지속적 외래 복막투석 환자의 절망감(Hopelessness)에 관한 연구

김행자,김정숙 성인간호학회 1994 성인간호학회지 Vol.6 No.2

This study was attempted to find out the degree of hopelessness, the understanding self-management for CAPD, recurrence of complications, and to identify the influencing factors to hopelessness of CAPD patients. This subjects were 36 patients underwent the CAPD operation at a renal dialysis unit of K. University Medical Center, they also have been attending to same unit for a follow up care. Data were collected from September 1993 to November 1994, but data gathering period per patient lasted for 6 months after CAPD operation. The degree of hopelessness was measured using Hopelessness Scale developed by Beck et al. and collected data were analyzed by descriptive statistics, t-test, ANOVA, Pearson Correlation Coefficient, Stepwise Multiple Regression with the SPSS program. The result of this study were as follows: 1. The mean of hopelessness score of CAPD patients was 55.19. 2. The mean score of understanding self-management for CAPD: The mean score of basic knowledge for CAPD was 22.08, and knowledge of CAPD management was 66.67, so the mean score of understanding self-management for CAPD(sum of mean scores of basic knowledge for CAPD and knowledge of CAPD management) of patients was 88.75. These mean scores were comparatively high compared to a possible range of mean scores 25.75, 100. 3. Recurrent rate of complications : Recurrent rate of peritonitis during the 6 months after CAPD operation was 41.62 percent, and that of pericatheter infection was 13.90 percent. The above percentages were lower than the results reported in Korea and other countries. 4. Episode of complications; The mean time of the first episode of pertionites was 103.86 days after CAPD operation, and that of pericatheter infection was 120.08 days. And the mean time of healing peritonitis was 5.87days. 5. The degree of hopelessness revealed a significant difference(F=4.22,p<.05) only in level of education among the demographic characteristics of CAPD patients. Therefore, education characteristics was defined as an influencing factor of the hopelessness score. 6. The relationship among the understanding self-management for CAPD (both of basic knowledge for CAPO and knowledge of CAPD management). recurrence rate of complications(both of peritonitis and pericatheter infection) and degree of hoplessness showed a negative correlation between the knowledge score of CAPD management and the recurrence rate of pericatherter infection (r=-.294). and between the knowledge score of CAPD management and recurrence rate of complications (both of peritonitis and pericatherter infection) (r=-.331) These results revealed that the higher the score of knowledge of CAPD management, the lower recurrence rate of pertionitis and pericatherter infection. 7. In conclusion, predictable factors influencing hopelessness in CAPD patients were factors related to complications, and recurrence rate of complications showed a negative correlation to the knowledge score of CAPD management. Therefore this study indicates that an intensive education program about CAPD management for patients could be effective in decreasing the recurrence rate of complications and the degree of hopelessness of CAPD patients.

말기신부전환자에서 치료수단인 혈액투석, 지속성복막투석 및 신이식에 따른 심혈관계변화와 재활율의 비교 연구

박선자 ( Park Seon Ja ),고용호 ( Go Yong Ho ),김민철 ( Kim Min Cheol ),이병준 ( Lee Byeong Jun ),김영곤 ( Kim Yeong Gon ),박상은 ( Park Sang Eun ),이재우 ( Lee Jae U ),이시래 ( Lee Si Lae ) 대한내과학회 1993 대한내과학회지 Vol.44 No.3

연구배경 및 방법 : 말기신부전증 환자에서 고혈압은 가장 많은 합병증 중의 하나이고 실혈관계 질환을 일으키는 주된 요인이 되므로 고혈압의 치료는 매우 중요하다. 이에 본 연구에서는 말기신부전 환자를 혈액투석군, 지속성복막투석군 및 신이식군으로 나누어 각 군에서 심혈관계 변화의 지표를 측정하고 이를 비교 분석하여 유병율과 사망률에 가장 중요한 역할을 하는 고혈압의 정도와 심혈관계 상태 및 생활의 질적상태를 비교 관찰하였다. 결과 : 1) 수축기 및 확장기 혈압은 CAPD 및 KTP군에서는 치료 후에 유의하게 감소하였으나(p<0.05) HD군에서는 수축기 혈압이 오히려 증가하였으며 확장기 혈압은 유의한 변화를 보이지 않았고, 동일 시점에서 비교할 때 KTP군에서 혈압이 가장 낮았으며 다음은 CAPD, HD 군의 순이었다. 2) 항고혈압제 요구량은 투석 및 신이식 전에 비해 치료 후 CAPD, KTP군에서는 유의한 감소를 보였으나(p<0.001) HD군에서는 유의하게 증가하였으며 동일 시점에서는 KTP, CAPD, HD군의 순으로 약제요구량이 적었다. 3) 심융곽비가 치료 후 감소를 보인 예는 HD, CAPD, KTP군의 순으로 42.2, 67.4, 77.4%였으며, 증가를 보인 경우는 각각 48.9, 23.3, 11.3%였다. 4) 심전도의 변화는 투석 및 신이식 후에 HD, CAPD, KTP군의 각각 6.7, 20.5, 37.6%에서 호전되었으며, 각각 23.3, 18.8, 2.2%에서 악화되었다. 5) 심초음파도의 변화로는 KTP군에서는 좌심실 확장기 및 수축기의 내경과 용적이 유의하게 감소하였고, CAPD군에서는 좌심실 확장기 내경, 일회구혈양 등이 유의하게 감소하였으며 감소의 정도는 KTP, CAPD, HD군의 순이었고, 구혈율과 %FS는 HD, CAPD, KTP군에서 각각 64.3, 61.5, 85.0%였다. 결론 : 이상의 성적으로 보아 심혈관계의 개선효과는KTP, CAPD, HD군의 순으로 좋았으며, 재활율은 투석군에 비해 신이식군에서 좋았으나 투석군 간에는 차이가 없었다. 이와같은 결과로 보아 신이식이 말기신부전증의 가장 좋은 치료수단이라고 생각되며, 투석요법 중에서는 복막투석이 혈액투석에 비해 심혈관계 개선효과면에서 더 우수한 치료방법이라 생각되나 그 기전에 관해서는 추후 연구가 요구된다. Background and Method : Hypertension and atherosclerosis are known to be most common complications and causes of death in end stage renal diseases. We, therefore, evaluated in the present study hemodynamics, requirement of antihypertensive drugs, and physicsal ability (assessed by karnofaky score) in 380 patients with end stage renal diseases treated by hemodialysis (HD, 65 patients), continuous ambulatory peritoneal dialysis (CAPD, 131patients) or renal transplantation (KTP, 184 patients) in Kosin Medical Center Hospital during the period of 1983 through 1991. Results : Systolic and diastolic blood pressures decreased significantly from 152.50±20.62 (mean±S.D.)/96.88±16.39mmHg before therapy to 146.46±17.32/96.2±10.62 at the end of 3 month therapy in HD group, from 158.49±24.8/96.49±17.86 to 144.11±20.27/90.27±12.27 in CAPD group, and from 154.28±21.60/95.69±14.50 to 133.33±14.57/84.07±11.93 in KTP group, the change being most extensive in KTP group and least in HD group. The number of antihypertensive drugs required was reduced after therapy in the order of KTP, CAPD and HD groups. Cardiothoracic ratio was decreased after therapy in 77.4% of KTP, 67.4% of CAPD and 42.2% of HD patients. In echocardiogram, LVIDd, LVIDs and SV appeared to be significantly decreased in KTP and CAPD groups with a greater extent in the former, but not in HD group. Electrocardiogram was improved in 37.6% of KTP, 20.5% of CAPD and 6.7% of HD patients. Karnofaky scores for the first grade rehabilitation were observed in 85% of KTP, 61.5% of CAPD and 64.3% of HD patients. Conclusions : These results indicate that, in terms of hemodynamics and physical ability, KTP is a better way of treatment of end stage renal diseases as compared with CAPD and HD, and that among dialysis treatments, CAPD is superior to HD.

소아에서의 지속성 외래 복막투석(CAPD)의 임상적 고찰

최원규,권민중,이재승,김병길 대한신장학회 1996 대한신장학회잡지 Vol.15 No.4

Comparison of Plasma Amino Acid Concentrations in End-stage Renal Disease Patients on Hemodialysis and Peritoneal Dialysis

(Dong Hee Kim),(Dong Ho Yang),(Sae Yong Hong) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.1

N/A Objectives : Recent reports have suggested that patients treated by CAPD have a re- latively increased risk of death compared to patients undergoing HD, although the cau- se of this discrepancy is poorly understood. Protein malnutrition is an important risk factor in ESRD. Also, amino acid concentrations, for which the physiological function differs from that of protein, may be an independent risk factor in ESRD. There is no doubt concerning the prevalence of low amino acid levels in both HD and CAPD patients. But the difference in plasma amino acid levels between these two groups has not been well defined. The purpose of this study is to compare plasma amino acid levels between patients with ESRD on HD and CAPD. Methods : A cross sectional study of overnight fasting plasma amino acid concen- trations was performed on 12 CAPD and 45 HD patients with ESRD, matched by age, sex and body mass index. The levels of individual plasma amino acid and TAA, EAA, NEAA and BCAA were compared for the HD and CAPD groups. In order to measure losses during HD and CAPD, amino acid and protein concentrations were measured from 10 dialysates obtained from 10 HD patients and 12 peritoneal dialysis solutions from 12 CAPD patients. Results : All of the measured amino acid concentrations were found to be lower in the CAPD group compared to the HD group. Furthermore, the levels of TAA (2017,3±781.1 vs. 903.3±316.1 μmole/L), EAA(1201.8±492.6 vs. 567.6±223.2μmole/L), NEAA(815.5±308.6 vs. 335.7±100.2 μmole/L), and BCAA (315.0±146.0 vs. 145.2±65.0μmole/L), were all lower in the CAPD group than in the HD group. The protein loss was 2.0±0.2 g/L in the peritoneal dialysate but was not detectable in the hemo- dialysates. TAA loss over a one week period was about 61.8±13.0mmole for the HD group and 38.0±13.0 mmole for the CAPD group. Conclusions : Our results show that amino acid concentrations are lower in ESRD patients on CAPD than on HD. It seems likely that protein loss in the peritoneal dialysate is a contributing factor to lowered plasma amino acid concentrations in ESRD patients on CAPD than on HD. We believe that the lowered amino acid concentrations observed in CAPD patients may worsen the clinical outcome compared to HD patients.

중추성 청각정보처리 장애의 특성 고찰

석동일 ( Dong-il Seok ) 한국특수교육문제연구소 2004 특수교육저널 : 이론과 실천 Vol.5 No.2

중추성 청각정보처리의 장애로 인한 청각재활의 문제를 가진 CAPD아동이 학습장애, 주의집중장애.과잉행동장애, 그리고 의사소통 장애와 관련되어 많은 출현율을 보임에도 국내에는 이들에 대한 연구가 극히 미흡하다. 따라서 이 연구에서는 CAPD의 정의, 관련장애와의 비교, 그리고 진단.평가에서 나타나는 특성을 종합적 분석을 하여 CAPD의 본질을 밝히는데 그 목적을 두었다. CAPD의 평가는 청각적 측면, 언어적 측면, 심리학적 측면, 교육적 측면, 그리고 기타 건강발달의 측면에서 검토되어야 하나 이 연구에서는 청각적 측면에 초점을 두었다. 이 연구에서의 주요 결론은 다음과 같다. CAPD는 원인과 증상사이에 1:1관계가 성립되지 않는다. CAPD에 대해 명확한 정의를하는 것이 어렵다. CAPD와 관련장애와의 구별이 어렵다. 그리고 CAPD의 핵심적인 특성의 내용은 다음과 같다. (1)말초 청력손실 즉 청각민감도는 정상이나 청력손실이 있는 경우와비슷한 청각적 행동을 한다. (2)일반적으로 소음배경에서 구어이해가 명확히 어렵다. (3)자극내용에서 시간적 정보, 이분자극, 저 잉여성 자극에 뚜렷한 장애를 나타낸다. (4)양이의 상호작용에 확실한 장애를 나타낸다. There was little research about children with CAPD although there is a high appearance rate of learning disorders, ADHD, hyperactivity disorders andcommunication disorders. This research aims to investigate the nature of CAPD, which are definition, comparison with other related disorders and diagnosis and assessment. Firstly, there``s no one to one relationship between causes and symptoms because the symptoms of CAPD show itself with other related disorders together. Secondly, it``s hard to define CAPD because the individual has over one symptom diversely. Thirdly, it``s hard to differ from other related disorders, especially, learning disorder, ADHD, hyperactivity disorder and communication disorder. The screeningtest has to be developed because there are lots of a point of sameness.Lastly, there are the important features of CAPD. 1) Auditory sensitivity is normal but they do auditory behavior likely to have hearing loss. 2) Generally, it``s hard to comprehend speech in background noise. 3) There``s some loss in temporal information, dichotic listening tests, low redundency stimulus. 4) There``s a certain disorder in binaural interaction tasks.

지속성 복막투석 환자와 혈액투석 환자의 우울과 불안 정도에 대한 비교 연구

정재용,한선호 大韓神經精神醫學會 1994 신경정신의학 Vol.33 No.5

만성 신부전증 환자중 CAPD와 혈액투석이라는 각각 다른 투석치료를 하고 있는 환자에서 치료도중 나타나는 우울과 불안감을 서로 비교해서 그 차이점을 알아보기 위하여 1993년 7월부터 1993년 10월까지 순천향의대 부속병원 인공신장실에서 치료중인 CAPD군 29명, 혈액투석군 41명을 대상으로 자기보고형 심리검사도구인 Beck Depression Inventory(BDI), State-Trait Anxiety Inventory(STAI) 및 면담에 의해 얻어지는 객관적인 심리검사도구인 Hamilto Rating Scale for Depression(HRAS)와 Hamilton Rating Scale for Anxiety(HRAS)를 사용하여 다음과 같은 결과를 얻었다. 1) CAPD군은 Hamilton Rating Scale for Depression(HRSD)검사 결과 혈액투석군 보다 우울증상이 유의하게 낮았다. 2) CAPD군은 Beck Depression Inventory(BDI)검사 결과 혈액투석군과 유의한 차이를 보이지 않았다. 3) 불안의 정도는 두 군사이에 통계적으로 의미있는 차이가 없었다. 결론적으로 CAPD 환자들은 혈액투석 환자에 비해 객관적인 우울증상은 덜 하지만 불안의 증상은 치료방법 자체로 영향을 받지 않는다는 결과를 보여주었다. This study was conducted to investigate the difference of depression and anxiety developed in the patients on CAPD and Hemodialysis. The authors survey 29 patients on CAPD treatment and 41 patient on Hemodialysis at Soonchunhyang University Hospital from Jul. 1993 to Oct. 1993. Depression and anxiety were evaluated with the Beck Depression Inventory and the State-Trait Anxiety Inventory known as self report assessment scale, and those with the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety as objective assessment scale by interview. The results were as follows : 1) The CAPD group was significantly less depressed than the Hemodialysis group on Hamilton Rating Scale for Depression. 2) The Beck Depression Inventory showed no significant difference in depression between the CAPD group with the Hemodialysis group. 3) There was no significant difference in anxiety between two groups. In conclusion, authors suggest that objective depressive symtomes were less in the CAPD group, but anxiety symptomes were not influenced by treatment modality itself.

복막투석 환자에서 혈청 LePtin과 Leptin의 발현에 관한 전향적 연구

오동진,김대중,강우현,이방훈,박진아,허우성,김윤구,오하영,강순아 대한신장학회 2000 대한신장학회잡지 Vol.19 No.4

지속성 외래 복막투석 환자에서 복막염의 위험인자에 관한 연구

이호영(Ho Yung Lee),김영수(Young Soo Kim),김영기(Young Ki Kim),김흥수(Heung Soo Kim),손승환(Seung Hwan Sohn),최규헌(Kyu Hun Choi),한대석(Dae Suk Han) 대한내과학회 1991 대한내과학회지 Vol.40 No.6

N/A Continuous ambulatory peritoneal dialysis (CAPD) has many advantages over hemodialysis, but it has certain inherent difficulties and is will known for its failure due to peritonitis. The authors studied CAPD patients of Yonsei University, College of Medicine, Severance Hospital, who were receiving CAPD up to September 1, 1990. They were individually studied for relative risk of possible risk factors, which are sex, age, place of domicile, status of marriage, motivation, educational level, economic status, employment status, sterile technique in exchanging a fluid bag, place of exchanging a fluid bag, CAPD duration, type of dialysate, diabetes, hypertension, hyperlipidemia, exit site infection, BUN, serum creatinine, and HBs Ag. The follow-up study traced the frequency of peritonitis in a total of 237 subjects. It was possible to study 127 patients who were subjected to a questionnaire and nutritional score system and who were receiving at least 6 months of CAPD. Through this study, material on the annual incidence of peritonitis, the interval between the insertion of CAPD and onset of the first peritonitis, the interval between the onset of the first and second peritonitis, and the risk factors which influenced the above subjects were obtained. The results obtained were as follows: 1) The number of patients comprised 53 men and 74 women, and the age distribution was between 17 and 80 years with a mean of 45.8 years. The mean duration of CAPD was 28.7 months with a range between 6.1 and 80.4 months. 2) The incidence ot peritonitis was higher in patients with poor nutritional status, no employment, and low education level according to univariate analysis (p<0.05). The results of the multiple regression model showed that the significant risk factors affecting the incidence of peritonitis were nutritional status, employment status, and place of domicile (relative risk<0.5 or >1.5). 3) The interval between the insertion of CAPD and the onset of the first peritonitis was shorter in poor nuteritional patients according to univariate analysis. In subjects who were unemployed, had diabetes mellitus, and who were women, the interval between the onset of the first and second peritonitis was shorter according to the Cox regression model (p<0.05). 4) The results of the Cox hazard regression model showed that the interval between the onset of the first and second peritonitis was shorter in patients without employment, with diabetes mellitus, and those living in rural areas (relative risk<0.5 or >1.5). From the above results, it can be seen that the risk factors significantly affecting the incidence of peritonitis were nutritional status, employment status. type of dialysate, and place of domicile. Significant risk factors affecting the interval before the onset of the first peritonitis were not found, but the interval from the first to the second pertionitis was affected by significant risk factors such as diabetes mellitus, employment status, and place of domicile. In conclusion, the maintenance of nutrition up to the level of normal physical activity can reduce the incidence of peritonitis in patients with CAPD.

말기 신부전증 환자에서 혈액투석과 지속성 외래 복막투석의 시작이 혈압에 미치는 영향

이승우(Seoung Woo Lee),김문재(Moon Jae Kim),송준호(Joon Ho Song),김경아(Gyeong A Kim),박우상(Woo Sang Park),이경주(Kyung Joo Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Studies describing the effects on blood pressure control by hemodialysis(HD) or continuous amulatory peritoneal dialysis(CAPD) have yielded conflicting results with respect to 24 hour blood pressure control, diurnal variation and blood pressure loads. The aim of the study was to investigate the effect of beginning with HD or CAPD on blood pressure control, diurnal variation and blood pressure loads using ambulatory blood pressure monitoring(ABPM). Twen-ty-seven end-stage renal disease(ESRD) patients(12 on HD and 15 on CAPD) were enrolled into the study. Patients with cardiovascular diseases, erythro-poietin therapy, or severe edema were excluded. ABPM were performed two times before and after the initiation of dialysis. Mean duration of interval between pre- and post-dialysis ABPM were 17±4 days on HD and 13±3 days on CAPD. Daytime and nighttime were defined as the time from 6: 00 AM to 10: 00 PM and from 10: 00 PM to 6: 00 AM of the next day. Systolic and diastolic loads were defined as the percentage of the incidence of systolic and diastolic blood pressure over l% and 90mmHg. Dipper meaning the presence of normal diurnal difference were defined as the differences of daytime- nighttime mean arterial pressure more than 5mmHg. In HD patients, mean systolic and diastolic blood pressure and mean arterial pressure were significantly decreased after dialysis during 24 hour, day- time and nighttime. In CAPD patients, those were also significantly decreased after dialysis during 24 hour, daytime and nighttime(p<0.05). Diurnal differences were increased after CAPD(3.3±9.4 vs 5.4±6.8mmHg) but decreased after HD(4.3±6.2 vs 2.4±10.8mmHg) and the differences of diurnal difference between two groups were significantly different(+2.1±9.0 vs 1.9±8.4mmHg, p<0.05). Proportions of dipper among patients were increased from 16.7 to 66.7% in HD and from 33.3% to 60% in CAPD without statistical significance between two groups. Systolic and diastolic loads were significantly decreased after HD(from 75.0± 38.0 to 37.5±43.8%, from 45.2±29.7 to 12.5±12.8%, respectively, p<0.05) and after CAPD(from 63.1±30,1 to 32.3±27.1%, from 43.4±36.2% to 12.2±16.9%, respectively, p<0.05). Systolic and diastolic loads of daytime and nighttime were significantly decreased after each dialysis modality except nighttime diastolic pressure load in HD. In conclusions, both HD and CAPD improve BP control in ESRD patients. CAPD has more benefit to control of diurnal variations in ESRD patients.

지속성 외래 복막투석 환자에서 고호모시스틴혈증

나명윤 全南大醫大 2001 전남의대학술지 Vol.37 No.2