB. Material and Method: The serial samples were collected from arterial blood via radial arterial catheter in 23 patients who are underwent open heart surgery (OHS) with CPB, the IL-6, TNF-$\alpha$ and TnT were checked. Result: \circled1 IL-6, TNF$\alpha$- and TnT concentration increased significantly during CPB with a peaking level of CPB-off (p 0.05). \circled2 IL-6 had highly positive correlation with aortic cross clamping time and total bypass time(r=0.80, 0.78; p 0.05, respectively). \circled3 There was no correlation among IL-6, TNF-$\alpha$ and TnT. Conclusion: In conclusion, these data showed that elevated production of serum IL-6 during CPB was attributable to ischemia/reperfusion induced-myocardial damage. IL-6 will become a new and sensitive biological marker in assessment of myocardial damage during OHS with CPB. However, further studies will be needed to apply IL-6 in more patient population.

• Journal of Chest Surgery
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• 제18권2호
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• pp.165-173
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• 1985

A clinical analysis was performed n 706 uses of patent ductus arteriosus experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 27 years period from 1958 to 1984. Of the 706 patients of PDA, 244 patients were male and 462 patients were female and ages ranged from 2 months to 53 years old with the average age of 8.5 years. The chief complaints on admission were dyspnea on exertion and frequent URI in 58.9%, non specific symptoms such as palpitation and easy fatigability in 9.7%, symptoms of CHF in 2.0% and no subjective symptoms in 29.4%. On auscultation of heart, continuous machinery murmurs were heard in 82% and only systolic murmurs were heard in 18% of patients. On simple chest PA of patients, cardiomegalies were detected in 78% and there were increased pulmonary vascularities in 93% of patients. EKG findings were as followed; LVH 56.9%, BVH 12.6%, RVH 2.9% and WNL 27.6%. Cardiac Catheterizations were performed in 512 patients and mean Qp/Qs was 2.56 and mean systolic pulmonary artery pressure was 45mmHg. Operation methods were as followed; in patients in whom operations were performed on PDA only, ligation 94.3%, division 3.7% and ligation [0.5%] or trans-pulmonary artery suture closure [1.5%] under cardiopulmonary bypass 2.0% and in patients in whom operations were performed with associated anomalies, ligation 17.6%, division 2.4%, and ligation [44.7%] or trans-pulmonary artery suture closure [35.3%] under cardiopulmonary bypass 80%. 52 postoperative complications [8.4%] were developed in 42 patients [6.8%] and its were as followed; permanent or transient hoarseness 16 [2.6%], intraoperative rupture of PDA 8 [1.3%], recannalization 6 [1.[%], operative death 5 [0.8%], late death 4 [0.6%] and other miscellaneous complications 13 [2.1%]. 140 associated cardiac anomalies [19.8%] were found in 105 patients [14.9%] and its were as followed; VSD 68 [9.6%], COA 15 [2.1%], Subaortic discrete membrane 7 [0.9%], ASD 6 [0.8%], TOF 5 [0.7%] and other miscellaneous and

• Journal of Chest Surgery
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• 제31권11호
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• pp.1097-1101
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• 1998

신세포암은 환자의 약 5∼10%에서 하대정맥을 침범한다. 이러한 경우 수술적으로 함께 제거하는 것이 가장 좋은 치료로 되어있다. 최근에는 간정맥 유입로 상부에 위치한 하대정맥내의 종양 혈전 제거술의 경우 체외 순환을 통한 순환 정지 방법이 사용되고 있다. 본 교실에서는 근치적 신적출술과 함께 하대정맥내의 종양 혈전 제거술을 4례 치험하였다. 모든 환자에서 간정맥이하의 하대정맥 혈전으로 체외 순환의 도움 없이 일반적인 방법으로 시행되었으나, 그 중 한 환자에서 간정맥의 유입로보다 상부에 위치한 하대정맥혈전이 재발되어 순환정지후 혈전제거술을 시행하였다. 네 명의 환자 모두 특별한 문제없이 회복되었다.

• 대한의용생체공학회:의공학회지
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• 제30권5호
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• pp.393-400
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• 2009

The present study developed a new technique with no physical object on the flow stream but enabling the air flow measurement and easily incorporated with the devices for cardiopulmonary resuscitation(CPR) procedure. A turbulence chamber was formed in the middle of the respiratory tube by locally enlarging the cross-sectional area where the flow related turbulence was generated inducing energy loss which was in turn converted into pressure difference. The turbulence chamber was simply an empty enlarged air space, thus no physical object existed on the flow stream, but still the flow rate could be evaluated. Computer simulation demonstrated stable turbulence formation big enough to measure. Experiment was followed on the proto-type transducer, the results of which were within ${\pm}5%$ error compared to the simulation data. Both inspiratory and expiratory flows were obtained with symmetric measurement characteristics. Quadratic curve fitting provided excellent calibration formula with a correlation coefficient>0.999(P<0.0001) and the mean relative error<1%. The present results can be usefully applied to accurately monitor the air flow rate during CPR.