과민성 장 증후군의 증상 경감을 위한 비약물적 접근 고찰

최명애,김금순,안경주,채영란,최정안,홍해숙,박미정,이경숙,신기수,정재심 대한기초간호자연과학회 2005 Journal of korean biological nursing science Vol.7 No.2

There have been many trials of clinical efficacy of multicomponent and single component treatments for irritable bowel syndrome(IBS). We reviewed effects of non phamacological treatments in the IBS. Though the efficacy of multi-component approaches was unclear, several results suggest that cognitive behavioral therapy was effective in improving gastrointestinal symptoms of IBS. As a single component, cognitive therapy and relaxation with or without biofeedback could improve the symptoms and psychological health of IBS patients. Yoga, meditation, self-help information and hypnotherapy could be applicable to IBS.

Pulmonary Insufficiency after Massive Blood Transfusion

Hae Keum Kil,Shin Ok Koh,Kyung Sook Chung,Kang Won Park Korean Society of Critical Care Medicine 1987 Acute and Critical Care Vol.2 No.1

Massive blood transfusion may be defined as the acute administration of blood more than one and a half times the patient's estimated blood volume. When stored whole blood is infused, complications such as coagulation defect, volume overload, acid-base disturbance and pulmonary complications. will deve1op. Massive transfusion has been associated with the development of adult respiratory distress syndrome(ARDS) in man, and both humoral factor and microemboli have been proposed as the injurious agent in the transfused blood. We experienced the patient who bad suffered from acute respiratory failure after the transfusion of massive amount of whole blood and managed him effectively with ventilatory support with positive end expiratory pressure under the monitoring of cardiopulmonary function via the Swan-Ganz Catheter at 1CU.

Clinical Study of Diffusion Hypoxia in Early Period after Nitrous Oxide Anesthesia

Hae Keum Kil,Won Oak Kim,Sung Jin Lee,Woo Kyung Lee Korean Society of Critical Care Medicine 1998 Acute and Critical Care Vol.13 No.1

Introduction: Anesthesiologists have been aware of the dangers of diffusion hypoxia in the early postoperative period after nitrous oxide anesthesia, but it was suggested of a little clinical significance in healthy patients. Goal of this study is to re-evaluate the possibility of diffusion hypoxia. METHODS: Eighty patients who were scheduled for vitrectomy were allocated to two groups by normal and abnormal chest X-ray findings and each group was divided into two subgroups by N2O concentration (1-a, 2-a; 50%, 1-b, 2-b; 60%). One and half hours after anesthesia, end-tidal alveolar concentration of oxygen (et-O2), N2O (et-N2O), and PaO2 were measured for 10 minutes after the inspired gases were changed to room air 2 L/minute with controlled ventilation in group 1-a. Those parameters were re-measured after re-administration of O2 and N2O of 50% of each for an hour and the inpired gases were changed to room air again. RESULTS: In group 1-a, there was no significant differences of et-N2O and PaO2 after 5 minutes by air flow. And there was no differences of et-N2O and PaO2 between group 1-a and 1-b by et-N2O after 4 minutes. In group 1-b, PaO2 was in normal range at 10 minutes after, although et-O2 was decreased to 14.9%. However, group 2-b showed peripheral arterial saturation lower than 96% after 6 minutes and mild hypoxemia (PaO2 75.3 mmHg) at 10 minutes. CONCLUSIONS: We suggest that hypoxemic episode during spontaneous breathing of room air in early postoperative period after nitrous oxide anesthesia may be occur due to decreased ventilatory function rather than diffusion of nitrous oxide. However, in patients with minimal abnormal chest X-ray findings even without clinical symptoms, it would be better to avoid high concentration of nitrous oxide.

기관내 삽관마취중 발생한 기도폐쇄

정경숙,박광원,길혜금,김원옥 대한마취과학회 1984 Korean Journal of Anesthesiology Vol.17 No.2

어려운 기관내 삽관의 예측인자에 대한 임상연구

허경,홍정연,김연진,길혜금,김원옥 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.4

Background: Unexpected difficult intubation is probably the result of inadequate preoperative examinations of the airway. The purpose of this study is to indicate that the oropharyngeal classification (OPC) and several tests may be predict difficult intubation in Korean. Methods: In each of 462 adults the OPC was determined in sitting position. In supine position, hyomental distance (HD) and sternomental distance (SMD) with head in neutral, and thyromenal distance (TD), SMD and inter-incisors distance (DI) on mouth opening with the head fully extended were measured. The laryngoscopic grades were determined at the time of induction. We defined the cases of intubation trials $gt; 3 times in patients with laryngoscopic grade 3 and 4 as difficult intubation. The datas were analyzed with Mann-Whimey and Kruskal-Wallis test. Results: 14 patients had difficulty in intubating (3.03%) and 1 of 14 was failed to intubate (0.22 %). Assignment to either OPC ≥ 3 and DI≤4.1 cm had relative high sensitivity, specificity and native predictive value (NPV) to predict difficult intubation. Of various combinations, OPC ≥ 3 and HD ≤ 5.5 cm had high sensitivity, specificity, and NPV. When DI and HD ≤ 4 cm were employed, combination of OPC and HD/DI resulted in increasing sensitivity and positive predictive value (PPV). Conclusions: Based on the results and performance indexes of patients in this study, we concluded that assignment to OPC, DI and HD, consider either alone or combinations, be valuable tests to predict difficult intubation before anesthesia in Korean.

체중조절프로그램이 과체중여성의 체중, 혈액지질조성 및 식행동에 미치는 영향

강금지,최성숙,한혜경 덕성여자대학교 자연과학연구소 2009 자연과학 논문집 Vol.15 No.-

This study was performed to investigate the effect of a weight control program that included nutritional education and exercise, on body weight, blood lipid profile, food habits and behaviors among overweight women. Twenty-three overweight women participated in the weight control program for 12 weeks. The body weight, body composition, blood lipid levels and food behaviors were analyzed before and after implementation of the weight control program. The body weight was significantly changed from 63.7±7.2 kg to 62.1±6.8 kg (p<0.001). The body mass index (BMI) was significantly decreased from 26.2±3.0 kg/㎡ to 25.4±2.6 kg/㎡(p<0.001). The waist circumference was significantly decreased from 84.6±6.9 cm to 75.1±5.5 cm(p<0.001).There was no change in body fat. The total cholesterol, HDL-cholesterol, triglyceride level and blood pressure profiles were not changed before and after implementing the program. With regards to food habits, after education, subjects showed a lower tendency to skip meals and an increased tendency to eat breakfast. Before implementing the nutritional education, the most frequently eaten meal was dinner, but this frequency decreased after education, thereby decreasing the amounts of meals taken. The food behaviors were therefore significantly altered. There was an increased frequency of fruit and fruit juice-intake (P<0.001), and regular meal times (p<0.05). There was also a reduced frequency of fried and saute´ed fatty food-intake (P<0.001), fattened meats, salt intake (P<0.001) as well as ice-cream and carbonated drink-intake (p<0.05). Thus the weight control program showed beneficial effects on the body weight and the food behavior of the individuals that participated.

우리나라 경제활동인구의 문제음주와 우울 및 자살생각과의 관련성

최혜금 ( Hae Keum Choi ),이현경 ( Hyun Kyung Lee ) 대한보건협회 2016 대한보건연구 Vol.42 No.1

연구목적 : 본 연구는 우리나라 경제활동인구의 문제음주 특성과 문제음주가 우울여부에 미치는 영향 및 자살생각여부에 미치는 영향을 분석하고자 하였다. 이를 위해, 우리나라 경제활동인구의 사회경제적 특성별 우울여부 및 자살생각여부에 차이가 있는 지를 분석하고, 문제음주별 우울여부 및 자살생각여부에 차이가 있는 지를 분석하고, 문제음주가 우울여부에 미치는 영향을 분석하고, 문제음주가 자살생각여부에 미치는 영향을 분석하고자 한다. 연구방법 : 본 연구대상에 사용된 자료는 국민건강영양조사 2013년도 원자료이며, 연령대상은 20세~69세, 현재 경제활동을 하고 있는 취업자를 대상으로 분석하였다. 분석에 사용된 응답자의 수는 2,876명(남자 1,505명, 여자1,371명)이며, 경제활동인구의 사회경제적 특성, 음주특성, 우울여부, 자살생각여부 등의 변수를 선정하여 경제활동인구의 문제음주와 우울 및 자살생각과의 관련성에 대해 분석하였다. 통계적 분석방법은 X2-test, Logistic Regression 등을 실시하였다. 연구결과 : 주요 연구결과는 다음과 같다. 첫째, 사회경제적 특성 및 직업 특성은 우울여부와 자살생각여부에 유의한 차이를 보였다. 둘째, 알코올남용의존군에서 우울있음은 10.4%였고, 자살생각있음은 6.3%로 나타났다. 셋째, 문제음주가 우울여부에 미치는 영향을 분석한 결과, 사회경제적 특성 및 직업특성 등 다른 변수들을 통제하였을 때, 정상음주군에 비해 알코올남용의 존군에서 우울을 경험할 위험이 약 2.6배 더 높은 것으로 나타났다(p<.01). 넷째, 문제음주가 자살생각여부에 미치는 영향을 분석한 결과, 사회경제적 특성 및 직업특성 등 다른 변수들을 통제하였을 때, 정상음주군에 비해 문제음주군에서 약 1.5배더 높은 자살생각의 위험이 있었으며(p<.05), 정상음주군에 비해 알코올남용의존군은 약 2.6배 더 높은 자살생각위험이 있는 것으로 나타났다(p<.01). 결론 : 우리나라 경제활동인구의 문제음주 양상은 심각하며, 문제음주가 우울에도 영향을 주며, 자살생각에도 영향을 주는요인이 됨을 알 수 있었다. 정신건강 문제를 사전 예방하기 위해 음주문제 역시 주요하게 다루어 져야 할 정책방향이 되어야할 것이다. 국가가 경제활동을 하는 인구의 정신건강에 더 큰 책임감을 가지고 체계적으로 적극적으로 지역사회 및 국가단위로 정신건강증진사업이 실시되어야 할 것이다. Objective: This study was conducted to investigate the effects of alcohol use on depressive mood and suicidal ideation among Korean workers. Methods: We analyzed data from the Korean National Health and Nutrition Examination Surveys (KNHANES), conducted in 2013. And, for this study, 2,876 individuals were analyzed. Statistical analysis methods used in this study were X2-test, logistic regression analysis and other basic statistics using SPSS version 21.0. Results: Depressive mood rate in alcohol abuse & dependence group was 10.4% in workers and suicidal ideation rate in alcohol abuse & dependence group was 6.3% in workers. After adjusting for socio-demographic characteristics and job-related characteristics, AUDIT (abuse&dependence: OR=2.6, p=0.002) was significantly affected to depressive mood. And, After adjusting for socio-demographic characteristics and job-related characteristics, AUDIT (problem drinking OR=1.5, p=0.047; abuse&dependence: OR=2.6, p=0.000) was significantly affected to suicidal ideation. Conclusion: The findings have reinforced the need for developing a mental health disease prevention program of workers in Korea with a more practical focus on alcohol use and mental health status.

소아의 사시교정술 시 안구심반사와 술후 오심 구토에 대한 Propofol-Nitrous Oxide 와 Propofol-진정맥마취의 비교

길혜금,김원옥,김연진,이우경 대한정맥마취학회 2000 정맥마취 Vol.4 No.1

서론: 수술중의 안구심반사와 술후 오심 구토는 소아의 사시수술에 잇어 흔한 증상이다. Propofol은 우수한 항오심효과가 있지만 안구심반사의 발생을 증가시킨다고 알려져 있다. 본 연구의 목적은 소아사시수술에 잇어서 propofol과 아산화질소를 병용하는 경우와 병용하지 않는 경우 수술중 안구심반사와 술후 오심구토의발생률간에 차이가 있는지를 관찰하는데 있다. 방법: 1세에서 14세 사이로 사시교정술을 받는 소아들을 무작위로 아산화질수 60%를 주는 군과 압축대기를 주는 두 군으로 분류하여 마취전투약 없이 fentanyl 2 ㎍/㎏과 propofol 2.2 ㎎/㎏으로 마취유도하고 atracurium 0.4 ㎎/㎏ 투여후 기관내 삽관하였으며 atropine 0.015 ㎎/㎏을 정주하였다. 마취는 propofol을 3단계 정주법으로 유지하였으며 술중 기초 맥박의 20% 이상이 갑자기 감소하는 경우를 안구심반사로 정의하여 관찰하였고 술후 24시간동안의 오심과 구토를 관찰하였다. 결과: 224명중 아산화질소군은 111예중 41예(36.9%)에서, 대기군은 113예중 66예(58.4%)에서 안구심반사가 나타나 유의한 차이를 보였으며 술후 오심 구토는 14예(12.6%), 12예(10.6%)로 차이가 없었다. 안구심반사는 외직근(39.5%)보다는 내직근교정(62.5%)시 빈발하였으며 안구심반사와 오심 구토간 유의한 상관관계는 없었다. 결론: 소아의 사시교정술에서 propofol사용시 전정맥마취보다는 아산화질소를 투여하는 균형마취가 술중 안구심반사의 발생빈도를 줄이면서 술후 향오심효과에 효과적인 것으로 생각된다. Background: Intraoperative oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) are common problems of pediatric strabismus surgery. Propofol is thought to increase the incidence of OCR in spite of profound antiemetic effect. The goal of this study was to assess, in pediatric strabismus surgery, the incidence of OCR and PONV in a propofol with and without nitrous oxide (N_2O) anesthesia. Methods: Children (1 - 14 yr.'s) undergoing strabismus surgery as in patients were randomly allocated to two anesthetic techniques: propofol with 60% N_2O and propofol with air instead of N_2O. All children received ⅳ fentanyl 2 ㎍/㎏, atropine 0.015 ㎎/㎏ and 1% lidocaine 1.5 ~ 2 ml before propofol 2.5 ㎎/㎏ injection. Anesthesia was maintained with three stage infusion method of propofol with and without N_2O by groups after intubation with atracurium 0.4 ㎎/㎏. A significant OCR was defined as an acute decrease in heart rate of 20% or greater associated with traction os an ocular muscle. Results: Data on 224 children were analyzed. An intraoperative OCR was elicited in 41 (36.9%) of the 111 children in the N_2O group and in 66 (58.4%) of the 113 children in Air group, while 14 (12.6%) and 12 (10.6%) developed PONV in the N_2O group and the Air group in the subsequent 24 h period. The OCR was more frequent during medial rectus muscle correction (62.5%) than in lateral rectus muscle correction (39.5%). There was no significant correlation between OCR and PONV. Conclusions: We conclude that propofol with N_2O anesthesia was effective in reducing the incidence of intraoperative OCR with a similarly excellent postoperative antiemetic effect in pediatric strabismus surgery compared to propofol without N_2O anesthesia.

지속성 천식으로 치료 중인 10세 여아에서 발견된 식도이완불능증 1례

정해민 ( Hae Min Chung ),금경혜 ( Kyung Hye Keum ),박혜진 ( Hye Jin Park ),이계향 ( Kye Hyang Lee ),이경훈 ( Gyeong Hoon Lee ),최은진 ( Eun Jin Choi ),김진경 ( Jin Kyung Kim ),김우택 ( Woo Taek Kim ),정혜리 ( Hai Lee Chung ) 대한소아알레르기 및 호흡기학회 2008 소아알레르기 및 호흡기학회지 Vol.18 No.1

The Neuroprotective Effects of 6-cyano-7-nitroquinoxalin -2,3-dione (CNQX) Via Mediation of Nitric Oxide synthase on Hypoxic-ischemic Brain Injury in Neonatal Rats

정지은,Kyung Hae Keum,Eun Jin Choi,김진경,김우택,정혜리 대한신생아학회 2011 Neonatal medicine Vol.18 No.1

Purpose: Current studies have demonstrated the neuroprotective effects of 6-cyano-7-nitroquinoxalin-2,3-dione (CNQX) in many animal models of brain injury, including hypoxic-ischemic (HI) encephlopathy, trauma and excitotoxicity, but limited data are available for those during the neonatal periods. Here we investigated whether CNQX can protect the developing rat brain from HI injury via mediation of nitric oxide synthase. Methods: In an in vivo model, left carotid artery ligation was done in 7-day-old Sprague-Dawley (SD) rat pups. The animals were divided into six groups; normoxia (N), hypoxia (H), hypoxia with sham-operation (HS), hypoxia with operation (HO), HO treated with vehicle (HV), and HO treated with CNQX at a dose of 10 mg/kg (HC). Hypoxia was made by exposure to a 2 hr period in the hypoxic chamber (92% N_2, 8% O_2). In an in vitro model, embryonic cortical neuronal cell culture of SD rats at 18-day gestation was done. The cultured cells were divided into three groups: normoxia (N), hypoxia (H), and hypoxia treated with CNQX (HC). The N group was prepared in 5% CO_2 incubators and the other groups were placed in 1% O_2 incubators (94% N2, 5% CO_2) for 16 hr. Results: In the in vitvo and in vivo models, the expressions of iNOS and eNOS were reduced in the hypoxia group when compared to the normoxia group, whereas they were increased in the CNQX-treated group compared to the hypoxia group. In contrast, the expression of nNOS was showed reversely. Conclusion: CNQX has neuroprotective property over perinatal HI brain injury via mediation of nitric oxide synthase.