Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향

최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-

Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.

톨루엔 노출 근로자에서 유전자적 요인, 생활습관 및 식이가 요중 마뇨산 배설에 미치는 영향

임현우,박정일,노영만,이강숙,이정민,이원철,이세훈,정치경 大韓産業醫學會 2000 대한직업환경의학회지 Vol.12 No.3

목 적 : 본 연구는 생물학적 지표 특성 연구를 위한 단면조사 연구로서 톨루엔 노출과 톨루엔의 생물학적 모니터링으로 이용되는 요중 마뇨산 농도간의 양-반응 관계에서 효과 변경인자로서 작용하는 유전자 ALDH2, CYPIAI, CYP2El의 다양성 분포를 조사하고, 이들 유전자가 요중 마뇨산 배설 농도에 미치는 영향을 알아보고자 하였다. 방 법 : 연구대상자는 경인지역에 위치한 22개의 사업체에서 페인트 제조 72명, 제조업에서 도장작업 50명, 인쇄업 12명, 접착작업 12명, 벽지의 코팅작업 14명등 160명의 근로자이었다. 성, 연령, 유기용제 작업장 근무경력, 흡연습관, 음주습관, 검사일 이전 밤에 음주 여부, 시료 채취전 6시간 이내에 섭취한 식품조사, 측정일 개인보호구의 착용 여부에 대하여 설문조사를 시행하였다. 톨루엔에 대한 개인노출량은 passive air sampler로 측정하였고, 요중 마뇨산은 요중 크레아틴으로 보정하여 측정하였다. 또한 aldehyde dehydrogenase 2 (ALDH2) , cytochrome P45O IAI(CYPIAI), 그리고 cytochrome P45O 2El(CYPfEl)의 유전적 다양성은 혈액으로부터 백혈구의 DNA를 추출하여 제한 효소 절단 길이 다양성 (restiction fragment length polymorphism, RFLP)법으로 검사하여 다음의 결과를 얻었다. 결 과 : 연구대상자의 요중 마뇨산 농도의 기하평균은 0.44g/g creatinine, 기하표준편차 2.80이었다. 톨루엔 노출 농도, 개인 보호구 착용여부, 안식향산이 함유된 식품의 섭취여부중 요중 마뇨산 배설농도에 영향을 미치는 인자는 톨루엔 노출 농도뿐이었다. ALDH2, CYPIAI, CYPfEl, 연령, 흡연, 근무기간에서 회귀계수간에 차이를 보이는 경향이 있었다. 요중 마뇨산 농도에 대한 다중회귀분석에서 톨루엔, ALDH2, CYPIAI, CYP2El유전자형의 회귀계수가 통계적으로 유의하였다. 결 론 : 톨루엔 노출로 인한 요중 마뇨산 배설 농도는 ALDH2, CYPIAI, CYP2El유전자 다양성에 의해 영향을 받기 때문에, 유전자형의 대사능의 차이를 고려하여 마뇨산 기준 농도를 찾는 연구가 이루어져야 하겠다. Objectives The purpose was to investigate the distributions and the effects of genetic polymorphism of aldehyde dehydrogenase 2(ALDH2), cytochrome P45O IAI (CYPIAI), and cytochrome P45O 2El (CYPfEl) on the toluene metabolism. Methods : The subacts consisted of 160 workers who were exposed to toluene in different industries such as paint manufacturing, painting on steel and wood products, printing, bonding, and coating. The exposed toluene level was monitored by passive air sam paler, and the questionnaire variables were age, sex, smoking, drinking, previous night's drinking, use of personal protectlve equipment, work duration, and taking benzoic acid containing food. The urinary hippurric acid collected in the end of shift was corrected by urinary creatinine concentration. The genotypes of ALDH2, CYPIAI, and CYP2El were investigated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods with DNA extracted from venous blood. Results'The geometric mean and the geometric standard deviation of urinary hippuric acid concentration were 0.44 g/g creatinine and 2.80. The urinary hippuric acid concentration was significantly related to personal exposed toluene level among personal exposed toluene level, use of personal protective equipment, and benzoic acid containing food diet. The slope differences of the regression for ALDH2, CYPIAI, and CYP2E1 genetic polymorphism, age, smoking, and work duration tended to be significant. In multiple regression analysis, the regression coefficient of toluene, ALDH2, 7YPIAl, CYP2E1 genetic polymorphism were significant. Conclusions : From the above results, urinary hippuric acid level after toluene exposure was significantly affected by the genetic polymorphism of ALDH2, CYPIAI, CYPfEl. It is needed further investigation of the urinary hippuric acid level considering the effect of genetic polymorphism.

신경독성 물질에 폭로되지 않은 건강한 남자의 신경행동학적 검사 수행능력

이세훈,김형아,이원철,장성실,이경재,박정일,정치경 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

Five items among neurobehavioral core test battery of World Health Organization, including Santa Ana dexterity, pursuit aiming, digit symbol, simple reaction time, and Benton visual retention, were administered to the workers occupationally non-exposed to neurotoxic agents by operational guide for the WHO neurobehavioral core test battery. Subjects were volunteers from the industrial workers(117) and clerks(40). Detailed occupational history such as exposed agents including noise or vibration, educational level, residence, smoking and drinking habit were recorded. Most of the neurobehavioral tests were correlated with age and educational level. Smoking was correlated with pursuit aiming and digit symbol. Vibration affected pursuit aiming. Job type(industrial workers vs. clerks) and noise exposure did not affected among tested items. Multiple regression analysis was done for establishing predict equation to estimate normal ranges of the tests for male workers. Age was shown to be main independent variable affected for all tests except wrong dot of pursuit aiming. Educational level was also shown to affected most of the tests except Santa ana dexterity and wrong dot of pursuit aiming. Alcohol consumption affected Santa Ana dexterity, non-preferred hand, and smoking affected only wrong dot of pursuit aiming after multiple regression analysis.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

전기경련요법에서 remifentanil이 혈역학에 미치는 효과

정순호,이상은,임세훈,이정한,이근무,최영균,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: Electroconvulsive therapy (ECT) is often associated with transient hypertension and tachycardia. Acute hemodynamic change may produce serious complications. Remifentanil is a potent ultra short acting opioid and has been found to reduce blood pressure and heart rate. The goal of this study was to evaluate effects of remifentanil on seizure duration, recovery parameters and hemodynamic changes during ECT. Methods: Ten ASA Ⅰ, Ⅱ patients enrolled in this prospective, randomized trial, each receiving more than four electroconvulsive therapy. Patients were randomized to receive placebo, group P (propofol 1mg/kg+0.9% normal saline 1ml, n=10), and propofol with remifentanil, group R (propofol 1mg/kg+remifentanil 1ug/Kg n=10). Supplemental dose of propofol was given as required to achieve loss of consciousness. We recorded hemodynamic parameters, seizure duration, and recovery parameters. Results: Seizure duration and recovery parameters were similar in group R and group P. Blood pressure and Hear rate after ECT were significantly lower in group R. Conclusions: Remifentanil(1ug/kg) attenuated the acute hemodynamic response to ECT under propofol anesthesia without adversely affecting the duration of seizure activity and recovery profile. Adjunctive use of remifentanil may be good alternative regimens for ECT.

급성 조증에서 기분안정제와 리스페리돈의 병합 투여 효과 : 다기관 개방연구

김광수,배치운,윤진상,김영훈,이양현,지익성,이철,송혜경,최성구,박원명 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Ohjective : The primary purpose of this study was a replication of the effectiveness and tolerability of rispehdone in the treatment of patients with acute mania in very larger cohon in naturalistic treatment setting to extend the data on the effect and tolerability of risperidone in the treatment of patients with acute mania to Asian population. Methods : A total of 909 patients with DSM-TV criteria of bipolar disorder current manic and hypomanic episode, entered this large, open, multicentre study. The Young Mania Rating Scale (YMRS), Clinical Global Impression (CGI) and Simpson-Angus Rating Scale (SARS) were measured at baseline and weeks 1, 3 and 6, for the assessment of effectiveness and extra-pyramidal symptom (EPS). Results : This study showed statistically significant reduction of scores on the YMRS and CGI-s (mean change=-23.5±11.8, p<0.0001 ; mean change=-2.7±1.5, p<0.0001, respectively) from the baseline to the endpoint (week 6). Number of patients with 50% reduction or more in the YMRS and CGI-s scores was 693 (77.8%) and 630 (70.7%) at endpoint, respec-tively. There were no statistically significant increments of scores on SARS. Risperidone was generally well tolerated. Conclusion : The present larger open study demonstrates that hsperidone add-on therapy is effective and tolerable in treat-ment of bipolar disorder, replicating results in various controlled and uncontrolled studies from Western countries.

경막 천자 후 두통 치료 목적의 자가 혈액 봉합술 시행 중 발생한 기뇌증

정순호,김책,김영환,임세훈,이정한,이근무,최영균,김영재,신치만 인제대학교 2006 仁濟醫學 Vol.27 No.-

A 57-year-old woman who was suffered from chronic back pain and radiating pain to left leg visited the local pain clinic. An accidental dural puncture happened at the L4-5 intervertebral space during the procedure with the loss of resistance technique using air. The epidural needle was removed, and a new insertion was done at the L3-4 intervertebral space with administration of the 0.5% lidocaine 8 ml mixed triamcinolone 40 mg. On the next day, she visited again the local pain clinic with complaining of headache. During an epidural autologuous blood patch procedure, she complained of a severe headache, nausea, vomiting, and developed generalized tremor of abrupt onset. There was no evidence of a dural puncture during the procedure. She was referred to our hospital at once. A brain CT scan showed air-filled cavities in basal cistern. She was given conservative treatment during 14 days. After 10 days, follow up brain CT scan showed no air-filled cavity in basal cistern. She was discharged from our hospital without complications.

네모나프라이드의 유효성 및 추체외로 부작용 : Haloperidol 및 Risperidone과의 자연관찰적 개방형 비교연구 A Naturalistic Open Comparative Study with Haloperidol and Risperidone

서영수,김용관,신동환,공보금,이정구,박정환,윤성환,정치영,이상경,김영훈 대한생물치료정신의학회 2001 생물치료정신의학 Vol.7 No.2

Objectives : This open prospective study was performed in order to evaluate the efficacy and extrapyramidal adverse effects of nemonapride in the schizophrenic patients, and was compared wit one of typical antipshchotics. haloperidol and one of atypical antipsychotics, risperidone. Methods : Thirty male and female schizophrenic patients(DSM-Ⅳ) were treated for 12 weeks with haloperidol(n=10), risperidone(n=10) and nemonapride(n=10). The overall efficacy was assessed at baseline, 1st week, 2nd week, 4th week, 8th week, and 12th week by the Positive and Negative Syndrome Scale for Schizophrenia(PANSS). Also the overall safety was assessed in the same time period by the Extrapyramidal Symptom Rating Scale(ESRS). Results : There were no significant differences in PANSS scores(total, positive, negative, and general psycho­pathology subscale) among haloperidol, risperidone, and nemonapride groups, Treatment responders, defined as at least 20% reduction of baseline total PANSS score, were achieved by 8 patients(80%) in haloperidol group, 10 patients(100%) in risperidone group, and 8 patients(80%) in nemonapride group. And there were no significant differences in ESRS total scores among haloperidol, risperidone, and nemonapride group. Inter-group comparison among haloperidol, risperidone and nemonapride group, as assessed by the ESRS, revealed no significant differences in the shifts to the maximum score, 9.4(±9.4), 6.2(±8.4), and 11.3(±8.1) respectively, and also revealed no significant differences in the mean time reaching the maximum score, 4.5(±4.5) week, 7.8(±4.8) week, and 4.6(±4.4) week, respectivily. Conclusion : There wee no significant differences in the efficacy and extrapyramidal adverse effects among haloperidal, rispecridone and nemonapride groups. These results suggest that nemonapride was as efficacious and safe in he treatment of schizophrenia, as well known and widely used antipsychotics, haloperidol and risperidone.

정신분열병에 대한 리스페리돈의 효과 및 안정성(장기투여연구)

이민수,김용구,강병조,김광수,김영훈,김희철,나철,노승호,백인호,연병길,오병훈,윤도준,윤진상,이종범,이철,전태연,정인과,정인원,지익성,채정호,한상익,서광윤 대한신경정신의학회 1999 신경정신의학 Vol.38 No.1

연구목적 : 정신분열병의 환자에서 리스페리돈의 장기 치료 효과와 안전성을 조사하기 위해 다기관 개방 연구를 시행하였다. 방 법 : DSM-Ⅳ 진단기준에 의거하여 정신분열병으로 진단된 환자중 리스페리돈 장기투여에 동의한 환자 116명을 대상으로 하였다. 임상 시험전에 연구자들을 대상으로 PANSS workshop을 통해 PANSS, ESRS에 대한 표준화 작업으로 평가기간 신뢰도를 높였다. 1주일간의 약물배설기간후 리스페리돈을 56주간 투여하였으며, 기준점, 8주후, 16주후, 24주후, 32주후, 40주후, 48주후 56주후에 평가되었다. 용량은 제 1일에는 리스페리돈 1㎎씩 1일 2회, 제 2일에는 2㎎씩 2회, 제 3-7일에는 3㎎씩 1일 2회 투여하였고, 이후 환자의 임상 상태에 따라 임의로 증량하였으며, 최대 일일 16㎎을 초과하지 않도록 하였다. 임상증상과 부작용은 PANSS, ESRS, CGI로 평가되었다. 결 과 : 116명중 87명(75%)이 56주의 장기연구를 완결하였다. 치료종결시점인 56주후 PANSS 총점수가 20% 이상 호전된 환자는 87명중 80명(92.0%)이었다. PANSS 총점수는 기준점, 투여 8주후, 16주후, 24주후, 32주후, 48주후에서 각각의 시점사이에 유의한 감소를 보였다. PANSS 양성증상, 음성증상, 일반정신병리점수에서 8주후, 16주후, 24주후, 48주후 각각의 시점사이에 유의한 감소를 보였다. ESRS에서 연구기간동안 모든 항목에서 유의한 변화를 보이지 않았다. 활력징후, 일반혈액학, 생화학, 심전도검사에서 유의한 변화는 없었으나, 체중에서 유의하게 증가하였다. 결 론 : 다기관 개방연구를 통해 정신분열증 환자에 대한 리스페리돈의 장기투여는 양성증상뿐만 아니라 음성에도 효과적이며, 추세외로 부작용이 적었고, 안전하였다. Objectives : The purpose of this study was to evaluate the long-term efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Methods : This multicenter open label study included 116 schizophrenic patients drawn form 19 university hospitals. After a wash-out period of 1 week, the patients were treated with risperidone for 56 weeks and evaluated at 8 points : at baseline, and the 8th, 16th, 24th, 32th, 40th, 48th, 52th weeks of treatment. The dose was started at 2㎎ of risperidone on day 1, and increased to 4㎎ on day 2, and 6㎎ on day 3 - 7 and adjusted to a maximum of 16㎎/day according to the individual's clinical response. The psychiatric and neurological status of the patients was assessed by PANSS. CGI, and ESRS scales. Results : Eighty-seven(75%) of 116 patients completed the 56-week trial risperidone. Clinical improvement(as defined by a 20% of reduction in total PANSS score at end point) was shown by 92.0% of the patients. The mean dose of risperidone was 5.0㎎/day in the 56 week follow-up. PANSS total scores showed significantly improvements between consecutive two points at baseline, 8th, 16th, 24th, 32th, and 48th week of treatment. CGI scores showed significant reductions between consecutive two points at baseline, 8th, 16th, 24th, and 48th weeks of treatment. There PANSS factors(positive, negative, general) showed a significant improvement from the 8th week of treatment, and, after then, remained improved in the rest of the study period. ESRS showed to no significant change the 56 week trial. Laboratory parameters showed no signifiant changes during the course of treatment. Conclusion : This multicenter long-term open study suggests that risperidone is a antipsychotic drug with long term efficacy safely in the treatment of schizophrenic patients.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.