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응급수술을 요하는 외상성 복강내출혈에서 응급실 체류시간이 사망에 영향을 주는가?
김익범,송화식,송인한 대한응급의학회 2008 대한응급의학회지 Vol.19 No.3
Purpose: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. Methods: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. Results: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7±100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. Conclusion: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.
유기금속 전구체로부터 초미립 $Fe_2O_3$ 분말의 저온 합성
김정수,김익범,강한철,홍양기 한국세라믹학회 1992 한국세라믹학회지 Vol.29 No.12
Ultrafine iron oxide powder, {{{{ gamma }}-Fe2O3 and $\alpha$-Fe2O3, were prepared by the thermal decomposition of organometallic compounds. The formation process of powder includes the thermal decomposition and oxidation of the organometallic precursors, Fe(N2H3COO)2(N2H4)2 (A) and N2H5Fe(N2H3COO)3.H2O (B). The organometallic precursors, A and B, were synthesized by the reaction of ferrous ion with hydrazinocarboxylic acid, and characterized by quantitative analysis and infrared spectroscopy. The mechanistic study for the thermal decomposition was performed by DAT-TG. The iron oxide powder was obtained by the heat treatment of the precursors at 20$0^{\circ}C$ and $600^{\circ}C$ for half an hour in air. The phases of the resulting product were proved {{{{ gamma }}-Fe2O3 and $\alpha$-Fe2O3 respectively. The particle shape was equiaxial and the particle size was less than 0.1 ${\mu}{\textrm}{m}$. Magnetic properties of the {{{{ gamma }}-Fe2O3 powder obtained from A and B was 234 Oe of coercivity, 64.26 emu/g of saturation magnetization, 23.59 emu/g of remanent magnetization and 24.1 Oe, 47.27 emu/g, 3.118 emu/g respectively. The value of $\alpha$-Fe2O3 powder was 1.494 Oe, 0.4862 emu/g, 0.1832 emu/g and 1,276 Oe, 0.4854 emu/g, 0.1856 emu/g respectively.
김수식,김익범 대한금속재료학회(대한금속학회) 1985 대한금속·재료학회지 Vol.23 No.8
In order to find out the formation procedures and the series of morphology for silicon nitride by the vapor phase reaction, the experiments have been carried out in the temperature range of 200-1550℃ and the various pressures. The reaction products and thermal decomposited powders in the various temperatures and pressures kave been thoroughly investigated by means of X-ray diffraction, infra-red spectroscopy and electron microscopy. As regards to silicon nitride powders, crystallized whisker shaped α-Si₃N₄ was obtained by treating the reaction product formed at 25℃ into 1450℃. At 1550℃ under the pressure of 2.9KPa, hexagonal shaped α-Si₃N₄ was obtained in the thermal decomposition, and rod shaped β-Si₃N₄ in the vapor phase reaction.
박귀웅,김익범,고혁상,오용해,최덕수,박희정,최일국,오성범 대한응급의학회 2008 대한응급의학회지 Vol.19 No.6
Purpose: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. Methods: We conducted a retrospective study over an 8- year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. Results: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7±220.5 minutes in patients who died and 395.5± 363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. Conclusion: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.